How untreated diabetes creates health complications

A diabetes diagnosis can come as a shock, or it can be surprising to learn that the ways that you’ve managed your diabetes in the past are no longer keeping the condition well managed. Diabetes can be a challenging condition to live with, but you’re not alone. In the U.S., 37.3 million people live with diabetes. And of those 37.3 million, over 8 million people don’t know they have it.

No matter how long you’ve had diabetes, taking steps to manage your condition can help you lead a healthy life. We’re here to answer your questions and help you stay healthy or get your health back on track.

How diabetes impacts the body

Diabetes is a condition in which the body can’t make insulin or can’t use it properly. Without the right amount of insulin, your body doesn’t absorb the glucose (sugar) it gets from the food you eat and use it as energy, as it normally would. This glucose remains in your bloodstream as blood sugar.

When blood sugar levels become too high it’s called hyperglycemia. Having hyperglycemia for long periods of time can damage the veins, arteries and capillaries – known collectively as blood vessels – that supply all parts of your body with blood. This dysfunction of the blood vessels puts you at risk for developing many different health problems.

What are the signs of diabetes or hyperglycemia?

In the U.S., 1.4 million people are diagnosed with diabetes each year, but many people don’t realize they have it. The most common type of diabetes is type 2, which accounts for 90-95% of all diabetes cases. However, there are several other types of diabetes, like type 1 and gestational diabetes, that share similar symptoms.

In the very early stages of type 2 diabetes, there may be very minor symptoms, or no symptoms at all. This is why regular testing at annual checkups is so important, especially if you have any of the risk factors for diabetes, like being overweight or having an immediate family member with diabetes.

The first symptoms of all types of diabetes are:

• Excessive thirst
• Urinating more often
• Increased hunger
• Blurry vision
• Unexplained weight loss

These are also the initial symptoms of untreated diabetes, which means having consistently high blood sugar. Some may refer to this state of diabetes as “uncontrolled” or “unmanaged.”

If you notice any of these symptoms in yourself or a loved one, it’s important to ask your primary care doctor about getting evaluated for diabetes. They will run tests to determine whether you have the condition and can connect you with a diabetes care team.

When someone hasn’t yet been diagnosed with diabetes, they can have a very high blood sugar level and not know it. Without knowledge of their condition, they have no strategies or tools to bring blood sugar levels back down.

There are several types of diagnostic tests for diabetes:

• A1C Test: An A1C test, or a hemoglobin A1C test, is a blood test that shows your average glucose level for the past 3 months or so. This test measures the amount of glucose stuck to your hemoglobin. Hemoglobin is the part of your red blood cells that carries oxygen to your body’s tissues. When your glucose level is high, more glucose sticks to your hemoglobin.
• Random (casual) plasma glucose test: If you need a rapid diagnosis, your doctor will perform this type of test. You do not need to fast beforehand, and it can be done at any time of day. It involves taking a small blood sample, usually from the finger, and using it to test glucose levels. Your doctor will likely order more tests to confirm diagnosis after this type of test.
• Fasting plasma glucose test: This test requires that you fast, or not eat or drink anything, for at least 8 hours beforehand. Your doctor will take a sample of blood and then test how much glucose it contains.
• Oral glucose tolerance test: You will need to fast before this test, and your doctor will take a blood sample to establish your blood sugar baseline. Then, they will give you a sugar solution to drink. After two hours, they will test your blood sugar again to see how your body has reacted to the sugar.

What happens when diabetes is “uncontrolled” for a long time?

Blood sugar levels can rise for multiple reasons, even when you’re managing your diabetes. The important thing is to bring your blood sugar back down into your safe range. This safe range can be different for everyone, but generally, your fasting blood sugar – when you haven’t recently had anything to eat or drink – should stay within 70-130 mg/dL. One to two hours after the start of a meal, sugar should go back to below 180 mg/dL.

Frequently high blood sugar leads to complications. In medicine, a complication is a secondary health issue or condition that develops due to an initial disease or procedure. Many of the complications related to diabetes typically develop slowly over the course of many years. Initial symptoms are very minor or not present at all, so you may not even realize they’re happening. This is why it’s so vital to continuously monitor your blood sugar levels and maintain regular checkups with your primary care doctor and diabetes care team.

