Skin Complications
Diabetes affects every part of the body, including the skin. A person suffering from diabetes may shows symptoms of skin disease, but there are a number of skin conditions which are recognized as being directly caused by diabetes, and which improve or grow worse directly in proportion to the sugar levels of the person.

Skin problems are often the first sign of diabetes. Skin conditions, if identified early can help in early diagnosis and management of diabetes.The early recognition of diabetes is of the greatest importance to the patient because Diabetics in whom the disease has been recognized in its early stages can live for many years and enjoy a comfortable life, if they are willing to submit themselves to their diabetic dietary regimen.

Some of the most common skin changes seen in diabetes are:
Dryness of the skin – Diabetics experience an annoying and sometimes very intense form of dryness of their skin especially when their blood sugars run high. The high blood causes the body to lose fluids and the skin tends to become dry. Dry skin can crack and itch and sometimes lead to infections. Keeping your skin moisturized when you have diabetes is one of the easiest ways to tackle skin dryness.
Furuncles and Carbuncles – These are probably the most common skin conditions which develop in diabetes. The furuncles may occur on any part of the body and sometimes appear as acne.A patient visiting the skin specialist for a recurrent furuncle or carbuncle should be advised to get their blood sugar tested to rule out diabetes.
Gangrene - The tendency of diabetics to develop gangrene of the skin has long been recognized. This complication is usually seen in old and feeble patients, who have long standing and “poorly controlled” diabetes. It is a very serious and often a fatal complication. Gangrene is commonest on the legs, particularly in old persons. Surgery is probably the only option available when gangrene sets in.
Acanthosis Nigricans – It is a condition in which tan areas appear. Patients usually present with an asymptomatic area of darkening and thickening of the skin. Itching may occasionally be present. It is usually seen on-
  • Sides of the neck
  • Armpits
  • Groin.
Acanthosis nigricans usually strike to people who are overweight. The best management way is to lose weight and application of some creams can help the spot look better cosmetically.
Diabetic Dermopathy – Diabetic dermopathy is a skin condition characterized by light brown or reddish, oval or round, scalypatches most often appearing on the legs. The patches do not hurt or itch. In diabetics, the high sugar levels lead to changes in small blood vessels which cause diabetic dermoppathy. Dermopathy is harmless and doesn't need to be treated.
Necrobiosis Lipoidica Diabeticorum - Necrobiosis lipoidica is a rare skin disorder which can affect the shin of insulin dependent diabetics.Typically in necrobiosis lipoidica, one or more yellowish brown patches develop slowly on the lower legs over several months. They may persist for years. They may be round, oval or an irregular shape. The center of the patch becomes shiny, pale, thinned, with prominent blood vessels. A minor injury to an established patch can cause it to ulcerate. This is often painless, but is at risk of secondary bacterial infection and delayed healing.
Allergic Reactions - Allergic skin reactions occur in response to medicines like insulin or diabetes pills. You should see your doctor if you think you are having a reaction to a medicine. Be on the lookout for:
  • Rashes
  • Depressions
  • Bumps at the sites where you inject insulin.

Diabetic Blisters - People with diabetes erupt in blisters. Diabetic blisters most often occur on:
  • Backs of fingers.
  • Hands.
  • Toes and feet.
  • Sometimes on legs or forearms.
They are sometimes large, but they are painless and have no redness around them. They heal by themselves in about three weeks. The way to manage is to bring blood sugar levels under control.
Disseminated Granuloma Annulare - In annulare, the person has well defined ring shaped raised areas on the skin. These rashes occur most often on parts of the body far from the trunk (for example, the fingers or ears).
But sometimes the raised areas occur on the trunk. They can be:
  • Red.
  • Red-brown.
  • Skin-colored.
See your doctor if you get rashes like this. There are drugs that can help clear up this condition.
Ways To Prevent Skin Problems With Diabetes:
  • Use a mild soap to rinse and dry thoroughly in every nook and cranny of your body. Use a moisturizer, but not between your toes.
  • Avoid very hot baths and showers as extended exposure to water softens the feet and makes your skin more prone to being pierced.
  • Inspect your body for red spots, blisters and sores that could lead to infection.
  • Look for any bumps or changes in appearance on your feet and have your doctor look at your feet at least twice a year.
  • Treat cuts right away. Wash minor cuts with soap and water.
  • Keep your blood glucose levels as close to normal as possible.
  • Drink plenty of water to keep your skin hydrated.
Eye Complications – Diabetic Retinopathy
Diabetic retinopathy is a complication of the eye seen in diabetics which can lead to vision loss or even blindness. It is a most commonly seen in individuals with “poorly controlled diabetes”.
Image PlaceholderSymptoms of Diabetic Retinopathy.

