Complications and Concomitant Disorders
Diabetes can result in complications with various organs. Particularly at risk are:
Obesity
Do you struggle with your weight? If so, you are not alone. Obesity is particularly common with type 2 diabetes. Losing some weight can help your diabetes therapy to progress more successfully. Even shedding just a few pounds can lead to a significant improvement in blood sugar levels. You will find some useful ideas and advice on losing weight in the "Exercise and Sports" and "Diet" sections, and in our brochure "Exercise is good for you".
Diabetic foot
Your feet therefore need special care:
- Examine your feet regularly
- Dry your feet thoroughly after washing
- Avoid damp areas between the toes
- Care for the dry skin regularly with a urea containing cream or foam
- Avoid injuries during foot care: do not use pointy or sharp objects such as scissors, nail clippers, corn planers, or the like.
- Buy shoes that are sufficiently wide to avoid pressure points
Blood pressure
High blood pressure (arterial hypertension): The medical term "hypertension" means chronically elevated blood pressure.
The World Health Organization, WHO, defines high blood pressure as a systolic blood pressure (the first reading) level of 140 mmHg or above, or a diastolic blood pressure (the second reading) of 90 mmHg or above. This term does not include temporarily elevated blood pressure that can be caused by stress, various illnesses, medication or pregnancy. The acronym "mmHg" means "millimetres of mercury column" and the unit used for measuring blood pressure.
Blood pressure classifications based on value (in mmHg):
| Blood pressure classifications | Systolic value | Diastolic value |
| Optimal blood pressure | Below 120 | Below 80 |
| Normal blood-pressure | 120-129 | 80-84 |
| Elevated normal blood pressure | 130-139 | 85-89 |
| Mild hypertension (Level 1) | 140-159 | 90-99 |
| Moderate hypertension (Level 2) | 160-179 | 100-109 |
| Severe hypertension (Level 3) | 180+ | 110+ |
| Isolated systolic hypertension | 140+ | Below 90 |
High blood pressure can be caused by a disturbance of the hormone system, the cardiovascular system and kidney damage. However, for the most part, it is caused by largely unknown factors. Medically, this type of high blood pressure is known as ‘primary’ or ‘essential’ hypertension. High blood pressure is more common among people with type 1 and type 2 diabetes, and significantly increases their risk of experiencing cardiovascular and microvascular complications; that is, complications that affect the cardiovascular system (heart attack for instance), and complications in small blood vessels.
Lowering your blood pressure significantly reduces the risk of cardiovascular events and fatalities. It can also slow the progression of diabetes damage to the kidneys (nephropathy) and eyes (retinopathy). People with diabetes particularly benefit from effective blood pressure reduction. The Deutsche Diabetes-Gesellschaft [German Diabetes Society] recommends a target level of below 130/80 mmHg.
A blood pressure below 120/80 mmHg is optimal. This particularly applies to the onset of kidney disease.
Have your blood pressure checked regularly, since high blood pressure can, over time, result in stroke, cardiac weakness, poor blood circulation to the legs, heart attack, and kidney failure. If your blood pressure does not drop as a result of weight loss, regular cardiovascular exercise, low salt intake, and stress reduction, your doctor can provide a prescription.
Cardiovascular system
Heart disease, coronary heart disease in particular, is a particular risk for diabetics. Heart attack and arrhythmias require full and proper treatment.
The nervous system
Nerve damage to the feet as a result of diabetes can cause abnormal sensations, such as:
- Tingling
- Burning
- Pain
- Numbness
- Impaired temperature sensitivity
If you suffer from any of these symptoms, beware: it may take you longer to notice when your shoes rub or you injure yourself. This can lead to infected sores. Impaired blood circulation to the legs can further complicate the healing process. Because of these changes to the feet, diabetes is the most frequent cause of foot amputations.
Kidneys
Diabetes can damage the kidneys (diabetic nephropathy) and, in the worst-case scenario, can result in kidney failure. An early indication is the elevated discharge of protein in the urine. You should therefore have your doctor perform an annual or semi-annual test of the protein discharge in the urine: this is easily done with a so-called "micro albuminuria test". You should ask for this. This test is particularly important if a diabetic retinopathy was already indicated.
Eyes
Diabetes can also affect the blood vessels in the eyes. Diabetic retinopathy is the name given to damage to the retina (back of the eye) this is typically associated with this. In extreme cases, this can cause blindness. In its early stages, diabetic retinopathy can often go unnoticed. You should therefore have your eyes tested every year to ensure an early diagnosis and treatment.
However, you can take steps to prevent complications: these are less likely if the blood pressure and diabetic values (blood glucose and HbA1c) are normal.
What can you do?
Keeping your blood glucose levels and blood pressure under control is of the utmost importance. You should also regularly check your cholesterol levels, and obtain treatment if needed. If you smoke, it is essential that you quit, since smoking is a major cause of vascular disease. You should also try to get as much exercise as possible, since a lack of activity is one of the biggest causes of poor circulation.
There are also many things you can do to manage your diabetes. Have your HbA1c levels tested every 3 months. The HbA1c level in your blood indicates what your average blood glucose level has been in the past 2 to 3 months. Ask your doctor how often you should measure your blood glucose levels, and enter these values into your daily diabetes diary. The daily diary is important for any treatment involving insulin or tablets. The diary will quickly highlight if your blood glucose regularly spikes at certain times of day.
Take advantage of the diabetes health passport to always have key information at hand. Your doctor can enter the results of the check-ups into the diary and discuss these with you.
Important target levels for type 2 diabetics at a glance:
| Pre-meal, fastening blood glucose level | 90 to120 mg/dL (5.0 to 6.7 mmol/L) |
| HbA1c | < 6.5 % |
| Total cholesterol | < 180 mg/dL (< 4.7 mmol/L) LDL: < 100 mg/dL (< 2.6 mmol/L), at KHK: < 70 mg/dL (< 1.8 mmol/L) |
| Triglyceride | < 150 mg/dL (< 1.7 mmol/L) |
| Albuminuria | < 20 mg/L Progression inhibition with existing nephropathy |
| Blood-pressure | < 130 / 80 mmHg At proteinuria > 1 g/L: RR < 120/75 mmHg |