High blood pressure

A major cause of high blood pressure is a condition called atherosclerosis – when a buildup of plaque on artery walls makes them narrower. Atherosclerosis can be brought on by prolonged high blood sugar. So untreated diabetes leads to high blood pressure, and many of the health issues associated with diabetes are made worse by high blood pressure. However, healthy lifestyle choices, like regular exercise, a diet low in sodium and weight loss if you’re overweight, can keep your blood pressure from rising.

Frequent infections and slow healing

High blood sugar makes your blood thicker, which can change the way it flows through your body. When you get a cut or scrape, your blood takes longer to reach the injured area and begin the healing process. This delay leaves you vulnerable to infection. Your blood also contains more sugar, which encourages the growth of bacteria.

With uncontrolled diabetes, you can be more susceptible to not just skin infections, but also urinary tract infections (UTIs), respiratory infections and gastrointestinal infections.

Nerve damage

Consistently high blood sugar can cause damage to the nerves in your body by impacting the blood vessels that fuel them. This is called neuropathy, which refers to the malfunction of nerves in the body. People with diabetes most commonly experience peripheral neuropathy. This type affects the extremities and can lead to frequent tingling sensations, pain and numbness in your feet and hands. This loss of feeling can make you less aware of injuries to your extremities, putting you at risk for ulcerative wounds (wounds that won’t heal), especially on your feet.

Kidney disease

High blood sugar can damage the veins and arteries that supply your kidneys with blood. As a result, your kidneys won’t filter waste from your body as well as they should. This can lead to further complications, like swelling due to fluid retention, anemia, heart disease and an eventual need for dialysis.

If you have diabetes, your diabetes care team will perform frequent lab tests – like urine collection – to see how well your kidneys are working. You can protect your kidneys by eating a diet low in salt, staying active, avoiding cigarettes and alcohol, monitoring your blood pressure and checking blood sugar levels regularly.

Eye damage

When the small, delicate blood vessels in our eyes are subjected to high levels of blood sugar, they break and allow blood and other fluids to leak into the inner eye. The eye will try to compensate by growing new blood vessels. However, these new blood vessels are weaker and less efficient. This is a condition called diabetic retinopathy, which can cause vision changes, and in some cases, eventual blindness.

The only way to detect diabetic retinopathy in its early stages is through a comprehensive eye exam. If you have diabetes, a yearly eye exam is recommended.

Cardiovascular disease

Atherosclerosis, or the narrowing of arteries mentioned above, causes a condition called peripheral artery disease, which is when arteries that supply blood to the extremities begin to narrow. Peripheral artery disease limits the amount of blood that is able to reach your neck, arms, legs and feet, among other areas. Without enough blood supply, these parts of your body are denied the oxygen and other nutrients carried by your blood.

Without treatment, peripheral artery disease can lead to tissue death (necrosis) and the eventual loss of extremities through amputation.

Can diabetes be cured?

There is currently no cure for diabetes. However, it’s possible for people with type 2 diabetes to go into remission. This means that they have maintained a safe blood sugar level without the need for diabetes medication for at least one year. For some, this can be achieved through consistent exercise and a healthy diet, but not always.

Unlike type 2 diabetes, type 1 diabetes is an autoimmune disease brought about by a different set of factors, often related to genetics. It is rare for people with type 1 diabetes to experience remission of their condition.

Managing diabetes to prevent complications

No matter the type of diabetes you have, it’s possible to prevent or delay the harmful effects of the disease through healthy lifestyle choices and habits. Managing your blood sugar will help you avoid hyperglycemia and keep diabetes under control.

Eat a balanced diet

Everyone experiences diabetes differently, so the best diet will vary from person to person. But there are a few general guidelines to help you get started creating the diet that is right for you. If everything you eat in a day adds up to 100%, try to break up your diet in this way:

• 50% non-starchy vegetables like broccoli, carrots, leafy greens, zucchini, brussels sprouts, eggplant, mushrooms, green beans, tomatoes and more.
• 25% lean protein, like chicken, white fish, salmon, beans, lentils, tofu and eggs.
• 25% carbohydrates, like whole grain bread and pasta, oatmeal, brown rice, beans, fruit, potatoes, sweet potatoes, butternut squash, milk and yogurt. (Carbohydrates become glucose in your body, so the amount of carbohydrates you eat can have the greatest direct effect on your blood sugar levels.)

