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What are the risk factors and complications of diabetes?

Uncontrolled blood sugars over time can affect your health, damaging healthy cells, tissues and organs. Damage can first be seen in your body’s small vessels (known as microvascular complications) as well as the larger vessels (known as macrovascular complications). You can minimize or delay the onset of these complications by following your self-management plan, which includes healthy eating, regular physical activity and taking any diabetes medications as prescribed.

Microvascular Complications of Diabetes

Eye disease - retinopathy

You may have damage to your eyes even if you do not have any changes in your vision. Early detection of any eye disease is critical in preventing blindness. It is best to be seen by an optometrist or ophthalmologist who can perform a dilated eye exam. Adults with type 1 diabetes should have the initial exam within 5 years of being diagnosed and then annually. Adults with type2 diabetes should have the initial exam shortly after diagnosis and then annually.

Kidney disease - nephropathy

Risk factors for developing kidney disease include genetics, blood sugar control and blood pressure control. The best way to reduce your risk is to keep your blood sugar in a healthy range, maintain your A1C at less than 7 percent and control your blood pressure at 130/80 or less. Even if you do not have high blood pressure, your physician may prescribe a blood pressure medication to help protect your kidney function over time. Regular medical follow-up care is also important so your doctor can check your kidney function with lab work.

Nerve disease – neuropathy

Most diabetic nerve damage occurs with the nerves on the bottom of your feet. However, uncontrolled blood sugars over a period of time can also damage nerves that assist with blood pressure control, breathing, digestion and affect your sexual health by causing erectile dysfunction and vaginal dryness.

Daily foot care is important in preventing diabetic foot ulcers or infection that could lead to the amputation of a toe or part of your foot.

  • Check your feet daily for redness, cuts, blisters, corns, calluses or anything unusual. See your healthcare provider for any changes you may note.
  • Wash your feet daily with warm water and a mild soap and dry them well especially between the toes.
  • Apply lotion to the tops and bottoms of your feet to moisturize any dry cracked skin. Do not put lotion between your toes as this could be a source for infection. Keep your toenails trimmed.
  • Wear a comfortable shoe that has good support and fits well. Also, keep your feel dry by wearing dry, soft socks that wick away moisture.
  • Always shake your shoes before putting them on to remove of any unwanted object such as a pebble. Never walk barefoot inside or outside your home.

Dental problems

Living with diabetes increases the risk for gingivitis, periodontal disease, thrush and dry mouth. Brush and floss your teeth regularly and use an alcohol-free rinse. See your dentist for regular checkups.

Macrovascular Complications of Diabetes

Heart Disease

People living with diabetes are at 2- 4 times greater risk for a heart attack or stroke, and many have high blood pressure and high cholesterol. You can lower your risk of heart disease by controlling your blood sugar, blood pressure and cholesterol.

Follow this ABC plan for heart health:

  • A1C less than 7 percent
  • Blood pressure at 130/80 or less
  • Cholesterol
    • Total cholesterol less than 200
    • HDL cholesterol (the healthy protective cholesterol) 40 for males and more than 50 for females
    • LDL cholesterol (the bad cholesterol) less than 100
    • Total triglycerides less than 150

Peripheral arterial disease

Peripheral arterial disease (PAD) occurs when the vessels in your legs narrow due to plaque buildup and decrease the blood flow to your legs and feet. Warning signs include pain in your legs when walking, weakness, difficulty walking, cramping, numbness, tingling or coldness to your feet, cuts or sore that are not healing, cracked skin on your feet and pain in your feet or toes at rest.

Lifestyle changes to reduce your risk of heart disease or PAD include:

  • A healthy eating plan that includes whole-grains high in fiber, low-fat dairy products, fruits and vegetables along with unsalted nuts and lean protein such as beans, lentils, chicken and fish
  • Healthy cooking methods such as baking, broiling or grilling and substituting salt with herbs and spices
  • Weight loss and maintaining a healthy weight
  • Regular physical activity
  • Being cautious with alcohol
  • Quitting tobacco use
  • Taking blood pressure, aspirin and cholesterol lowering medications as prescribed

Because people with diabetes are at a higher risk of heart attack and stroke, it is wise to be aware of the warning signs, so you can call 9-1-1 immediately if necessary.

Warning signs of a heart attack:

  • Chest pain, pressure or tightness or indigestion and heartburn
  • Pain that moves down your arm, up into your jaw, up into your neck or back
  • Shortness of breath
  • Sweating
  • Nausea or vomiting
  • Tiredness or feeling faint

Warning signs of a stroke:

  • Weakness or numbness on one side of the body
  • Sudden confusion or trouble understanding
  • Difficulty speaking
  • Dizziness, loss of balance or difficulty walking
  • Trouble seeing or double vision
  • Severe headache

How to reduce the risk factors of diabetes

Regular medical follow-up care is key in reducing your risk for complications.

Each doctor’s office visit:

  • Blood pressure check
  • Weight check
  • Foot exam

Every 3 – 6 months:

  • A1C (blood test used to diagnose type 1 and type 2 diabetes or to gauge how well you're managing your diabetes)

Once a year:

  • Cholesterol levels
  • Foot exam
  • Eye exam
  • Flu and pneumonia vaccine

You may also want to work with a Certified Diabetes Educator who can assist you in learning more about diabetes and your diabetes self-management plan.


The information presented on this page is educational and not intended as medical advice or the practice of medicine. Specific aspects of your outcomes and care should be addressed and answered after consultation with your physician.