Big changes in blood sugars over time increase the risk of complications such as heart disease, retinopathy and diabetic neuropathy. Being informed and taking part in your health care can help lower the chances of complications.

Maya Feller, M.S., R.D., C.D.N.
August 31, 2020
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Getty \ Ariel Skelley

When living with diabetes, the goal is level blood sugars (also called euglycemia). Keeping blood sugar highs and lows in check while striving to maintain targets can go far in minimizing the risk of developing diabetes-related complications, such as kidney disease and eye issues. Here are some of the complications that can occur, plus tips for preventing them from happening.

Complications associated with consistently high blood sugar

Having hyperglycemia, or high blood glucose levels of > 240mg/dL, on a regular basis increases the risk of a number of complications, some of which include:

  • Damage to the vagus nerve (sends signals from your gut to your brain) and gastrointestinal cells resulting in diabetic gastroparesis (delayed stomach emptying), which can be quite uncomfortable

  • Diabetic ketoacidosis (DKA) where the body rapidly breaks down fat for energy, resulting in acids called ketones building up in the bloodstream. Side effects can include nausea, vomiting, difficulty breathing and, worst-case scenario, a coma and even death.

  • Hyperosmolar hyperglycemic syndrome (HHS), a rare and dangerous condition resulting when sustained very high blood sugars cause glucose to spill into the urine, leading to severe dehydration and confusion

  • Diabetic retinopathy, which is damage to the blood vessels of the eyes and retina that can cause blindness

  • Cardiovascular disease including high blood pressure and elevated lipids

  • Delayed wound healing including painful diabetic foot ulcers, which result from reduced circulation

  • Diabetic kidney disease from damage to the blood vessels in the kidneys

  • Increased infection rates

  • Increased admission to the hospital with the risk of prolonged or extended stay and, worst-case scenario, death

Conversely, consistent hypoglycemia (or low blood sugar), as defined by the American Diabetes Association, falls into 3 categories:

  • Stage 1 hypoglycemia is a blood glucose level between 70 mg/dL and 54 mg/dL. At this stage, signs and symptoms may include shaking, sweating, dizziness and hunger as the body signals distress and tries to self-correct.

  • Stage 2 hypoglycemia is a blood glucose level of less than 54 mg/dL. At this stage, there is a significant neurological risk as the brain is reliant upon glucose for energy and functioning. Signs and symptoms may include confusion and mood shifts as the brain is deprived of energy.

  • Stage 3 hypoglycemia is not marked by a specific blood glucose level but rather a severe decrease in glucose, usually below 40 mg/dL, resulting in the inability to function. At this stage, the person in question requires emergency care.

Tips for Reducing Your Risk for These Complications

Learn more about your condition

It's important to remove any stigma associated with having or developing diabetes. You are not to blame nor should you feel shame from being diagnosed with diabetes. Rather it's an opportunity to learn how nutrition and lifestyle impact your blood sugars as well as the possibility of developing further conditions.

Making individual changes that are sustainable and fit into your lifestyle can help reduce the risk of complications. The more you know about the signs and symptoms associated with blood sugar highs and lows, the more you will find yourself better equipped to manage and treat them should they arise. Regular monitoring of your blood sugars and taking medication as prescribed helps keep your sugars within expected limits.

Should you find that you are continually experiencing variability in your blood sugar, this would be an opportunity for further exploration, education and possibly a medication adjustment with your primary care provider. Additionally, group nutrition education as a part of a short- or long-term diabetes self-management group may be beneficial.

Find an eating pattern that works for you

A growing body of evidence supports following a balanced diet that includes vegetables, fruits, whole grains and heart-healthy fats. Current research suggests that increasing your intake of vegetables and fruits helps to keep blood sugars level and can be supportive of optimal health outcomes. While access to fruits and vegetables varies by neighborhood, the good news is even adding one serving of whole and minimally processed vegetables and fruits to your routine each day can result in improved outcomes.

Make time for intentional movement

Research suggests that creating space and time to engage in intentional physical activity is good not only for cardiovascular health but also for blood sugar management. You don't need any fancy equipment. It can be as simple as making time for a brisk walk on most days. It's always recommended to reach out to your primary care provider or health care team before starting an exercise routine.

Bottom line

Managing diabetes doesn't need to be as complicated as it may feel at first. Small steps can go a long way in balancing blood sugars and preventing dangerous complications. Work with your care team to find the best strategies for keeping your blood sugars in check, so you can feel your best.