Double Diagnosis: Type 2 Diabetes + Common Complications

If the day of your type 2 diagnosis came with the discovery of one or several diabetes-related complications, you’re not alone.

At the time of diagnosis, about 50% of people with type 2 diabetes are also diagnosed with complications. While managing an A1c between 5 to 7% is thought to reduce your risk of developing complications, some people may still develop them.

The signs and symptoms of prediabetes and type 2 diabetes (T2D) can easily go unnoticed for years—making it more likely that complications could develop during those years. 

Here, we look at the most common complications that are diagnosed alongside type 2 diabetes. 

The most common diagnosis at the time of T2D diagnosis

The most commonly diagnosed condition at the time of a type 2 diabetes diagnosis isn’t technically a diabetes complication. Instead, it’s metabolic syndrome. While metabolic syndrome isn’t the result of persistently high blood sugar levels, it is very common in people with T2D. 

Metabolic syndrome is essentially a group of conditions that often develop together—including high blood pressure, high cholesterol, high blood sugar, high triglycerides and increased body fat.

“At the time of your diabetes diagnosis, your health care team should also look at your kidney and liver function, and evaluate you for risk factors of heart disease,” explains Deena Adimoolam-Gupta, MD, an endocrinologist at Mount Sinai Hospital in NY.

Based on a variety of research findings, metabolic syndrome develops in approximately 22 to 30% of people with T2D. Metabolic syndrome significantly increases your risk of a stroke or heart attack.

“In fact, it’s not uncommon to diagnose a person with type 2 diabetes when they come into the emergency department for a cardio issue, like a heart attack or stroke,” says Adimoolam-Gupta.

“People with type 2 diabetes are twice as likely to have heart disease or a stroke. It’s important to never ignore the signs and symptoms of heart attack and stroke, and work with your health care team to reduce your risk.” 

Complications commonly found at your T2D diagnosis

Diabetes complications can develop in many different areas of the body. They are usually the result of years of persistently high blood sugar levels that cause damage to the blood vessels, nerves and organs. 

But there are several factors that can increase your risk of complications beyond your A1c and blood sugar levels.

“Your gender, age, weight, if you smoke and if you have hypertension—these all increase your risk of developing a diabetes complication,” says Adimoolam-Gupta. “Your medical history, genetics and what medications you take are other factors.”

Generally, the three most commonly diagnosed diabetes complications—regardless of whether it coincides with your diabetes diagnosis—are:

• Chronic kidney disease
• Neuropathy in the feet
• Retinopathy

All three of these complications can be treated with support from your health care team! An annual diabetes eye exam, annual urine sample to test your kidney function and sensitivity testing in your feet can help catch the earliest stages of these complications. 

Different types of diabetes complications

Here’s a rundown of complications that can develop in people with diabetes. 

• Nephropathy (kidney disease): Also known as “diabetic nephropathy” and “diabetic kidney disease,” it is one of the two leading causes of kidney failure in Canada (the other is high blood pressure). It develops as a result of persistently high blood sugars damaging three parts of your kidneys: blood vessels, nerve endings and urinary tract. In the later stages, it can mean lifelong dialysis or a kidney transplant. Luckily, in the earlier stages, nephropathy can be managed, treated and sometimes reversed.  
• Cardiovascular disease (heart disease): Also referred to as “heart disease,” it can develop in non-diabetics, too. It’s usually caused by the gradual narrowing—or a complete blockage—of the blood vessels that supply your heart with the blood (and oxygen) that it needs in order to function. This is also the number one cause of a heart attack.
• Peripheral neuropathy: Also referred to as “diabetic neuropathy” or “PN,” this diabetes complication is the result of persistently high blood sugar levels limiting healthy blood flow and eventually damaging the nerves throughout your hands, fingers, toes, arms, feet and legs. The earliest signs are a loss of sensation in your toes or fingers and a tingling numb feeling. There are a variety of modern treatments available today.
• Eye diseases (retinopathy, macular edema, glaucoma, cataracts): When your blood sugar levels are persistently high, the excess glucose and pressure on the nerves, blood vessels and other structures in your eye can become damaged, swollen, burst and leak fluid into your eye. Over time, this ongoing damage can lead to significant loss of sight or blindness. 
• Periodontal disease (gum disease): Also referred to as “gum disease,” this can develop as a direct result of persistently high blood sugar levels. Your gums, teeth, tongue and saliva are all heavily impacted by your blood sugar levels. Persistently high blood sugar levels can damage the nerves and blood vessels throughout your entire mouth, especially your gums and increase your risk of cavities, mouth ulcers, fungal infections, bone loss and more. 
• Skin conditions: There are actually a dozen different diseases and infections that can develop in and on your skin as a result of persistently high blood sugar levels. Chronic itching, severe blisters, trigger fingers, discoloring, bacterial and fungal infections and more. If you notice any skin condition or cut/blister worsening, tell your health care team immediately to prevent severe infections and possible amputation.
• Gastroparesis: Also referred to as “delayed gastric emptying,” gastroparesis can develop in people with diabetes when persistently high blood sugar levels damage the nerves and blood vessels in your digestive system. Overall, gastroparesis means your stomach digests food extremely slowly and unpredictably, making it doubly hard to manage blood sugar levels, and often making basic digestion painful and uncomfortable. 
• Hearing loss: Also the result of persistently high blood sugar levels, diabetes-related hearing loss develops when nerves and blood vessels throughout your entire auditory system are damaged. If you suspect you’re suffering from hearing loss, talk to your health care team ASAP to rule-out fixable causes such as an infection, excess wax, or another blockage. 

If you believe you might be experiencing any of these complications, reach out to your health care team right away. Experiencing complications—and even the thought of developing them—can be overwhelming and scary, but the sooner you take action to treat and manage a diabetes complication, the sooner you can potentially slow or reverse its progression.

Educational content related to severe hypoglycemia is made possible with support from Lilly, an active partner of Beyond Type 2 at the time of publication. Editorial control rests solely on Beyond Type 2.