A Full-Body Disease: Complications That Can Accompany Diabetes

By Rebecca McKinsey

Diabetes is far more than a disease involving insulin and blood sugar—it can affect most of the body, and there are a variety of complications and comorbidities that can accompany it.

“You have to understand that it exists across different tissue types,” says David G. Armstrong, DPM, MD, PhD, professor of surgery at University of Southern California’s Keck School of Medicine and founder and co-director of the Southwestern Academic Limb Salvage Alliance (SALSA). “If we don’t address that, then we’re just oversimplifying it.”

Following are areas of the body that can be affected by diabetes—and conditions and complications that may be caused by the disease or can occur alongside it.

— Heart: There is a greater risk of heart attack and heart failure. Cardiovascular disease is one of the leading causes of death in people with diabetes. Recent evidence shows heart failure is the most prevalent cardiovascular complication for people with both type 1 and type 2 diabetes, states Rodica Pop-Busui, MD, PhD, a diabetologist, professor of internal medicine, metabolism, endocrinology, and diabetes, and vice chair of clinical research in the Department of Internal Medicine at the University of Michigan.

— Vessels: Vascular issues can exist, such as atherosclerosis (hardening of the arteries) and peripheral artery disease (PAD), sometimes called peripheral vascular disease (PVD).

— Nerves: Nerve damage from diabetes commonly affects the extremities or limbs through diabetic peripheral neuropathy (DPN)—causing pain, loss of sensation, loss of balance, risk for falls and fractures, and in some cases ulcerations and amputations. Another risk is autonomic neuropathy, which can affect the nerves controlling the functions of the cardiovascular, gastrointestinal, and urogenital systems, and more.

— Feet: The feet are the area most commonly damaged by DPN. Because of the loss of sensation, wounds can go unchecked, leading to amputations. “Amputations remain unacceptably high with people with diabetes,” Pop-Busui asserts.

— Brain: There is an increased risk of strokes and diminished cognitive functioning. Mental health is affected as well. “We have clear evidence that because this is such a complex disease, mental health is also a huge issue with diabetes,” Pop-Busui shares.

— Joints: High blood sugar can react with collagen to cause problems such as joint pain, dislocations, or frozen shoulder.

— Bones: Diabetes can cause changes in bone structure or density that can increase the risk of fracture.

— Kidneys: Nephropathy, or kidney disease, can occur. Diabetic damage to kidneys is the leading cause for end-stage renal disease, the final stage of nephropathy.

— Liver: Diabetes can cause fat to build up in the liver, even in those who do not drink alcohol, leading to nonalcoholic fatty liver disease.

— Pancreas: People with diabetes are at higher risk of pancreatitis.

— Eyes: Diabetes can damage the neurons in the eyes and the retinas, leading to vision loss.

— Ears: Those with diabetes are twice as likely to experience hearing loss, according to the American Diabetes Association (ADA).

— Mouth: Diabetes increases the risk of gum disease such as gingivitis and periodontitis.

— Skin: There is an increased risk of bacterial infections, fungal infections, itching, or less common diabetes-related skin issues such as diabetic blisters, according to the ADA.

— Gastrointestinal system: Nausea, acid reflux, bloating, constipation, or diarrhea are common issues. Diabetes is the leading cause of gastroparesis, which affects digestion.

— Urogenital system: Those with diabetes can experience urinary tract infections, bladder problems, and sexual dysfunction such as erectile dysfunction or vaginal dryness.

— Diabetic ketoacidosis: This is a life-threatening condition caused by an influx of ketones, the chemical produced by the body in response to a lack of insulin.

— Inflammation: Elevated glucose can lead to persistent inflammation, which can worsen other complications.

Regular monitoring of diabetes and its potential complications is vital: “These complications are very quiet,” Armstrong explains. “You can have a serious problem about which you’re not aware.”