Type 1 Diabetes Complications
You Can Prevent Short- and Long-term Complications
Type 1 diabetes is complicated—and if you don’t manage it properly, there are complications, both short-term and long-term. “If you don’t manage it properly” is an important if statement: by carefully managing your blood glucose levels, you can stave off or prevent the short- and long-term complications. And if you’ve already developed diabetes complications, controlling your blood glucose levels can help you manage the symptoms and prevent further damage.
Diabetes complications are all related to poor blood glucose control, so you must work carefully with your doctor and diabetes team to correctly manage your blood sugar (or your child’s blood sugar).
Short-term Diabetes Complications
- Hypoglycemia: Hypoglycemia is low blood glucose (blood sugar). It develops when there’s too much insulin—meaning that you’ve taken (or given your child) too much insulin or that you haven’t properly planned insulin around meals or exercise. Other possible causes of hypoglycemia include certain medications (aspirin, for example, lowers the blood glucose level if you take a dose of more than 81mg) and alcohol (alcohol keeps the liver from releasing glucose).
There are three levels of hypoglycemia, depending on how low the blood glucose level has dropped: mild, moderate, and severe. If you treat hypoglycemia when it’s in the mild or moderate stages, then you can prevent far more serious problems; severe hypoglycemia can cause a coma and even death (although very, very rarely).
The signs and symptoms of low blood glucose are usually easy to recognize:
- Rapid heartbeat
- Paleness of skin
- Numbness in fingers, toes, and lips
- Slurred speech
- Diabetic Ketoacidosis: Diabetic ketoacidosis (sometimes abbreviated to DKA) is sometimes the first indication that a person has type 1 diabetes, and can be a serious complication of lack of insulin.
Diabetes develops gradually and so people may not realize that they have it—until it becomes very serious very quickly and they have diabetic ketoacidosis. However, it’s also possible to develop diabetic ketoacidosis after you’ve been diagnosed with diabetes—if you aren’t taking care of your blood glucose levels as you should.
Here’s how diabetes ketoacidosis develops: When the body runs out of insulin—and that will happen as the effects of diabetes take their toll—you can’t use glucose properly or effectively. Without glucose to fuel your body, it starts to use fat to get its energy.
When fat is broken down by the body, ketones are released. When too many ketones build up in the blood, it makes the blood acidic, leading to diabetic ketoacidosis if the situation isn’t dealt with.
The signs and symptoms of DKA are:
- Frequent urination
- Extreme thirstiness
- Abdominal pain
- Weight loss
- Fruity smell on breath (that’s the smell of ketones being released from your body)
- Cold skin
If you think you (or your child) has DKA, you can quickly confirm it with two at-home tests:
- Check the blood glucose level: If it’s above 250mg/dl, you have very high blood sugar (blood glucose), and it’s quite possible that you have diabetic ketoacidosis.
- Use a ketone strip to test urine for ketones: Keep these handy at home so that if you suspect DKA, you can immediately test. You can get ketone strips at your local pharmacy; you don’t need a prescription for them. The strip will turn a deep purple if too many ketones are in the body. (If you can’t urinate, drink 8oz and wait 10 to 20 minutes. You should then be able to urinate.)
Diabetic ketoacidosis must be treated, so as soon as you confirm DKA, call your doctor. If you don’t have any ketone strips available but still suspect DKA, go to the nearest hospital emergency room immediately to be evaluated.
Long-term Diabetes Complications
By tightly controlling your blood glucose level (or your child’s blood glucose level), you can avoid long-term complications of type 1 diabetes. Basically, if you work to avoid the short-term complications, you’ll also be doing some long-range planning and avoiding the complications listed in this section.
These complications develop over many years—usually at least 10 years—and they all relate to how blood glucose levels can affect blood vessels. Uncontrolled blood glucose can, over time, damage the body’s tiny and large blood vessels.
Damage to your tiny blood vessels causes microvascular complications; damage to your large vessels causes macrovascular complications.
Microvascular Complications: Eye, Kidney, and Nerve Disease
You have small blood vessels that can be damaged by poor blood glucose control. Damaged blood vessels don’t deliver blood as well as they should, so that leads to other problems, specifically with the eyes, kidneys, and nerves.
- Eyes: Because of type 1 diabetes, you can develop cataracts and/or retinopathy in your eyes. Retinopathy, or damage to the retina, is much more common than cataracts in type 1 diabetes, but both can cause loss of vision. To avoid eye problems associated with type 1 diabetes, keep your blood glucose under control and have yearly dilated eye check-ups to monitor your eye health.
- Kidneys: If untreated, kidney disease (also called diabetic nephropathy) leads to dialysis and/or kidney transplant. Uncontrolled (or poorly controlled) diabetes will likely eventually cause the kidneys to fail; they’ll be unable to clean the blood like they should. To prevent diabetic nephropathy, you (or your child) should be tested every year for microalbuminuria, which is a condition that’s an early sign of kidney problems. The test measures how much protein is in the urine. When the kidneys begin to have problems, they start to release too much protein.
- Nerves: Nerve damage caused by diabetes is also known as diabetic neuropathy. The tiny blood vessels “feed” your nerves, so if the blood vessels are damaged, then the nerves will eventually be damaged as well.
There are various types of diabetic neuropathy: peripheral, autonomic, proximal, and focal. Diabetic peripheral neuropathy is the most common form of nerve damage, and it most often affects the nerves going to the feet.
People who have had type 1 diabetes for a very long time and who haven’t done well managing their blood glucose may lose sensation in their feet. They may also experience pain, weakness, or tingling.
The most serious complication of diabetic peripheral neuropathy in the feet is that people may not realize when they have a sore on their foot. The sore can become infected, the infection can spread, and left untreated, the foot may need to have surgery to keep the infection from spreading more.
Macrovascular Complications: The Heart
Type 1 diabetes can also affect the large blood vessels, causing plaque to eventually build up and potentially leading to a heart attack. To prevent heart disease as a result of diabetes, you should manage your diabetes well. However, you should also make heart-healthy choices in other areas of your life: don’t smoke, keep your blood pressure under control, and pay attention to your cholesterol.
These are the main complications, both short-term and long-term, that are associated with type 1 diabetes. By carefully controlling your blood glucose, you can prevent these complications.
- American Diabetes Association. Standards of Medical Care in Diabetes—2009. Diabetes Care. 2009;32:S13-61.