Symptoms are usually not seen until the disease is in the advanced stage. When symptoms start, they include:
  • Blurry vision
  • Dark or floating spots
  • Trouble seeing things that are at the center of your focus when reading or driving
  • Trouble telling colors apart
Diagnostic Tests for Diabetic Retinopathy.

  • Dilated eye exam – During this exam, the eye doctor gives you eye drops to make your pupils open up. The doctor then looks at the back of your eye at the retina. That’s the part of the eye that is damaged by diabetic retinopathy.
  • Digital retinal imaging – For this test, a technician takes pictures of the eye with a special camera and sends the pictures to an eye doctor, who checks for disease. It is OK to use this test if your past eye tests have all been normal or if you have no eye doctors nearby. Otherwise, you should have a dilated eye exam.
How Often Should I Get Tested?

  • For people with type 1 diabetes, yearly eye exams should start 3 to 5 years after diagnosis.
  • For people with type 2 diabetes, yearly eye exams should start right after diagnosis.
Image PlaceholderHow can Diabetic Retinopathy be Treated?

Treatment options for diabetic retinopathy include:
  • Photocoagulation – This is a laser surgery to seal leaking blood vessels in the retina.
  • Vitrectomy – This surgery removes blood from the part of the eye called the “vitreous humor” Doctors do this surgery if the blood vessels in the retina leak into the vitreous humor.
  • Medicines – Medicines are injected into the vitreous humor are sometimes used along with photocoagulation or vitrectomy.
Can Diabetic Retinopathy be Prevented?

Yes. If you have diabetes, you can reduce your chances of getting diabetic retinopathy by keeping your blood sugar and blood pressure levels as close to normal as possible
Diabetic Neuropathy (Nerve Damage)
Image PlaceholderNeuropathy is the medical term for nerve damage. Neuropathy is a common complication of type 1 and type 2 diabetes. By the time a patient is diagnosed with diabetes, neuropathy may have already set in. A generalized type of neuropathy, known as polyneuropathy, is the most common type of diabetic neuropathy.

Signs and Symptoms of Diabetic Neuropathy
  • Pain
  • Burning
  • Tingling or numbness in the toes or feet, and extreme sensitivity to light touch. The pain may be worst at rest and may improve with activity, such as walking. Some people initially have intensely painful feet while others have few or no symptoms.
If you keep your blood glucose levels on target, you may help prevent or delay nerve damage. If you already have nerve damage, this will help prevent or delay further damage. There are also other treatments that can help.

Potential Complications — As you lose the ability to sense pain or hot and cold, your risk of injuring your feet increases. Injuries that would normally cause pain like stepping on a splinter, wearing shoes that create a blister, developing an ingrown toe nail will not necessarily cause pain if you have neuropathy. Unless you inspect your feet on a daily basis, a small injury has the potential to develop into a large ulcer. One of the most serious complications of foot ulcers is the need for amputation of a toe, or in extreme cases, the foot itself.

Treatments for Diabetic Neuropathy are Available, and Include Several Elements Like
  • Control of blood glucose levels
  • Prevention of injury
  • Control of painful symptoms.
  • Medication as prescribed by your doctor.
Foot Complications
People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications.Fortunately, most of these complications can be prevented with careful foot care. Regular examination of the feet will ensure that problems are detected before they become serious. It may take time and effort to build good foot care habits, but self-care is essential.

Diabetes can lead to many different types of foot complications including
  • Athlete's foot (a fungal infection),
  • Calluses
  • Other foot deformities,
  • Ulcers that can range from a surface wound to a deep infection.
Reasons Contributing To Foot Complications In Diabetics-
  • Poor circulation — High blood sugar can damage blood vessels over a period of time, decreasing blood flow to the foot. This poor circulation can weaken the skin, contribute to the formation of ulcers and impair wound healing. These ulcers are prone to bacterial and fungal infections. Gangrene is a very serious complication that may include infection; widespread gangrene may require foot amputation.
  • Nerve damage (neuropathy) — Elevated blood glucose levels over time can damage the nerves of the foot, decreasing a person's ability to notice pain and pressure. Without these sensations, it is easy to accidentally injure the skin, soft tissue, bones, and joints.
Nerve damage, also called neuropathy, can also weaken certain foot muscles, further contributing to foot deformities.

