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12 Silent Diabetes Complications You Need to Know About—and How to Avoid Them

High blood sugar levels can cause head-to-toe diabetes complications. Being aware of the risks can help you avoid them.

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Diabetes complications: Serious, but preventable

Everyone knows about the worst-worst-worst case scenarios. But the experts Reader’s Digest interviewed assured us that they’re rare—and very preventable. “Just because you have diabetes doesn’t mean you will lose your sight or your kidneys or your legs,” says Aaron Cypess, MD, PhD, investigator at the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health. “None of these things has to happen. You can stop or reverse the progression and get back your quality of life.”

The key is to be aware of the risks that can happen when diabetes isn’t well controlled (these everyday habits can ruin diabetes control)—and work with your doctors to make sure yours is.

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Diabetes complications: You can get more cavities and gum infections

People with diabetes don’t have as much saliva, which can lead to dry mouth and a greater risk of cavities and gum disease, says George L. King, MD, research director at Joslin Diabetes Center, a professor of medicine at Harvard Medical School, and author of The Diabetes Reset. And you need a normal blood sugar to maintain proper oral health, says Dr. Cypess. “It’s very important for people with diabetes to have regular evaluations of their teeth and gums, or else they could lose them. People with diabetes need to be more vigilant about brushing, flossing, and seeing a dentist than a person ordinarily would be.” Here are some things your dentist wishes you would do differently.

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Diabetes complications: You can get more urinary tract infections

Almost 10 percent of people with type 2 diabetes get urinary tract infections, almost double the number of people without diabetes who get them, according to recent data. Sugar in the urine becomes a breeding ground for bacteria. Diabetes also contributes to nerve damage in the bladder, which can allow urine to pool—and bacteria to grow. Urinary tract infections are treated with antibiotics.

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Diabetes complications: Your sexual function may be affected

Diabetes in both men and women can detract from intimacy. According to figures from Joslin Diabetes Center, more than 50 percent of men with type 2 diabetes experience erectile dysfunction; about 30 percent of men whose diabetes is well controlled do. “An erection requires good, healthy blood vessels, which get damaged in diabetes patients,” says Dr. Cypess. (These are the most common nine signs of diabetes in men.) And about 35 percent of women with diabetes may experience sexual dysfunction, including lack of desire, pain or discomfort, and inability to orgasm. High blood sugar can damage the blood vessels and nerves that make intercourse enjoyable, according to Health.com. Here are some tips for a healthy sex life if you have diabetes.

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Diabetes complications: Your memory and mental sharpness can suffer

Numerous studies suggest a link between type 2 diabetes and an increased risk of cognitive issues, including dementia. One paper in the journal Neurology found that adults over age 60 with type 2 diabetes were 70 percent more likely to develop dementia over an 11-year period as those who didn’t have diabetes, Diabetes Forecast reported. "Insulin seems to play a role in learning and memory," William Klein, PhD, professor of neurology at Northwestern University, told the magazine. Diabetes can also damage blood vessels in the brain, which can affect blood flow and nutrient delivery to cells and contribute to a condition known as vascular dementia. These are the life-saving lessons one woman learned from her father's Type I diabetes.

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Diabetes complications: You can be more likely to get depression

Rates of depression are two to three times higher in diabetes patients than in the general population, says Dr. King. Scientists suspect that diabetes can contribute to depression and that depression can contribute to diabetes risk—a two-way street. Feeling depression-like symptoms are also a silent sign you have diabetes.

Brain scan studies have shown that certain parts of the brain are particularly affected by changes in glucose levels, which could affect depression risk. “People who are depressed have elevated levels of stress hormones such as cortisol, which can lead to problems with glucose or blood sugar metabolism, increased insulin resistance, and the accumulation of belly fat—all diabetes risk factors,” according to Frank Hu, MD, PhD, MPH, professor of nutrition and epidemiology at the Harvard School of Public Health in Boston, on WebMD.com. That's why a mental health counselor is one of the six diabetes doctors you're forgetting to see.

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Diabetes complications: You feel indigestion, nauseous, or very full after meals

Diabetes can affect the function of the vagus nerve, which controls how food moves through your digestive tract, according to the American Diabetes Association. When this nerve doesn’t work properly, food takes longer to leave your stomach, which can lead to a host of uncomfortable symptoms, such as heartburn, nausea, and vomiting, bloating, feeling full after meals, and lack of appetite. (These are the five most critical things to check on a nutritional label to prevent diabetes.) If you have gastroparesis, your doctor might recommend eating-habit tweaks such as having smaller meals or avoiding high-fat or high-fiber foods.  You might also need to change or adjust your medications, including the timing and dosage of insulin. These are the best superfoods for diabetics.

