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Other Complications

Here are some other complications that can be detected and treated early with proper care and testing.

Foot Problems

Your feet deserve special care - especially if you have diabetes. Small problems can turn into major complications if not found and treated promptly. People with poorly controlled diabetes are at increased risk of foot problems and amputation. BUT if found and treated early, most foot problems are minor.

Nerve damage (called neuropathy), poor blood flow, and changes to the shape of your toes and feet can cause foot problems. You may have tingling, numbness, or a feeling of "pins and needles" in your feet. These are symptoms of nerve damage to your feet. There are medications that can help control nerve pain.

If you have loss of feeling, neuropathy, you may have an injury to your feet but not be aware of it. Small sores, cuts or burns can become infected if not noticed and treated quickly. When infections are left untreated they can lead to amputations of the feet, toes or lower legs.

Poor blood flow, called Peripheral Vascular Disease, makes it harder for sores to heal. Smoking makes this problem worse.

Some structural changes to your feet and toes make finding shoes that fit well more difficult. Poorly fitting shoes can cause ulcers and pressure sores to the feet and toes. Talk to your healthcare provider about shoes that are available if you notice changes to your feet. Medicare and some insurance companies may cover the cost of special shoes if your doctor orders them.

According to the American Diabetes Association, there are many things you can do to keep your feet healthy:

• Take care of your diabetes. Work with your health care team to keep your blood glucose in your target range.
• Check your feet every day. Look at your bare feet for red spots, cuts, swelling, and blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for help.
• Be more active. Plan your physical activity program with your health team.
• Ask your doctor about Medicare coverage for special shoes.
• Wash your feet every day. Dry them carefully, especially between the toes.
• Keep your skin soft and smooth. Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes.
• If you can see and reach your toenails, trim them when needed. Trim your toenails straight across and file the edges with an emery board or nail file.
• Wear shoes and socks at all times. Never walk barefoot. Wear comfortable shoes that fit well and protect your feet. Check inside your shoes before wearing them. Make sure the lining is smooth and there are no objects inside.
• Protect your feet from hot and cold. Wear shoes at the beach or on hot pavement. Don't put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it.
• Keep the blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles up and down for 5 minutes, two (2) or three (3) times a day. Don't cross your legs for long periods of time. Don't smoke.
• Get started now. Begin taking good care of your feet today.  Set a time every day to check your feet. 

Sexual Problems

It is fairly common for both men and women with diabetes to experience some form of sexual problem. This can occur as a result of nerve damage which affects the blood flow to sexual organs.

The estimates of men with diabetes who experience erectile dysfunction (problems with achieving and maintaining an erection) range between 9 and 95 percent. Men who have diabetes are two to three times more likely to have erectile dysfunction than men who do not have diabetes.

Poor glucose control, peripheral and autonomic neuropathy, age and duration of diabetes all play a role in the development of erectile dysfunction.

There are medications that can be prescribed to treat erectile dysfunction in men with diabetes. They work by increasing blood flow to the penis and preventing movement of the blood out of the penis.

Approximately 35 percent of women with diabetes may experience some form of sexual dysfunction. Diabetes can cause a decrease in libido (interest in sexual activity), dyspareunia (discomfort during intercourse due to lack of vaginal lubrication) and an inability to experience orgasms. Vaginal lubricants may be helpful for treating the symptoms of female sexual dysfunction from diabetes.

If you are experiencing sexual problems, talk with your healthcare provider.

Depression

Studies have shown that people with diabetes have a greater risk of depression than people without diabetes.

Depression can interfere with your ability to take good care of yourself. You may have trouble eating well, being physically active, taking medications and checking your glucose regularly. This leads to worsening control of diabetes and increased rates of complications.

Symptoms of depression include:

• Frequent feelings of sadness that last most of the day
• Decreased interest in most things that were once enjoyed
• Loss of self-esteem or feelings of guilt and worthlessness
• Sleep problems, such as sleeping too much or having trouble sleeping
• Difficulty concentrating or making decisions
• Unintentional changes in weight (weight loss or gain)
• Irritability or restlessness
• Decreased energy
• Possible thoughts of death or suicide

Talk to your healthcare provider if you are experiencing any of these symptoms. There are many effective ways to treat depression. Consider joining a support group to help you cope with diabetes.

Eating Disorders

Girls and young women with type 1 diabetes have about twice the risk of developing an eating disorder as those who do not have diabetes.

The two most common eating disorders are anorexia nervosa and bulimia nervosa. If untreated, these can lead to poor glucose control, increased risk of diabetes complications, and could result in hospitalization.

Estimates are that up to 40% of young women with type 1 diabetes will manipulate their insulin doses to keep their weight down.They may omit or take a lower dose so that glucose levels rise, and spill into the urine. This results in calories that are not used and stored by the body. This can lead to rapid weight loss and poor nutrition status.

Warning Signs for Eating Disorders Include

• Extremely high A1C test results
• Frequent bouts of and hospitalizations for poor blood sugar control
• Anxiety about or avoidance of being weighed
• Frequent requests to switch meal-planning approaches
• Frequent severe low blood sugar
• Widely fluctuating blood sugar levels without obvious reason
• Delay in puberty or sexual maturation or irregular or no menses
• Binging with food or alcohol at least twice a week for 3 months
• Exercise more than is necessary to stay fit
• Severe family stress

If you or a loved one might have an eating disorder, please talk to your healthcare provider.

Dental Problems

High blood glucose levels can lead to oral health problems including inflammation of the gums (gingivitis), bacterial infections along the teeth below the gums (periodontitis), tooth abscess and tooth loss.

Tooth and gum infections may make blood glucose control more difficult. Treatment of periodontal (tooth and gum) disease has been shown to improve diabetes control.

Dental exams should be used as opportunities for prevention, early detection, and treatment of periodontal disease. Dental cleaning improves glucose levels in people with poorly controlled diabetes.

To protect your teeth:

• Keep your blood glucose in your target range
• See your dentist twice a year
• Brush at least twice a day
• Floss daily