Risk Factors
  • Patients who have had a previous foot ulcer are more likely to have future foot complications.
  • Nerve damage
  • Poor circulation
  • chronically high blood sugar levels
How Often Should You Get Your Feet Examined?
  • People with type 1 diabetes for at least five years should have their feet examined at least once a year.
  • People with type 2 diabetes should have their feet examined once per year.
Image PlaceholderPossible Foot Problems

Poor circulation — Poor pulses, cold feet, thin or blue skin, and lack of hair signal that the feet are not getting enough blood.
Nerve damage — Nerve damage may lead to unusual sensations in the feet and legs, including pain, burning, numbness, tingling, and fatigue
Skin changes — Excessive skin dryness, scaling, and cracking may indicate that circulation to the skin is compromised. Other skin changes may include healed or new ulcers, calluses, and broken skin between the toes
Deformities — the structure and appearance of the feet and foot joints can indicate diabetic complications. Nerve damage can lead to joint and other foot deformities. The toes may have a peculiar "claw toe" appearance, and the foot arch and other bones may appear collapsed. This destruction of the bones and joints is called Charcot arthropathy.

Preventing Foot Problems In Diabetes
Controlling blood sugar levels can reduce the blood vessel and nerve damage that often lead to diabetic foot complications.
The following strategies can reduce the chances of developing foot problems.
  • Controlling blood sugar levels.
  • Regular care for the feet.
  • Avoiding activities that can injure the feet.
  • Carefully trimming the nails.
  • Choosing loose fitting socks.
  • Asking for foot exams twice a year.
  • Medications as prescribed by your doctor.
Treatment of Foot Problems With Diabetes
Treatment of superficial ulcers usually includes cleaning the ulcer and removing dead skin and tissue by a healthcare provider

If the foot is infected, antibiotics are generally prescribed. Few things to keep in mind here are-the patient should not walk with the affected foot. The foot should be elevated when sitting or lying down. The ulcer should be checked by a healthcare provider at least once per week to make sure that the ulcer is improving.

Ulcers that involve muscle and bone usually require hospitalization with intravenous antibiotics Surgery may be necessary to remove infected bone.

If part of the toes or foot become severely damaged, causing areas of dead tissue (gangrene), partial or complete amputation may be required. Amputation is reserved for patients who do not heal despite aggressive treatment, or whose health is threatened by the gangrene. Untreated gangrene can be life-threatening.
Mental Health
Deal with natural emotions like stress, sadness, anger and denial before they lead to depression. Share and talk with other facing similar problems. Talking with a group of people with diabetes will help you cope better with diabetes. However, if depression sets in treating it is must. Treatment for depression helps people manage symptoms of both diseases, thus improving the quality of their lives. Treat depression with:
  • Psychotherapy
  • Medication
  • Combination of these treatments can improve a patient’s well-being and ability to manage diabetes.
HYPOGLYCEMIA Also Known as Low Blood Glucose
Hypoglycemia is a condition characterized by abnormally low blood glucose (blood sugar) levels, usually less than 70 mg/dl. Hypoglycemia is common in people with diabetes who take insulin and some oral diabetes medications.However, it is important to talk to your health care provider about your individual blood glucose targets, and what level is too low for you.

Possible causes for low blood sugar
  • Taking too much insulin
  • Not eating enough food
  • Vigorous exercise without eating a snack or decreasing the dose of insulin beforehand
  • Long gaps between meals
  • Drinking excessive alcohol
Signs and Symptoms of Hypoglycemia
  • Nervousness or anxiety
  • Sweating, chills and clamminess
  • Irritability or impatience
  • Confusion, including delirium
  • Rapid/fast heartbeat
  • Lightheadedness or dizziness
  • Hunger and nausea
  • Sleepiness
  • Blurred/impaired vision
  • Tingling or numbness in the lips or tongue
  • Headaches
Low blood sugar prevention
The best way to prevent low blood sugar is to monitor your blood sugar levels frequently and be prepared to treat it promptly at all times. You and a close friend or relative need to learn the symptoms and should always carry glucose tablets, hard candy or sweets.
Treatment
  • If your blood sugar is 51 to 70 mg/dL, eat 10 to 15 grams of fast-acting carbohydrate (eg, 1/2 cup fruit juice, 6 to 8 hard candies, 3 to 4 glucose tablets).
  • If your blood sugar is less than 50 mg/dL, eat 20 to 30 grams of fast-acting carbohydrates.
  • Recheck your blood glucose after 15 minutes • If hypoglycemia continues, repeat.15 grams of simple carbohydrates
Hypoglycemia Unawareness
Hypoglycemia unawareness occurs most frequently in those:
  • Who frequently have low blood glucose episodes (which can cause you to stop sensing the early warning signs of hypoglycemia).
  • Who have had diabetes for a long time.
  • Tightly control their diabetes (which increases your chances of having low blood glucose reactions)
If you think you have hypoglycemia unawareness, speak with your health care provider. Your health care provider may adjust/raise your blood glucose targets to avoid further hypoglycemia and risk of future episodes.
HYPERGLYCEMIA Also Known As High Blood Glucose
High blood glucose happens when the body has too little insulin or when the body can't use insulin properly.