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Diabetes complications: Your eyesight can deteriorate

In the short term, fluctuations in glucose levels can cause the lens of the eye to swell, which can make your vision blurry, says Dr. King. In fact, when patients are first treated for diabetes, their vision may even seem to get worse—which is totally normal—because as their blood sugar levels drop, the lens can change shape. But the eye will adjust within a few weeks.

However, over time, diabetes raises the risk of far more serious problems, including a cluster of issues known as diabetic eye disease: diabetic retinopathy (damage to blood vessels in the back of the eye);  cataracts (clouding of the lens); and glaucoma (fluid in the eye that damages the optic nerve and causes vision loss). The National Eye Institute recommends that diabetes patients get a comprehensive eye exam every year to catch these problems as early as possible, when they are more treatable. These 30 simple habits help protect your eyes.

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Diabetes complications: You can get ringing in your ears

Nerves in the ear can be damaged in diabetes patients, which can lead to ringing, or tinnitus, according to Dr. King. Managing blood glucose levels can improve symptoms.

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Diabetes complications: You’re more prone to sleep apnea

People with diabetes are more likely to have sleep apnea (don't ignore these silent symptoms of sleep apnea). Doctors used to think it was connected to weight—that being heavy increased your risk for both sleep apnea and diabetes. Now, the latest thinking suggests that the connection may have to do with insulin resistance, says Dr. King. For example, thin people who are insulin resistant also are more likely to get sleep apnea. Sleep apnea, a condition in which you repeatedly stop and start breathing throughout the night, can raise the risk of many other serious problems, including high blood pressure. Proper treatment, commonly with a mask you wear during sleep that helps keep your airway open, can make a big difference.

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Diabetes complications: You can get fatty liver

In another example of, “which came first?”, this build-up of fat in the liver may contribute to diabetes risk—and people with diabetes may also be more likely to deposit fat in the liver. Either way, the connection is striking: 80 percent of people with diabetes have fat in the liver, Kenneth Cusi, MD, an endocrinologist at the University of Florida in Gainesville, told Diabetes Forecast. An accumulation of fat makes it harder to control blood glucose levels.

Fatty liver often has no symptoms (here are some fatty liver signs to watch out for), but causes inflammation and scarring that over time can prevent the liver from working properly. Slimming down—losing even just 5 percent of body weight—and reducing carb intake can dramatically improve fatty liver, according to Dr. Cusi.

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Diabetes complications: You can have foot problems

Foot problems commonly plague diabetes patients, but simple routine steps can protect them. Damaged nerves in the feet can cause you to lose sensation down there, so you’re less likely to feel pain, heat, cold—or, say, a blister from a new shoe, according to the National Diabetes Information Clearinghouse. Since you can’t feel these early warning signs, feet can more easily become infected; what’s more, high levels of glucose in the blood and impaired blood vessel scan make the infections slower to heal. (In very severe cases, bad infections just keep getting worse, causing skin tissue to die. This is what leads to the need for amputations).

But simply looking at your feet every day can ensure this never happens. In one study, patients who examined their feet, kept them clean, used cream in the winter to avoid cracks in the skin cut their risk of infection and amputation by 50 percent.

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Diabetes complications: Your heart has to work overtime

The risk of heart disease is two to three times higher in people with diabetes, making it the strongest risk factor for heart disease, according to Joslin Diabetes Center. A cluster of issues are at play. Blood vessels in diabetes patients—already impaired—are more vulnerable to wear-and-tear from other risks like smoking, high cholesterol, and high blood pressure. (And according to Joslin, 90 percent of diabetes patients have one or more of these additional risk factors). Diabetes patients also have increased low-grade inflammation in the lining of their arteries, which can lead to the stiffness that precipitates heart disease.

Fortunately, many of the same good lifestyle habits can help prevent both diabetes and heart disease. Even if you’ve heard them before, these big ones bear repeating: Stop smoking, lose weight if you need to, maintain a healthy blood pressure and blood fats/cholesterol, get physical activity, and keep blood glucose levels in check. Don't miss these simple tricks for living well with diabetes—from people who have it.