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Long-Term Complications of Diabetes

Helping kids with diabetes manage their blood sugar levels is a key part of preventing long-term diabetes problems. Here's why.

What Long-Term Complications Can Diabetes Cause?

Long-term complications related to diabetes are often linked to having high blood sugar levels over a long period of time. But blood sugar control isn't the only thing that determines someone's risk for complications. Things like genetics also can play a role.

Many diabetes complications don't appear until after many years of having the disease. They usually develop silently and slowly over time. So even if kids show no symptoms, they still might eventually have problems.

Managing diabetes with good nutrition, regular exercise, and medicine can help protect kids from these problems.

Where Can Diabetes Cause Complications?

The major organs and body systems involved in diabetes complications are the:

  • eyes
  • kidneys
  • nerves
  • heart and blood vessels
  • gums

What Eye Problems Can Diabetes Cause?

People with diabetes have a greater risk for eye problems, including:

  • Cataracts: A cataract is a thickening and clouding of the lens of the eye. The lens is the part of the eye that helps you focus on what you see. People with diabetes are more likely to develop cataracts. Cataracts can make vision blurry or impair night vision. Cataracts that affect vision can be surgically removed.
  • Retinopathy: Diabetic retinopathy involves changes in the retina, the light-sensitive layer at the back of the eye. These are due to damage to, or abnormal growth of, the small blood vessels in the retina, which are thought to be related to high blood sugar levels over time. Someone with retinopathy may not have vision problems at first, but if the condition becomes severe, it can cause blindness.

    Retinopathy is more likely to become a problem in people with diabetes who also have high blood pressure or use tobacco. Kids with diabetes usually go for annual exams by an eye specialist (an ophthalmologist or optometrist) when they reach puberty. Damage caused by retinopathy can be slowed or sometimes even reversed by improving blood sugar control, if it is discovered early. Retinopathy that becomes more advanced may need laser treatment to help prevent vision loss.
  • Glaucoma: People who have diabetes also are at risk for glaucoma. In this disease, pressure builds up inside the eye, which can decrease blood flow to the retina and optic nerve and damage them. At first, a person may not have symptoms, but if it's not treated, glaucoma can cause vision loss. The risk increases as a person gets older and has had diabetes longer. Treatment for glaucoma includes medicines to lower the pressure inside the eye and sometimes surgery.

To help prevent these problems: Keep your child's blood pressure and blood sugar levels in check and go to all appointments for eye exams.

What Kidney Problems Can Diabetes Cause?

High blood sugar can damage the blood vessels in the kidneys, leading to kidney disease (or diabetic nephropathy). This means that the kidneys, which filter the body's wastes, stop working properly. When this happens, the waste products build up in the blood and can affect other organs.

As with diabetic retinopathy and neuropathy, kidney disease:

  • is more likely in people who have had poor long-term blood sugar control
  • usually doesn't show up before puberty
  • is worsened by high blood pressure and tobacco use

Kidney disease doesn't cause symptoms in its early stages, but if it leads to kidney failure, it can be a serious health threat.

Screening for Kidney Problems

Doctors usually test for kidney disease about once a year in kids with diabetes who have reached puberty and had diabetes for several years.

The test measures the amount of the protein albumin in the urine (pee). Increased albumin leaking from the kidneys into the urine is the earliest sign of possible disease. Screening is important, because if it's detected and treated early enough, the damage can possibly be reversed. If the albumin gets too high or other signs of kidney disease appear, doctors may do a kidney   to confirm a diagnosis of diabetic nephropathy.

Treating Kidney Problems

Treating kidney disease can include:

  • limiting the protein in the diet to help prevent further kidney damage
  • taking medicines to reduce damage to the blood vessels in the kidneys

Controlling high blood pressure is very important, as it can make kidney disease worse and may be a sign that the disease is progressing.

Kidney disease that gets worse may lead to end-stage kidney failure. This requires dialysis (regular use of a machine to clean the blood as the kidneys normally would) or a kidney transplant. But thanks to earlier detection and better treatment, kidney disease is less likely to result in kidney failure.

To Help Prevent These Problems: To help prevent diabetic kidney disease, maintain good blood sugar control by following the diabetes treatment plan. Regular blood pressure checks and urine albumin tests also are important. Talk to your child about the dangers of smoking.

What Nerve Damage Can Diabetes Cause?