What Causes Hyperglycemia?
A number of things can cause hyperglycemia:
  • If you have type 1, you may not have given yourself enough insulin.
  • If you have type 2, your body may have enough insulin, but it is not as effective as it should be.
  • You ate more than planned or exercised less than planned.
What are the Symptoms of Hyperglycemia?
The signs and symptoms include the following:
  • High blood glucose.
  • High levels of sugar in the urine.
  • Frequent urination.
  • Increased thirst.
How Do I Treat Hyperglycemia?
  • Exercising when ketones are present may make your blood glucose level go even higher hence it is very important to check for the presence of ketones in a urine examination before you start exercising.
  • Cutting down on the amount of food you eat might also help.
  • Work with your dietitian to make changes in your meal plan.
  • If exercise and changes in your diet don't work, your doctor may change the amount of your medication or insulin or possibly the timing of when you take it.
What if it Goes Untreated?
Hyperglycemia can be a serious problem if you don't treat it, so it's important to treat as soon as you detect it. If you fail to treat hyperglycemia, a condition called Ketoacidosis (diabetic coma) could occur.

Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include:
  • Shortness of breath.
  • Breath that smells fruity.
  • Nausea and vomiting.
  • Very dry mouth.
Talk to your doctor about how to handle this condition.
How Can I Prevent Hyperglycemia?
Best is to practice good diabetes management and learn to detect hyperglycemia so you can treat it early before it gets worse.
Diabetic Nephropathy
The kidneys play an important role in the body by filtering the blood, removing waste products and excess salt and water. If the kidneys become diseased, they falter in their task, leaving the blood polluted. It is important to take steps to protect your kidneys before the problem advances.

In diabetes, the kidneys sometimes get affected leading to a condition called diabetic nephropathy.Diabetic nephropathy can eventually cause the kidneys to stop working altogether. If that happens to you, you will need to have a kidney transplant or dialysis, a procedure that filters the blood artificially several times a week.

How do you know if your kidneys are affected?
Diabetic nephropathy usually causes no symptoms, and people who have the condition often produce normal amounts of urine. To detect diabetic nephropathy, your doctor will rely on tests that measure protein levels in the urine and blood tests to evaluate the level of kidney function.

When the kidneys are working normally, they prevent protein from leaking into the urine, so finding protein in the urine is a sign that the kidneys are in trouble. Often people who have diabetic nephropathy also have high blood pressure.

Diabetic nephropathy risk factors
There are several factors that increase your risk of developing diabetic nephropathy that you can change. These include:
  • Having chronically elevated blood sugar levels.
  • Being overweight or obese .
  • Having chronically elevated blood sugar levels.
  • Smoking.
  • Having a diabetes-related vision problem (diabetic retinopathy) or nerve damage (diabetic neuropathy).
How often should you get tested?
Urine tests are recommended once per year in people with type 1 diabetes, beginning about five years after diagnosis, and in people with type diabetes diabetes, starting at the time of diagnosis.

The urine test is looking for a protein called albumin. If there is a very large amount of albumin (protein) in your urine, it means you have diabetic nephropathy.

Diabetic Nephropathy Treatment
People with diabetes often focus on keeping their blood sugar levels in the right ranges. And while it is important to control blood sugar, it turns out that controlling blood pressure is at least as important. That's because high blood sugar and high blood pressure work in harmony to damage the blood vessels and organ systems.
For these reasons, the most important things you can do to stall kidney disease and protect against other diabetes complications are to:
  • Make healthy lifestyle choices.
  • Keep your blood sugar as close to normal as possible.
  • Keep your blood pressure below 140/90, if possible with the help of blood pressure lowering medications.
 Make sure to repeat urine and blood tests to determine if urine protein levels have improved.