Since your child's diabetes diagnosis, you've probably focused on your child's day-to-day needs, like giving insulin injections or making healthy snacks that fit into the meal plan. These activities are important because they help your child manage his or her blood sugar levels - and keeping them in a healthy range can help prevent long-term diabetes problems.
Long-term complications related to diabetes are often linked to having high blood sugar levels over a long period of time. But blood sugar control isn't the only thing that determines a person's risk for complications. Other factors, like genes, can also play a role. Many of the complications of diabetes don't show up until after many years of having the disease. They usually develop silently and gradually over time, so even if your child isn't having any symptoms, he or she may still eventually develop complications.
Talking or thinking about long-term complications can be scary for parents and kids. And it's difficult for kids to make changes in how they live today to decrease their risk for health problems that may not show up for decades. But being aware of diabetes complications can help you and your child anticipate and avoid them. In fact, helping your child manage his or her diabetes with good nutrition, regular exercise, and medication under the supervision of your child's diabetes health care team is the best way you can help your child reduce the risk of developing complications and increase your child's likelihood of enjoying a healthy future.
What Parts of the Body May Develop Complications?
The major organs and body systems involved in diabetes complications are the:
- eyes
- kidneys
- nerves
- heart and blood vessels
- gums
- feet
Eye Problems
People with diabetes have a greater risk of developing eye problems, including:
- Cataracts: A cataract is a thickening and clouding of the lens of the eye. The lens is the part of the eye that helps you focus on what you see. People with diabetes are more likely to develop cataracts. Cataracts can make a person's vision blurry or make it hard to see at night. If cataracts interfere with a person's vision, they can be surgically removed.
- Retinopathy: Another eye problem, called diabetic retinopathy, involves changes in the retina, the light-sensitive layer at the back of the eye. These changes are due to damage to, or abnormal growth of, the small blood vessels in the retina. These changes are also thought to be related to having high blood sugar levels over time. Usually, changes in the retinal blood vessels don't appear before a child has reached puberty and has had diabetes for several years. At first, a person with retinopathy may not have any problems seeing, but if the condition becomes severe, he or she can become blind. Retinopathy is more likely to become a problem in people with diabetes if they also have high blood pressure or if they use tobacco. Although a child's eyes will be examined at regular visits to their doctor or the diabetes health care team, it's generally recommended that kids with diabetes start seeing an eye specialist (an ophthalmologist or optometrist) for more extensive examinations yearly after they reach puberty. Damage caused by retinopathy can be slowed or sometimes even reversed by improving blood sugar control, if it is discovered in its early stages. If retinopathy becomes more advanced, laser treatment may be needed to help prevent vision loss.
- Glaucoma: People who have diabetes also have a greater chance of getting glaucoma. In this disease, pressure builds up inside the eye, which can decrease blood flow to the retina and optic nerve and damage them. At first, a person may not have symptoms, but if it's not treated, glaucoma can cause a person to lose vision. The risk increases as a person gets older and has had diabetes longer. Treatment for glaucoma includes medications to lower the pressure inside the eye and sometimes surgery.
What You Can Do to Help Prevent These Problems: Keeping your child's blood pressure and blood sugar levels in check and making sure that your child gets his or her eyes examined on a schedule prescribed by the doctor are ways that you can help reduce your child's risk of developing these long-term complications.
Kidney Disease (Diabetic Nephropathy)
When blood sugar is high, it can cause damage to the blood vessels in the kidneys, leading to kidney disease (which is also called diabetic nephropathy). Kidney disease is when the kidneys, which are responsible for filtering the body's wastes, stop functioning properly. When they aren't working properly, the waste products that aren't being filtered build up in the blood and can affect other organs in the body.
As with diabetic retinopathy and neuropathy (see below), kidney disease:
- is more likely to occur in people who have had poor long-term blood sugar control
- usually doesn't show up before puberty
- is worsened by high blood pressure and tobacco use
In its early stages, kidney disease doesn't cause symptoms, but over time, if it progresses to kidney failure, it can be a serious health threat to a person with diabetes.
Doctors usually test kids with diabetes for kidney disease about once a year, if they have reached puberty and have had diabetes for several years. The test measures the amount of a protein called albumin in the urine. An increase in the amount of albumin leaking from the kidneys into the urine is the earliest sign that the disease may be developing. Screening for kidney disease in this way is important, because if it's detected early enough, the damage to the kidney can possibly be reversed with proper treatment. If the amount of protein in the urine increases beyond a certain point, or if there are other signs of kidney disease, doctors may recommend a biopsy of the kidney to confirm the diagnosis of diabetic nephropathy.
Treatments for kidney disease can include limiting the amount of protein in the diet, which can help prevent further damage to the kidneys, and taking medications that can help reduce damage to the blood vessels in the kidneys. If a child or teen has diabetic nephropathy, it's very important to control high blood pressure, which can worsen cases of kidney disease and may be a sign that the disease is developing. If the kidney disease gets worse, a person may develop end-stage kidney failure, which requires dialysis (regular use of a machine to clean the blood as the kidneys normally would) or a kidney transplant. But thanks to earlier detection and better treatment than was available in the past, kidney disease is less likely to result in kidney failure today.
What You Can Do to Help Prevent These Problems: The best way to help prevent diabetic kidney disease is to maintain good blood sugar control by following your child's diabetes treatment plan. It's also important for your child to get regular blood pressure checks and urine albumin tests. In addition, talk to your child about the dangers of smoking, which can increase the risk of kidney problems and other diabetes complications and health problems.
