Major Types of Diabetes
Type 1 Diabetes
Type 2 Diabetes
Gestational Diabetes
Pre-Diabetes
Additional Resources
Type 2 Diabetes - Complications

Managing diabetes and having a healthy lifestyle are extremely important. There are several complications associated with Type 2 Diabetes accompanied by higher risk factors then for people without diabetes. Complications prevalent with Type 1 Diabetes includes heart disease, kidney disease (nephropathy), eye complications, foot complications, skin complications, gastroparesis and depression.

Heart Disease
Diabetes carries an increased risk for heart attack, coronary artery disease, stroke, and complications related to poor circulation. Lifestyle changes, such as choosing foods wisely and being physically active, as well as taking medication can help. Coronary artery disease is caused by a narrowing or blocking of the blood vessels that go to your heart. It’s the most common form of heart disease. Your blood carries oxygen and other needed materials to your heart. Blood vessels to your heart can become partially or totally blocked by fatty deposits. A heart attack occurs when the blood supply to your heart is reduced or cut off.

You can lower your risk by keeping your ABCs of diabetes on target with wise food choices, physical activity, and medication. Losing weight can also help you manage your ABCs and prevent heart disease. A is for A-1-C. An A-1-C is the blood glucose (sugar) check “with a memory.” It tells you your average blood glucose for the past 2 to 3 months. The American Diabetes Association (ADA) recommends that people aim for an A-1-C below 7. B is for blood pressure. Your blood pressure numbers tell you the force of blood inside your blood vessels. When your blood pressure is high, your heart has to work harder than it should. The ADA recommends that you keep your blood pressure below 130/80 (said as “130 over 80”) mmHg. C is for cholesterol. Your cholesterol numbers tell you the amount of fat in your blood. Some kinds, like HDL cholesterol, help protect your heart. Other kinds, like LDL cholesterol, can clog your blood vessels and lead to heart disease. Triglycerides are another kind of blood fat that raises your risk for heart disease.

Kidney Disease (Nephropathy)
Kidneys are remarkable organs. Inside them are millions of tiny blood vessels that act as filters. Their job is to remove waste products from the blood. Sometimes this filtering system breaks down. Diabetes can damage the kidneys and cause them to fail. Failing kidneys lose their ability to filter out waste products, resulting in kidney disease.

When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood. Diabetes can damage this system. High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak. Useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria. When kidney disease is diagnosed early, (during microalbuminuria), several treatments may keep kidney disease from getting worse. Having larger amounts is called macroalbuminuria. When kidney disease is caught later (during macroalbuminuria), end-stage renal disease, or ESRD, usually follows.

Eye Complications
You may have heard that diabetes causes eye problems and may lead to blindness. But most people who have diabetes have nothing more than minor eye disorders. You can keep minor problems minor. And if you do develop a major problem, there are treatments that often work well if you begin them right away. The eye is a ball covered with a tough outer membrane. The covering in front is clear and curved. This curved area is the cornea, which focuses light while protecting the eye. After light passes through the cornea, it travels through a space called the anterior chamber (which is filled with a protective fluid called the aqueous humor), through the pupil (which is a hole in the iris, the colored part of the eye), and then through a lens that performs more focusing. Finally, light passes through another fluid-filled chamber in the center of the eye (the vitreous) and strikes the back of the eye, the retina. Blood vessels in and behind the retina nourish the macula. The smallest of these blood vessels are the capillaries.

Glaucoma occurs when pressure builds up in the eye. In most cases, the pressure causes drainage of the aqueous humor to slow down so that it builds up in the anterior chamber. The pressure pinches the blood vessels that carry blood to the retina and optic nerve. Vision is gradually lost because the retina and nerve are damaged. People with diabetes are 40% more likely to suffer from glaucoma than people without diabetes.

Cataract problems can arise. Many people without diabetes get cataracts, but people with diabetes are 60% more likely to develop this eye condition. To help deal with mild cataracts, you may need to wear sunglasses more often and use glare-control lenses in your glasses. For cataracts that interfere greatly with vision, doctors usually remove the lens of the eye. In people with diabetes, retinopathy can get worse after removal of the lens, and glaucoma may start to develop.

Diabetic retinopathy is a general term for all disorders of the retina caused by diabetes. There are two major types of retinopathy: nonproliferative and proliferative. In nonproliferative retinopathy (most common), capillaries in the back of the eye balloon and form pouches. Nonproliferative retinopathy can move through three stages (mild, moderate, and severe), as more and more blood vessels become blocked. Although retinopathy does not usually cause vision loss at this stage, the capillary walls may lose their ability to control the passage of substances between the blood and the retina. Fluid can leak into the part of the eye where focusing occurs, the macula. When the macula swells with fluid, a condition called macula edema, vision blurs and can be lost entirely. The second issue proliferative retinopathy, occurs if retinopathy progresses and becomes more serious. In this form, the blood vessels are so damaged they close off. In response, new blood vessels start growing in the retina. These new vessels are weak and can leak blood, blocking vision, which is a condition called vitreous hemorrhage. The new blood vessels can also cause scar tissue to grow. After the scar tissue shrinks, it can distort the retina or pull it out of place -- this is called retinal detachment.



Skin Complications
Diabetes can affect every part of the body, including the skin. As many as one third of people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. In fact, such problems are sometimes the first sign that a person has diabetes. Luckily, most skin conditions can be prevented or easily treated if caught early. Some of these problems are skin conditions anyone can have, but people with diabetes get more easily. These include bacterial infections, fungal infections, and itching. Other skin problems happen mostly or only to people with diabetes. These include diabetic dermopathy, necrobiosis lipoidica diabeticorum, diabetic blisters, and eruptive xanthomatosis.

Foot Complications
Foot problems most often happen when there is nerve damage, also called neuropathy, which results in loss of feeling in your feet. Poor blood flow or changes in the shape of your feet or toes may also cause problems.

Gastroparesis
Gastroparesis is a disorder affecting people with both type 1 and type 2 diabetes, where the stomach takes too long to empty its contents. It happens when nerves to the stomach are damaged or stop working. The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped. Just as with other types of neuropathy, diabetes can damage the vagus nerve if blood glucose levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves. Signs and symptoms are heartburn, nausea, vomiting of undigested food, an early feeling of fullness when eating, weight loss, abdominal bloating, erratic blood glucose (sugar) levels, lack of appetite, gastroesophageal reflux and spasms of the stomach wall.

Depression
At any given time, most people with diabetes do not have depression. But studies show that people with diabetes have a greater risk of depression than people without diabetes. There are no easy answers about why this is true. The stress of daily diabetes management can build. You may feel alone or set apart from your friends and family because of all this extra work. If you face diabetes complications such as nerve damage, or if you are having trouble keeping your blood sugar levels where you'd like, you may feel like you're losing control of your diabetes. Even tension between you and your doctor may make you feel frustrated and sad. Just like denial, depression can get you into a vicious cycle. It can block good diabetes self-care.