People who have had diabetes for a long time may develop a type of nerve damage called diabetic neuropathy (noo-RAH-puh-thee).

Diabetic neuropathy can involve nerves in many different parts of the body. The most common early symptoms are numbness, tingling, or sharp pains in the feet or lower legs. If untreated, nerve damage can cause other health problems. For example, foot numbness might make a cut on the foot harder to notice, so it could get infected before it's found.

Nerve damage can happen anywhere in the body. So problems can affect almost any organ system, including the digestive tract, urinary system, eyes, and heart. The risk of nerve damage in diabetes increases over time. Diabetic neuropathy is more likely to happen after puberty, but can also affect younger kids with poor blood sugar control.

Talk to your doctor if your child has any symptoms of neuropathy. Doctors usually diagnose nerve damage with a physical exam, but a biopsy of nerve tissue or other special tests might be done. The doctor might recommend seeing a nerve specialist (neurologist).

To Help Prevent These Problems: Because of the link to high blood sugar levels over time, controlling blood sugar levels with diet, exercise, and diabetes medicines will help reduce risk.

What Foot Problems Can Diabetes Cause?

Adults who have had diabetes for many years can have foot problems because of poor blood flow in the feet and nerve damage. These things make it harder for someone to avoid foot injuries or irritation, and easier for wounds on the feet to heal improperly or get infected.

Starting at puberty, doctors will regularly check your child's feet for any signs of problems. Tell the doctor about any foot problems, such as ingrown toenails, calluses, dry skin, or irritation from footwear or repetitive injury from sports or other physical activities.

To Help Prevent These Problems: Good foot care includes wearing comfortable shoes that fit well and keeping the toenails trimmed to the shape of the toe. Exercise increases blood flow to the feet and can help keep them healthy. Smoking can make foot problems more likely and more serious. So this is another reason to make sure your child or teen quits smoking or doesn't start in the first place. The diabetes health care team will discuss good foot care habits that can help prevent problems.

What Heart and Blood Vessel Diseases Can Diabetes Cause?

People with diabetes have a higher risk for some cardiovascular diseases, including:

  • heart attack (caused by a blockage of the blood vessels supplying blood to the heart)
  • stroke (caused by a blockage of the blood vessels supplying the brain)
  • blocked blood vessels in the legs and feet, which can lead to foot ulcers, infections, and even loss of a toe, foot, or lower leg

Blood sugar problems probably play a role, but the connection isn't as clear as it is for some of the eye, kidney, and nerve complications of diabetes. Whether a person has diabetes or not, the risk for these problems is greater if someone smokes, is obese, or has abnormal levels of blood lipids (triglycerides or cholesterol), high blood pressure, or a family history of heart attack or stroke before age 50.

To Help Prevent These Problems: If your child is overweight, your doctor can suggest ways to reach and keep a healthy weight. The doctor might do regular blood lipid level (cholesterol and triglycerides) and blood pressure checks to see if they're in a healthy range. Kids should follow the meal plan, exercise regularly, and take diabetes medicines as prescribed. Talk about the dangers of smoking, which can put your child at risk for heart and blood vessel problems, and other diabetes complications.

How Can Diabetes Lead to Gum Disease?

People with diabetes are at risk for gum disease because they may have:

  • more plaque (a sticky film of sugar and bacteria) and less saliva (spit)
  • higher blood sugar levels (which means more sugar in the mouth)
  • some loss of collagen, a protein in gum tissue
  • poor blood circulation in the gums

Signs and symptoms of gum disease include bleeding, sensitive, painful, receding, or discolored gums. Dentists can diagnose gum disease during regular checkups.

To Help Prevent These Problems: Gum disease is preventable. Kids should to manage their blood sugar levels, take good care of their teeth by brushing and flossing daily, and get regular dental checkups.

How Can I Help My Child?

Teens and kids think in the present, so you can't always expect them to think about the long-term health complications of diabetes. When you talk to your child about these health risks, keep it simple.

Talk about how good habits help people with and without diabetes live healthier lives. You might explain that everyone has some risk of things like heart disease or vision problems as we get older. But healthy steps taken now will help keep your child active later in life.

Tell the diabetes health care team about any problems or concerns, and make sure your child keeps all appointments with them.

Having a child with diabetes may seem overwhelming at times, but you're not alone. Your diabetes care team is there to help you deal with medical issues and to support you and your child.

Reviewed by: Steven Dowshen, MD
Date reviewed: February 2018
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