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Complications

By Mayo Clinic staff

Diabetes complications vary depending on the type of diabetes you have.

Complications of type 1 and type 2 diabetes
Short-term complications of type 1 and type 2 diabetes require immediate care. Left untreated, these conditions can cause seizures and a state of unconsciousness (coma).

  • High blood sugar (hyperglycemia). Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough glucose-lowering medication.
  • Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat. This produces potentially toxic acids known as ketones.
  • Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it's known as low blood sugar. Your blood sugar level can drop for many reasons, including skipping a meal and getting more physical activity than normal. However, low blood sugar is most likely if you take glucose-lowering medications that promote the secretion of insulin or if you're receiving insulin therapy.

Long-term complications of diabetes develop gradually. The earlier you develop diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening.

  • Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you are twice as likely to have heart disease or stroke.
  • Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and over a period of months or years gradually spreads upward. Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to problems with erectile dysfunction.
  • Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant.
  • Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness.
  • Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections. Severe damage might require toe, foot or even leg amputation.
  • Skin and mouth conditions. Diabetes may leave you more susceptible to skin problems, including bacterial infections, fungal infections and itching. Gum infections also may be a concern, especially if you have a history of poor dental hygiene.
  • Bone and joint problems. Diabetes may put you at risk of bone and joint problems such as osteoporosis.

Complications of gestational diabetes
Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby.

Complications in your baby can occur as a result of gestational diabetes:

  • Excess growth. Extra glucose can cross the placenta, which triggers your baby's pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia). Very large babies are more likely to become wedged in the birth canal, sustain birth injuries or require a C-section birth.
  • Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal.
  • Respiratory distress syndrome. If your baby is delivered early, respiratory distress syndrome — a condition that makes breathing difficult — is possible. Babies who have respiratory distress syndrome may need help breathing until their lungs become stronger.
  • Jaundice. This yellowish discoloration of the skin and the whites of the eyes may occur if a baby's liver isn't mature enough to break down a substance called bilirubin, which normally forms when the body recycles old or damaged red blood cells. Although jaundice usually isn't a cause for concern, careful monitoring is important.
  • Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
  • Death. Rarely, untreated gestational diabetes results in a baby's death either before or shortly after birth.

Complications in you can also occur as a result of gestational diabetes:

  • Preeclampsia. This condition is characterized by high blood pressure and excess protein in the urine. Left untreated, preeclampsia can lead to serious or even life-threatening complications for both mother and baby.
  • Subsequent gestational diabetes. Once you've had gestational diabetes in one pregnancy, you're more likely to have it again with the next pregnancy. You're also more likely to develop diabetes — typically type 2 diabetes — as you get older.

Complications of prediabetes
Prediabetes may develop into type 2 diabetes.

Preparing for your appointment Risk factors
References
  1. All about diabetes. American Diabetes Association. http://www.diabetes.org/about-diabetes.jsp. Accessed Dec. 25, 2008.
  2. Collazo-Clavell ML, ed. The Essential Diabetes Guide. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2008.
  3. Diagnosis and management of type 2 diabetes mellitus in adults. Bloomington, Minn.: Institute for Clinical Systems Improvement. http://www.icsi.org/diabetes_mellitus__type_2/management_of_type_2_diabetes_mellitus__9.html. Accessed Jan. 1, 2009.
  4. Gastroparesis: What you should know. American Academy of Family Physicians. www.aafp.org/afp/20080615/1703ph.html. Accessed Jan. 1, 2009.
  5. McCulloch DK. Overview of medical care in adults with diabetes mellitus. http://www.uptodate.com/home/index.html. Accessed Jan. 1, 2009.
  6. Your guide to diabetes: Type 1 and type 2. National Diabetes Information Clearinghouse. http://diabetes.niddk.nih.gov/dm/pubs/type1and2/YourGuide2Diabetes.pdf. Accessed Jan. 1, 2009.
  7. Diabetes in pregnancy. March of Dimes. http://search.marchofdimes.com/cgi-bin/MsmGo.exe?grab_id=6&page_id=12648448&query=gestational+diabetes&hiword=DIABETIC+GESTATION+GESTATIONS+diabetes+gestational+. Accessed Jan. 29, 2009.
  8. Gestational diabetes. American Diabetes Association. http://www.diabetes.org/gestational-diabetes.jsp. Accessed Jan. 1, 2009.
  9. Am I at risk for type 2 diabetes? National Diabetes Information Clearinghouse. http://diabetes.niddk.nih.gov/dm/pubs/riskfortype2/risk.pdf. Accessed Jan. 1, 2009.
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  11. Diabetes and pregnancy. American College of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp051.cfm. Accessed Jan. 1, 2009.
  12. Managing gestational diabetes. National Institute of Child Health and Human Development. http://www.nichd.nih.gov/publications/pubs/gest_diabetes/. Accessed Jan. 1, 2009.
  13. Am I at risk for gestational diabetes? National Institute of Child Health and Human Development. http://www.nichd.nih.gov/publications/pubs/upload/gest_diabetes_risk_2005.pdf. Accessed Jan. 1, 2009.
  14. Diabetes. In: Williams Obstetrics. 22nd ed. New York, N.Y.: McGraw-Hill; 2005. http://www.accessmedicine.com/content.. aspx?aID=738493. Accessed Jan. 1, 2009.
  15. Pancreas transplantation. American Diabetes Association. http://www.diabetes.org/type-1-diabetes/pancreas-transplants.jsp. Accessed Jan. 1, 2009.
  16. Other diabetes medications. American Diabetes Association. http://www.diabetes.org/type-2-diabetes/oral-medications.jsp. Accessed Jan. 1, 2009.
  17. Tetanus disease in-short (Lockjaw). Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/vpd-vac/tetanus/in-short-both.htm. Accessed Jan. 1, 2009.
  18. Smoking. American Diabetes Association. http://www.diabetes.org/type-1-diabetes/smoking.jsp. Accessed Jan. 1, 2009.
  19. Eye complications. American Diabetes Association. http://www.diabetes.org/type-2-diabetes/eye-complications.jsp. Accessed Jan. 6, 2009.
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  22. International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32:1.

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June 13, 2009

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