It’s also recommended that you avoid sugary drinks like sodas, as well as tea and coffee with added sweeteners.

Knowing what and how much to eat, and sticking to it, can be challenging. Registered dietitians who specialize in diabetes care and education are excellent resources for help and guidance in creating a new diet plan.

Exercise regularly to control diabetes

The benefits of exercise are endless, and if you have diabetes, physical activity can have a significant impact on your health and well-being. Regular exercise can:

• Manage your blood sugar naturally by making your body more responsive to insulin and burning through excess blood glucose for energy
• Control blood pressure and cholesterol levels
• Lower your risk of diabetes complications like heart disease, kidney disease and nerve damage

The Centers for Disease Control and Prevention (CDC) recommends that adults do moderate-intensity physical activity for at least 150 minutes each week. Moderate-intensity activities include brisk walking, swimming laps, dancing, bicycling and even cleaning around the house.

It’s a good idea to work out 1-3 hours after eating, when blood sugar levels are higher. Test your blood sugar levels before each workout, as well as after particularly intense exercise. If you’re currently taking insulin or other medications that lower blood sugar, you may want to carry a form of glucose, like glucose tablets, glucose gel or a 4-oz juice box, with you during workouts in case your blood sugar levels dip too low. And, to protect your feet, wear well-fitting shoes that won’t cause blisters.

There are multiple tools available to regularly check your blood sugar levels at home. A glucose meter is a device that uses a small amount of blood, usually just a drop from your finger, to give you an immediate reading of your current blood sugar level. Your diabetes care team can give you an idea of when and how often you should test.

You can also use a continuous glucose monitor (CGM), which is a device that constantly reads and records your glucose levels. A CGM allows you to check your blood sugar level at a moment’s notice and alerts you right away if it’s too high or low. Keep in mind that it takes some time to learn how to use these technological tools, but they can help make managing diabetes easier.

When you keep track of your blood sugar, you can see what foods cause it to spike and what kind of exercise helps bring it down – and know when you’re hyperglycemic and need to take action.

Take diabetes medication as directed

People with type 1 diabetes must take insulin because their body can’t make it, but those with type 2 diabetes may not have to take insulin if they’re managing their condition with a healthy diet, exercise and other medications. Insulin can be delivered through a needle and syringe, an insulin pen or an insulin pump. There are different kinds of insulin, based on how long it takes to work and how long it lasts.

Talk to your diabetes care team about what type of insulin and insulin delivery method is right for you.

Set goals around your diabetes care

With diabetes, you and your diabetes care team can develop goals to manage your blood sugar levels. A good goal is to keep your blood sugar within your “target range” – otherwise known as a healthy blood sugar level that’s not too high or too low. This will help you avoid the physical damage caused by too much sugar in your blood.

To help you stay within your range, you can set goals around your exercise and diet. Just remember that lasting change happens gradually.

Don’t be afraid to ask for help in managing diabetes

Diabetes can be an overwhelming condition, and it’s okay to need help managing it. While it’s not always easy to ask for help, the results may surprise you.

• Talk to a trusted friend or family member if you need more support at home. Your loved ones may not know how best to support you, and you may have to tell them what you need.
• Tell your doctor or diabetes care team if something isn’t working for you. Your care plan is exactly that: yours. If there’s an aspect of your diabetes care plan that just doesn’t work for you, let your doctor know. They can suggest alternatives that might be a better fit, and easier to sustain long term.
• Join a community group for people with diabetes. Talking to other people with diabetes can be incredibly helpful and remind you that you’re not alone.

Find the resources and support you need to manage your diabetes

Diabetes is complex, and it takes dedication and diligence to keep it under control. It’s normal to get tired of all the extra health measures you have to consider, so there’s nothing wrong with needing more support when it comes to managing your diabetes.

Our primary care doctors are here to support you in living a full, healthy life. They can provide help, tools, resources or referrals to our compassionate certified diabetes care and education specialists (CDCES) and endocrinologists.