About Your Eyes
Retinopathy (eye disease)
Nonproliferative retinopathy is the most common eye disease in people with diabetes. Very often there are no symptoms or disturbance in vision in the early stages. But with uncontrolled blood sugar, this can get worse. It is important to have an annual eye exam. In the early stages of retinopathy, the tiny blood vessels in the eye can become blocked, so the retina does not get the blood supply that it needs. Knowing about this early on can help someone get treatment and prevent it from getting worse.
If nonprolferative retinopathy progresses to proliferative retinopathy, new blood vessels form and try to provide blood supply to the damaged retina. These new vessels have very thin walls and can leak. Proliferative retinopathy can continue to worsen and the bundles of new blood vessels can begin to lift the retina, causing it to detach. Loss of vision can occur at this stage.
Macular edema, or swelling, which can occur during any stage of retinopathy, is caused by leakage of fluid into the eye. This can cause vision loss.
Diabetic retinopathy is the leading cause of vision loss in industrialized countries. And approximately one-fifth of patients with type 2 diabetes have retinopathy at the time of diagnosis. Again, it is important for people with diabetes to have an annual dilated eye exam in order to know the status of their eye health.
Once retinopathy is diagnosed, the progression of the disease can be slowed with improved control of blood sugar. More advanced stages of retinopathy can be treated with laser photocoagulation.
Keeping your blood sugar levels in your target range can help prevent or delay further progression of complications of eye disease.
About Your Kidneys
Nephropathy (kidney disease)
Diabetic nephropathy occurs in 20% to 40% of patients with diabetes, and it is the leading cause of kidney failure in developed countries. It is characterized by proteinuria (protein in the urine), increased blood pressure, and progressive renal (kidney) dysfunction.
The stages of nephropathy include:
- Microalbuminuria
- Overt nephropathy
- End Stage Renal Disease (ESRD)
The earliest clinical sign of nephropathy is microalbuminuria, which is slightly increased levels of albumin in the urine (≥30 mg/day). Left untreated, microalbuminuria will slowly progress, over 10 to 15 years, to overt nephropathy or macroalbuminuria (≥300 mg/day), which is often accompanied by the presence of high blood pressure and edema. More than 75% of patients with type 1 diabetes and 20% of patients with type 2 diabetes are at risk for progressing to ESRD after the onset of overt nephropathy.
People with type 1 diabetes should be tested for microalbuminuria approximately 5 years after diagnosis, and people with type 2 diabetes should be tested for microalbuminuria at the time of diagnosis. People with diabetes should have their creatinine and urine albumin excretion measured every year.
Keeping your blood sugar levels in your target range can help prevent or delay further progression of complications of kidney disease.
About Your Nerves
Neuropathy (nerve damage)
Diabetic neuropathy occurs in approximately half of people with diabetes. It is a group of nerve disorders with different signs and symptoms. Neuropathy can be:
- Peripheral neuropathy, which affects the feet, toes, legs, arms, and hands
- Autonomic neuropathy, which affects the heart and blood vessels, digestive system, urinary tract, sex organs, sweat glands, and eyes
- Proximal neuropathy, which affects the thighs, hips, and buttocks
- Focal neuropathy, which affects the eyes, facial muscles, ears, pelvis and lower back, thighs, and abdomen
Symptoms of peripheral neuropathy include numbness or insensitivity; tingling, burning, or prickly sensation; sharp pains or cramps; extreme sensitivity to touch; and loss of balance and coordination. Peripheral neuropathy typically occurs in the feet and legs before the hands and arms. People with diabetes should check their feet daily to ensure that they do not have an injury that has gone undetected, especially if they have decreased sensation from peripheral neuropathy. Blisters and sores on the foot need to be treated immediately to prevent infection.
Autonomic neuropathy can cause changes in digestion (called gastroparesis), difficulty swallowing, irregular bowel movements, and changes in bladder function, such as urinary incontinence. It can also cause changes in sexual response and perspiration. Patients with autonomic neuropathy may also have difficulty recognizing low blood sugar level.
Proximal neuropathy, which is more common in older patients and in those with type 2 diabetes, typically starts as a pain in the thigh, hip, buttock, or leg (on one side of the body) and causes weakness in the legs. Often, people with proximal neuropathy are unable to stand up from a sitting position without assistance.
Focal neuropathy causes a sudden weakness of one or a group of nerves, and most often affects the head, torso, or leg. Symptoms of focal neuropathy include inability to focus the eye, double vision, aching behind one eye, paralysis on one side of the face, severe pain in the lower back or pelvis, pain in the chest or stomach, or pain on the outside of the shin or inside of the foot.
Keeping your blood sugar levels in your target range can help prevent or delay further progression of complications of nerve damage.