Nerve Damage (Diabetic Neuropathy)
Another complication that people who have had diabetes for a long time may develop is a type of nerve damage called diabetic neuropathy.
Diabetic neuropathy can involve nerves in many different parts of the body. The most common early symptoms of the condition are numbness, tingling, or sharp pains in the feet or lower legs. If it's not treated, nerve damage can cause other health problems. For example, because of the numbness, a person with neuropathy might not realize that he or she has a cut or an area of irritation on the foot, which could become seriously infected before it's discovered. Because nerve damage can happen anywhere in the body, problems can occur in almost any organ system, including the digestive tract, urinary system, eyes, and heart.
The risk of nerve damage in diabetes increases over time. Diabetic neuropathy is more likely to occur after puberty, but it can also happen in younger people with poor blood sugar control.
It's a good idea to talk to your child's doctor if your child is developing any symptoms that might be caused by neuropathy. Doctors usually diagnose nerve damage with a physical exam, but a biopsy of nerve tissue or other special tests might be necessary. The doctor might recommend that the patient see a nerve specialist (neurologist).
What You Can Do to Help Prevent These Problems: Again, since the condition is thought to be linked to having high blood sugar levels over time, doctors believe that controlling blood sugar levels with diet, exercise, and diabetes medications will help reduce a person's risk of developing this complication.
Heart and Blood Vessel Diseases (Cardiovascular Diseases)
People with diabetes have a higher risk of developing certain cardiovascular diseases, including heart attack (caused by a blockage of the blood vessels supplying blood to the heart), stroke (caused by a blockage of the blood vessels supplying the brain), and blockage of blood vessels in the legs and feet, which can lead to foot ulcers, infections, and even loss of a toe, foot, or lower leg.
Blood sugar control probably plays a role in these problems as well, although the link between long-term blood sugar control and cardiovascular disease isn't yet as clear as it is for some of the eye, kidney, and nerve complications of diabetes. It is known, however, that whether a person has diabetes or not, the risk for these problems is greater if the person smokes, is obese, or has abnormal levels of blood lipids (triglycerides or cholesterol), hypertension, or a family history of heart attack or stroke before age 50.
What You Can Do to Help Prevent These Problems: If your child is overweight, your child's doctor can suggest ways to help your child get to and maintain a healthy weight. The doctor may also check your child's blood lipid levels (cholesterol and triglycerides) and blood pressure regularly to be sure they're in a healthy range. Achieving the best possible control of your child's diabetes by following a good meal plan, getting regular exercise, and taking diabetes medications as prescribed may help prevent or delay the development of heart and blood vessel problems. In addition, talk to your child about the dangers of smoking, which can increase the risk of heart and blood vessel problems, as well as other diabetes complications.
Periodontal Disease (Gum Disease)
People with diabetes are more likely than others to develop gum disease because they may have:
- more plaque and produce less saliva
- higher blood sugar levels (which results in having more sugar in the mouth)
- some loss of collagen, a protein that's in gum tissue
- poor blood circulation in the gums
All of these factors can contribute to gum disease. Signs and symptoms of gum disease include bleeding, sensitive, painful, receding, or discolored gums. Dentists can diagnose gum disease during regular checkups.
What You Can Do to Help Prevent These Problems: Gum disease is preventable. It's important for kids with diabetes to manage their blood sugar levels, take good care of their teeth by brushing and flossing daily, and get regular dental checkups.
Foot Problems
Adults who have had diabetes for many years can have foot problems because of poor blood flow in the feet and nerve damage (diabetic neuropathy). These things make it more difficult for the person to avoid foot injuries or irritation and for wounds on the feet to heal properly and resist becoming infected.
Starting at puberty, doctors will regularly check your child's feet for any signs of problems. Your child should tell his or her doctor about any foot problems, such as ingrown toenails, calluses, dry skin, or evidence of irritation of the feet due to improper footwear or repetitive injury from sports or other physical activities.
What You Can Do to Help Prevent These Problems: Preventive foot care includes wearing comfortable shoes that fit properly and keeping your child's toenails trimmed to the shape of the toe. Exercise, which increases blood flow to the feet, can also help keep feet healthy. Smoking heightens the risk and severity of diabetes foot problems, so this is another reason to make sure your child or teen quits smoking or doesn't start in the first place. Your child's diabetes health care team will give you information on how to establish good foot care habits that will help prevent foot problems in the future.
Talking to Your Child
Whether they're 7 or 17, kids think in the present, so you can't necessarily expect them to consider the long-term health complications of diabetes as they go about their daily activities. But by helping your child manage his or her diabetes now, you're laying the groundwork for a lifetime of good habits and health.
When you talk to your child about long-term health risks, it's best to keep it simple. It's important to clearly and honestly answer your child's questions and provide the information that he or she will need to know in a way he or she will understand. When you're discussing long-term complications, it's a good idea to put them in the same context as you would when talking about health issues with a child without diabetes: Everyone needs to have healthy habits so we can live long, healthy lives. You might explain that all adults have some risk of things like heart disease or vision problems as we get older. It might also be helpful to emphasize the actions your child can take now - eating right, exercising, taking medicines, and avoiding smoking - that will allow him or her to stay healthy and do all the things he or she wants to do.
You can also help prevent long-term complications by discussing any problems or concerns with your child's diabetes health care team and making sure your child keeps his or her regular appointments with doctors and other health care providers. Having a child with diabetes may seem overwhelming at times, but you're not alone. Your child's diabetes care team is not only a great resource for dealing with medical issues, but also for supporting and helping you and your child cope and live with diabetes.
Reviewed by: Steven Dowshen, MD
Date reviewed: September 2007
