What are the complications of type 2 diabetes?

In a previous post, we set about exploring what type 2 diabetes is, the role that insulin plays in its development, and some of the common symptoms of this potentially devastating health condition.

In this article, we’ll dive into some of the most common complications caused by diabetes. Specifically, we’ll talk about two categories of complications—both of which result from chronically elevated blood sugar. The first category is chronic complications, or longer-term issues which develop over time and cause serious damage if they are not dealt with. Acute complications, on the other hand, can occur at any time and may be life-threatening.

What are the chronic complications of type 2 diabetes?

1) Eye problems (retinopathy)

Those with type 2 diabetes are at risk of developing an eye disease called diabetic retinopathy. Elevated blood sugar levels seen in diabetes lead to high blood pressure, which can cause damage to important blood vessels in the eyes. When these blood vessels are damaged, they can get blocked, leak, or grow randomly, meaning that the retina no longer receives the blood supply it needs. Over time, this can lead to significant problems with vision.

2) Serious foot problems

Those with diabetes are 20 times more likely to experience an amputation, again due to damaged blood vessels. Everyone with diabetes has the right to an annual NHS foot check. If you notice any of these changes you should see your GP: pins and needles, burning pain, dull aches, shiny skin, hair loss on feet, numbness / loss of feeling in feet and / or legs, swollen feet, cramps, and wounds which don’t heal well.

3) Heart attack and stroke

When blood sugar levels are elevated (as we’ve learned is the case in diabetes), the body often responds by turning these sugars into fats in an effort to decrease blood sugar. This fat can in turn be deposited inside the walls of your arteries in the form of cholesterol.

The heart is supplied by a few main arteries referred to as coronary arteries. When fat deposits are made in coronary arteries, the heart muscle can struggle to get enough oxygen, meaning that the heart must pump more in order to achieve the same levels of blood circulation that your body needs—and can fatigue over time.

Even more concerning is the risk that one of these fat deposits ruptures and blocks the artery altogether. This completely stops blood flow through the artery, causing a heart attack (as your heart will no longer receive the oxygenated blood it needs to function). Diabetes causes 530 heart attacks per week in the UK.

Still further, if one of these deposits breaks off and makes it to the brain, a stroke can occur. Diabetes causes 680 strokes per week in the UK; even larger a number than heart attacks.

4) Kidney disease

Almost one in five people with diabetes will require treatment for kidney disease. Kidney disease begins as a result of elevated blood sugar and blood pressure caused by diabetes—a combination which causes kidneys to “leak” and to release unusual levels of protein from the blood via urine. Symptoms of the disease include: blood in the urine, shortness of breath, swollen feet, hands, and ankles, and fatigue.

5) Diabetic neuropathy

Nerves are responsible for carrying messages from our brain to all other parts of our body, enabling all of our senses—seeing, hearing, feeling, and moving.

Diabetes can cause damage to three main types of nerves: sensory nerves, autonomic nerves, and motor nerves.

Sensory neuropathy causes damage to nerves that carry sensations from the skin, bones, and muscles to the brain—for example, touch, temperature, and pain. In addition to the foot problems cause by damaged blood vessels, sensory neuropathy can result in further feet risks, as it’s possible for a diabetic to have a foot wound which they can’t even feel. Symptoms of sensory neuropathy include: tingling and numbness, loss of feeling of pain or shooting pains, lack of temperature detection, and loss of coordination.

Autonomic neuropathy affects the nerves carrying messages to the organs and glands controlling the stomach, bowels, the beating of the heart, and even sexual organs. Symptoms of autonomic neuropathy include loss of bladder control, irregular heartbeats, sweating, impotence, constipation, and diarrhoea.

Motor neuropathy affects our movement. Once these nerves are damaged, they cannot communicate with the muscles which enable bodily movements, with symptoms including muscle twitching, weakness, and muscle wasting.

6) Gum disease

Gum disease is common across the world, yet people with type 2 diabetes are three times as likely to develop it due to elevated sugar levels in the saliva. You can think of it kind of like eating extra sugar, except without the benefit of enjoying your treat. With more sugar-rich saliva, the bacteria in your mouth produces more of the acid which attacks and damages the gums. Brushing teeth regularly is an easy way to reduce the sugar levels in the saliva.

7) Sexual problems

As we’ve learned above, type 2 diabetes can result in damage to nerves and blood vessels, both of which are critical to normal sexual functioning. In men, this can increase the chances of erectile dysfunction, whilst for women, it leads to increase vaginal dryness.

Furthermore, whilst diabetes doesn’t necessarily lead to it, high blood sugar levels lead to increased risks of thrush, urinary tract infections, and sexually transmitted diseases.

What are the acute complications of type 2 diabetes?

1) Hypoglycaemia

This occurs when your blood sugar levels are too low—typically lower than 4mmol/l. Symptoms include disorientation, sweating, anxiety, paleness, palpitations, tingles in the lips, blurry vision, feeling shaky, headaches, hunger, and fatigue. For type 2 diabetes, hypoglycaemia is typically not a result of the disease itself (as high blood sugar is the issue), but rather due to taking too much blood sugar lowering medication (particularly if you are exercising, skipping meals, or drinking alcohol in excess). Hypoglycaemia can be life-threatening, so it’s important to understand how to avoid it—and what to do if it does occur—if you’re on insulin or certain blood sugar lowering tablets. Your doctor should ensure you’re fully educated about these topics before prescribing these medications.

2) Hyperglycaemia

As you might guess after reading the above, this occurs when blood sugar levels are too high—benchmarked as above 7mmol/l before a meal or great than 8.5mmol/l two hours after a meal. This could be due to excessive intake of carbohydrates, stress, illness, missing a medication dose, or simply over-treating a hypoglycaemia. Symptoms include thirst, headache, fatigue, and more urination than usual.

3) Hyperosmolar Hyperglycaemic State (HHS)

This complication only occurs in people with type 2 diabetes who have extremely high blood sugar levels—around over 40mmol/l—and occurs due to extreme dehydration and illness. HHS can lead to loss of consciousness, dry skin, and nausea. It is a potentially life-threatening emergency, and those suffering from it will need to seek emergency care where they can reduce glucose levels to appropriate levels through rehydration and insulin via drips.

We’ll never be the bearer of bad news for no reason, but type 2 diabetes is a serious condition with a great variety of both chronic and acute—so it’s worth knowing the facts.

However, it isn’t all doom and gloom. Firstly, it’s worth noting that the complications arising from type 2 diabetes can be reduced drastically via regular health checks, a healthier diet, exercise, and changes in lifestyle. And perhaps more excitingly, recent studies have shown that type 2 diabetes can actually be reversed! Check out this article to understand a bit more about the research behind type 2 reversal and whether it’s a possibility for you.