End Stage Renal disease

The mechanism of end-stage renal disease (ESRD) in diabetes mellitus is similar to that of peripheral vasculopathy and neuropathy secondary to diabetes. Here again, the microvessels are deprived from blood supply, leading to inappropriate provision of nutrients to the kidneys. As a result of that, the kidneys can suffer ischemic injury. As a result of capillary damage, the glomeruli of the kidneys thicken and start leaking albumin. Urine tests at that stage could reveal microalbuminuria. If the condition persists, then complete thickening (sclerosis) of the glomeruli occurs, a condition known as Kimmelstiel–Wilson syndrome, or nodular diabetic glomerulosclerosis; a condition that requires renal dialysis and eventually kidney transplant to ensure the patient’s survival.

Diabetic retinopathy

Diabetic retinopathy is one of the most common causes of blindness in adults aged 20-50s. Here again, microvascular injury is the cause of the incurred damage. At the beginning stages, the damage is non proliferative: micro-injury to the retinal vessels simply causes leaking of fluid in the macula, resulting in swelling. At that stage, all you might experience is blurred vision or haziness. But as the disease progresses, fibrodysplastic changes start to develop, with over stimulation of the retinal epithelium and formation of new blood vessels to sustain the retina. However, those blood vessels are not strong enough and henceforth can easily bleed and cloud the retina. In some instances, the bleeding could get worse and subsequently cause retinal detachment. On fundoscopic exam, the characteristic “cotton-wool” appearance of the retina is observed.

Laser surgery and thorough follow-up care are thought to reduce the risk of diabetes-induced blindness by 90%.

Cancer

Diabetic patients who use pioglitazone are at higher risk of some cancers, especially bladder cancer. This was demonstrated through a 2010 Consensus Report from a panel of experts selected by both the American Diabetes Association and the American Cancer Society. Similarly, patients treated with metformin were found to have a better chance of survival from cancer compared to those treated with other diabetic medications. This observation was made valid through all geographic locations, thus eliminating the “race” and “geographical location” factors. The risks were particularly reduced for the cancers of the prostate, breast and colon, but not for lung cancer. Studies have not yet demonstrated the intrinsic mechanism through which metformin provides such results.

See Also: Types of Diabetic Neuropathy

Cognitive Decline

A study performed on middle and early old age patients suffering of diabetes type 2 revealed that diabetic patients were very likely to develop brain changes similar to those observed in Alzheimer disease. Such changes included but were not limited to frontal, temporal lobes, limbic and hippocampal systems’ atrophy.

Foot Complications

High blood sugar levels, the hallmark of diabetes, can wreak havoc on the feet in various ways. The onset of neuropathy, or nerve damage, is a frequent complication. As sugar levels rise, they can impair the peripheral nerves, predominantly in the feet, leading to symptoms ranging from a slight tingling sensation to complete numbness.

The insidious nature of this complication lies in its subtlety; if the feet lose sensation, even minor injuries like cuts or blisters can go undetected, paving the way for more significant issues. Concurrently, diabetes can constrict blood circulation, which not only elongates the healing process for injuries but can also dry out the skin, making it susceptible to cracking and potential infections.

Among the more severe foot complications is the emergence of foot ulcers. These open sores, often situated on the foot's ball or the base of the big toe, can delve into deeper skin layers if neglected, leading to severe infections. Another alarming condition is Charcot's Foot, where weakened foot bones fracture effortlessly. Due to diminished sensation from neuropathy, patients may not immediately detect these fractures, leading to deformities as they continue to walk on them.

At the stage where we are with science and medicine, a cure is still to be found for diabetes. Up to now, what we do is manage the symptoms and try to live a happy life with restrictions: this is called “adapting”. Diabetes is not a fatality anymore, and medical therapy has proven to be effective in decreasing the symptoms of the disease and improving the quality of one’s life. However, failure to adhere to medical treatment will more than likely result in the development of life-threatening diabetes complications.