FOUR. What Are the Consequences of Diabetes?

What can happen if my diabetes is not properly treated and controlled?

What is diabetic neuropathy?

I hear a lot about footwear and foot care for diabetes. Why is this so important?


What can happen if my diabetes is not properly treated and controlled?

Uncontrolled diabetes, which generally refers to glucose levels that are higher rather than lower than the target range, can lead to immediate short-term and longer- term consequences. The short-term consequences result from the very high blood glucose itself, which is described in Question 4. If severe enough or untreated for long enough, markedly high blood glucose levels can result in coma and ultimately death, due to the severe abnormalities of blood chemistry that occur. It is important to note that only a very small minority of patients with either form of diabetes will die in this way. Therefore, although immediate decompensation of diabetes is a serious and life-threatening condition, with a high death rate if detected and treated too late, the majority of people with diabetes should be more concerned about the damaging effects of diabetes that are not well controlled, yet not sufficiently poorly controlled to focus their attention.


A serious deterioration in a medical condition.

The longer-term consequences of less than adequate diabetes control are the result of damage to the small (micro) and larger (macro) vessels of the circulation. The most common manifestations are diabetic eye disease (retinopathy), which is the leading cause of blindness in working-age adults in the United States; diabetic kidney disease (nephropathy), which is the leading cause of severe kidney failure necessitating dialysis or transplantation in working-age adults in the United States; and nerve damage (neuropathy), which is present in about 1 out of 3 people with diabetes at the time of diagnosis and in over 7 out of 10 by the time diabetes has been present for 10 years. Both retinopathy and nephropathy can be entirely without symptoms until they reach an advanced and irreversible stage, leading to blindness and the need for kidney dialysis or transplant. Diabetic neuropathy can cause very troublesome symptoms and lead to loss of sensation, mainly in the feet, which places the patient at high risk of trauma, infection, and amputations of the legs and feet.

Disease of the large blood vessels leads to a high rate of heart attack, stroke, heart failure, and amputation of the (usually lower) limbs. About two of every three patients with diabetes will die as a result of large vessel disease. Fortunately, studies have shown that good control of diabetes can prevent or delay the progression of many of these serious problems, but other contributing factors, such as blood pressure and cholesterol, must also be given careful attention.

However, we are only achieving target levels of diabetes control in about half of all people with diabetes in America today.

Does diabetes put me at risk of any other diseases or illnesses?

Aside from the direct consequences of high blood sugar itself, which are discussed in Question 29, people with diabetes are at risk of suffering from other associated diseases. In the case of type 1 diabetes, the diseases either result from the high blood sugar or from the root cause of the diabetes, which is a predisposition to destroy the hormone-producing tissues (called autoimmunity). Thus, a person with type 1 diabetes is more likely to suffer from adrenal gland damage (Addison's disease), thyroid gland damage (Graves' or, much more commonly, Hashimoto's disease), and several other disorders. Fortunately, except in the case of thyroid disease, which affects about one in three people with type 1 diabetes, the likelihood of developing one of these other disorders is not high, but can be so in certain families. Most people with type 1 diabetes are screened annually for thyroid disease. In the case of type 2 diabetes, the other diseases appear to be independent, but related. In other words, they and the diabetes arise from a common soil in the affected person's metabolic makeup. These related diseases include cholesterol and other blood fat abnormalities (dyslipidemia), high blood pressure (hypertension), and gout. The first two are commonly seen in people with type 2 diabetes, while the third is less so.


A predisposition to produce autoantibodies.


Cholesterol and other blood fat abnormalities.


High blood pressure.

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