Many children and adolescents with diabetes and their families worry about the long-term effects of diabetes on the body. While we know that poor diabetes control over a prolonged period can cause damage to certain parts of the body, research has shown that improving diabetes control may reduce the risk of any long-term problems. Regular screening is important for early detection of any complications, as there are treatment and management options available to reduce the risk of further damage to the body. Factors associated with the risk of diabetes related complications include age, duration of diabetes, long-term blood glucose control and genetics. Damage is thought to occur when higher than normal blood glucose levels over a long period of time, result in changes to the blood vessels and nerves of the body, causing problems with: Eyes Damage can occur to the back of the eye (retina) where there are blood vessels and nerves important for vision. This is called retinopathy. While small changes to the retina (background retinopathy) are common in people who have had diabetes for 15-20 years, these changes do not threaten vision. If diabetes control is poor, this damage may progress to a more serious form of retinopathy (proliferative retinopathy), which may be vision threatening and require treatment by laser or surgery. Sometimes children and adolescents with diabetes have problems with blurred vision and an inability to focus properly. These changes are temporary and due to high blood glucose levels (often at diagnosis or during stabilisation). This situation is not vision threatening. Cataracts can also occur in people with diabetes. This happens when the lens becomes milky, threatening vision. This usually occurs in old age and responds well to surgery. Screening: Complications screening is recommended in adolescents two years after diagnosis and in children (before puberty) five years after diagnosis and then usually every two years. Screening involves checking the back of the eye with non-invasive photographic equipment and should be carried out by a qualified Ophthalmologist experienced in diabetes. Kidneys Damage can occur to the filters of the kidneys, which are important for removing waste products from the body. This is called nephropathy. Those who smoke or have high blood pressure are particularly at increased risk. Detection of early kidney changes and appropriate treatment, including well controlled BGLs and medication for high blood pressure may reduce the risk of long-term kidney damage. Screening: Complications screening is recommended in adolescents two years after diagnosis, and in children (before puberty), five years after diagnosis and then usually every two years. Screening involves checking urine samples for evidence of protein (microalbuminuria) and is carried out by your diabetes team. Nerves Damage can occur to nerves in different parts of the body. This is called neuropathy. Symptoms of neuropathy include tingling and loss of sensation, particularly in the feet or legs. Neuropathy can also affect other parts of the body, including the gastrointestinal tract (gastroparesis – delayed stomach emptying). Neuropathy is uncommon in children, however should be part of the routine complications screening to detect any early changes. Screening: Complications screening is recommended in adolescents two years after diagnosis, and in children (before puberty), five years after diagnosis and then usually every two years. Screening for nerve damage is included in foot care checks as described below. Feet Damage to the feet may be caused by neuropathy or a decreased blood supply to the area. Problems with the feet are not commonly seen in children and adolescents with type 1 diabetes, however regular examination is important to prevent problems later in life. Day to day care of the feet should include checking for ingrown toenails, calluses, corns, warts, cuts and abrasions – with prompt treatment if detected. Well fitting shoes and socks can help to protect the feet. Screening: Complications screening is recommended in adolescents two years after diagnosis, and in children (before puberty), five years after diagnosis and then usually every two years. Podiatry (foot) screening involves checking the nerve sensations in the feet, foot structure and for possible presence of deformities. Blood Vessels Diabetes can cause damage to the large blood vessels in the body, which may increase the long-term risks of heart disease, stroke, erectile dysfunction (impotence) and circulation problems in the legs. Disease of the large vessels is rare in young people with type 1 diabetes, however, there are factors that may increase the risk of these problems later in life which include: Screening: Most paediatric diabetes services check blood pressure at least once year and cholesterol with blood tests every one to two years. Reducing the Risk of Long Term Complications Studies have shown that even small improvements in diabetes control can make a difference to the risk of long-term complications. To reduce the risk of complications, it’s important to: • Follow the management plan advised by your diabetes team, this includes regular BG testing, with appropriate insulin adjustment to match your child’s lifestyle |
