CHAPTER 12 — COMPLICATIONS AND HOW TO PREVENT THEM Type 2 Diabetes affects more than blood sugar readings. Over time, high glucose and insulin resistance can damage blood vessels, nerves, and organs throughout the body. The purpose of this chapter is not to create fear, but to explain clearly what can happen and, most importantly, what can be done to reduce the risk. HOW HIGH BLOOD SUGAR DAMAGES THE BODY When glucose remains high over months and years:
- Sugars attach to proteins and fats in the body, forming advanced glycation end products.
- These substances interfere with normal cell function and make tissues stiffer and more fragile.
- Blood vessel walls become damaged and inflamed.
- Nerves receive less oxygen and nutrients.
- The kidneys and eyes are placed under increased pressure.
At the same time, high insulin, high triglycerides, and low grade inflammation add further strain. MAIN TYPES OF COMPLICATIONS Complications are often divided into two main groups: 1. Microvascular complications These affect small blood vessels and include:
- Eye disease (retinopathy).
- Kidney disease (nephropathy).
- Nerve damage (neuropathy).
2. Macrovascular complications These affect larger blood vessels and include:
- Heart disease.
- Stroke.
- Peripheral artery disease in the legs.
Not everyone with Type 2 Diabetes develops these problems, and the risk can be significantly reduced with good management. EYE COMPLICATIONS (RETINOPATHY) High blood sugar can damage the tiny vessels in the retina at the back of the eye. Early changes:
- Small leaks and swelling.
- Often no symptoms at first.
Later changes:
- Blurred or distorted vision.
- Dark spots or floating shapes.
- Risk of bleeding and scarring inside the eye.
Prevention and monitoring:
- Regular eye examinations with pupil dilation, as advised by a professional.
- Good control of glucose, blood pressure, and cholesterol.
- Stopping smoking if present.
KIDNEY COMPLICATIONS (NEPHROPATHY) The kidneys filter the blood and remove waste. Diabetes can damage the small filters and vessels within the kidneys. Early signs:
- Small amounts of protein in the urine.
- No obvious symptoms in daily life.
Later signs:
- Swelling in ankles or around the eyes.
- Raised blood pressure.
- Changes in blood tests for kidney function.
Prevention and monitoring:
- Regular checks for urine albumin and kidney function.
- Blood pressure control.
- Avoiding unnecessary use of medicines that stress the kidneys.
- Good glucose management over time.
NERVE COMPLICATIONS (NEUROPATHY) High and fluctuating glucose can injure nerves, particularly in the feet and legs. Common symptoms:
- Numbness or reduced sensation.
- Tingling, burning, or sharp pains.
- Feeling like socks or gloves are on when they are not.
- Problems with balance.
In advanced stages:
- Loss of protective sensation in the feet.
- Increased risk of unnoticed injuries.
Prevention and monitoring:
- Regular foot checks by a professional.
- Daily self inspection of the feet.
- Comfortable, well fitting footwear.
- Prompt attention to any blisters, cuts, or colour changes.
HEART AND BLOOD VESSEL DISEASE Type 2 Diabetes increases the risk of heart attacks, strokes, and circulation problems in the legs. Contributing factors:
- High blood sugar.
- High blood pressure.
- Unhealthy cholesterol patterns.
- Abdominal fat and insulin resistance.
- Smoking and chronic stress.
Warning signs:
- Chest pain or pressure, especially with exertion.
- Unusual shortness of breath.
- Pain, heaviness, or weakness in the legs when walking.
- Sudden difficulty speaking, weakness on one side, or facial drooping (possible stroke signs).
Prevention:
- Glucose, blood pressure, and cholesterol control.
- Smoking cessation.
- Regular physical activity.
- Healthy eating pattern with minimal trans fats and processed foods.
- Appropriate use of medicines such as blood pressure tablets and cholesterol lowering drugs when prescribed.
FOOT PROBLEMS Feet are especially vulnerable because they are far from the heart and subjected to daily pressure. Risk factors:
- Reduced sensation due to neuropathy.
- Poor circulation.
- Foot deformities or calluses.
- Infections that heal slowly.
Potential complications:
- Ulcers that do not heal.
- Infections in the skin or bone.
- In severe cases, risk of tissue loss and amputation.
Prevention:
- Daily inspection of feet, including soles and between toes.
- Keeping feet clean and dry.
- Avoiding walking barefoot on hard or hot surfaces.
- Regular nail care and callus management by trained professionals.
- Immediate attention to cuts, blisters, or colour changes.
ORAL AND DENTAL HEALTH High glucose can affect the gums and mouth. Issues include:
- Gum disease.
- Tooth loss.
- Infections and delayed healing.
Prevention:
- Regular dental check ups.
- Daily brushing and flossing.
- Glucose management.
MENTAL HEALTH AND QUALITY OF LIFE Living with a long term condition can affect mood and mental health. Common experiences:
- Worry about future complications.
- Frustration with food and routine changes.
- Feelings of guilt or failure after set backs.
- Low mood or depressive symptoms.
Protective steps:
- Honest discussion with health professionals about emotional impact.
- Connecting with supportive groups or communities.
- Involving family members or close friends in lifestyle changes.
- Seeking counselling or therapy when needed.
HOW RISK CAN BE REDUCED The risk of complications is not fixed. Many large studies show that:
- Better average blood sugar over time reduces microvascular complications.
- Managing blood pressure and cholesterol further protects the heart, brain, and kidneys.
- Quitting smoking lowers cardiovascular risk.
- Regular physical activity and weight management improve overall outcomes.
Even small improvements matter. A modest drop in A1C, a few centimetres less around the waist, a small rise in daily movement, and better sleep can collectively shift risk in a safer direction. REGULAR CHECKS AND SCREENING Important routine checks often include:
- A1C every 3 to 6 months.
- Blood pressure at each visit.
- Lipid profile at least yearly, or as recommended.
- Kidney function and urine albumin tests.
- Yearly or regular eye examinations.
- Foot examinations.
These checks allow early detection and timely intervention before problems advance. KEY POINTS SUMMARISED
- Complications of Type 2 Diabetes mainly involve the eyes, kidneys, nerves, heart, blood vessels, and feet.
- Many complications develop silently and require regular screening.
- Long term high glucose, high blood pressure, abnormal lipids, smoking, and inflammation all contribute to damage.
- Good management of glucose, blood pressure, cholesterol, and lifestyle factors can significantly reduce risk.
- Early action and regular monitoring allow problems to be found and treated sooner, preserving quality of life and independence.
Later chapters will focus on building a long term maintenance strategy that integrates medical care, lifestyle changes, and personal goals to minimise complications and support a full, active life.