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Chronic Complications
Diabetics undergoing intensive therapy to keep blood glucose levels as close to normal as possible experience lower the risk of chronic complications when compared to diabetic individuals undergoing conventional treatment (See Figure 4). (52)
Figure 4: Type 1 Decreased Risk of Complications after Intensive Treatment for Diabetes
High levels of blood glucose cause microvascular damage and impair the body's infection fighting abilities. This can result in frequent infections of the skin, mouth, bladder and sexual organs. (3,19,21,22)
Diabetic Retinopathy and Macular Edema
Diabetic retinopathy is the leading cause of blindness in adults. There are two types, non-proliferative diabetic retinopathy (early stage usually left untreated) and proliferative retinopathy (more advanced and usually treated with laser surgery). The deterioration or alteration of small blood vessels in the eye result in loss of vision or blindness. In the early stage, diabetic retinopathy goes unnoticed by the individual. Nearly half of all persons with diabetes will develop diabetic retinopathy during their lifetime. The risk of onset increases with the duration of diabetes and degree of hyperglycemia.
Diabetic macular edema (macula swells from the leaking fluid) can be associated with any stage of diabetic retinopathy. 40% of Type 1 diabetics will develop diabetic macular edema. This condition may also result in loss of vision or blindness.
The connection between diabetes and these disorders remains unclear. Decreased retinal capillary integrity, proliferation of new vessels and contraction of fibrous tissues are all pathological processes resulting from chronic hyperglycemia.
Treatment for these disorders centers on timely surgical intervention. Laser surgery is indicated in the early stages. Vitrectomy (necessary when there has been massive bleeding into the vitreous) is performed if the disease is too advanced for laser surgery.
Cataracts
Cataracts (clouding of the lens) can occur at a younger age in those diagnosed with diabetes. An individual with diabetes is twice as likely to develop cataracts then those without diabetes. Although complications occur frequently, surgery is up to 95 percent successful in restoring vision.
Glaucoma
Open angle glaucoma (a progressive form of glaucoma in which the drainage channel for the aqueous humor remains open) is 1.4 times more likely in diabetics. The prevalence of this disease increases with age and duration of diagnosis.
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