Skin and Eye Complications from Diabetes

Common skin conditions for people with type 2 diabetes

People with  diabetes are at an increased risk of developing skin problems, or from complications of skin problems that have not been spotted soon enough, often because of reduced skin sensation.

Most  skin conditions can be prevented and successfully treated if caught early. However, if not cared for properly, a minor skin condition in a person with diabetes can turn into a serious problem with potentially severe consequences.

Skin conditions linked to diabetes

• Scleroderma diabeticorum: This condition causes a thickening of the skin on the back of the neck and upper back. This condition is rare but can affect people with  type 2 diabetes. The treatment involves bringing your  blood glucose level under control. Lotions and moisturisers may help soften the skin.
• Diabetic dermopathy: Also called shin spots, this condition develops as a result of changes to the  blood vessels that supply the skin. Dermopathy appears as a shiny round or oval lesion of thin skin over the front lower parts of the lower legs. The patches do not hurt, although rarely they can be itchy or cause burning. Treatment is usually not necessary.
• Diabetic blisters (bullosis diabeticorum): In rare cases, people with diabetes develop  blisters that resemble burn blisters. These blisters can occur on the fingers, hands,  toes,  feet, legs or forearms. Diabetic blisters are usually painless and heal on their own. They often occur in people who have severe diabetes and  diabetic neuropathy. Bringing your blood glucose level under control is the treatment for this condition.
• Disseminated  granuloma annulare: This condition causes sharply defined, ring or arc-shaped areas on the skin. These  rashes most often occur on the fingers and  ears, but they can occur on the chest and  abdomen. The rash can be red, red-brown or skin coloured. Treatment is usually not required, but sometimes a topical steroid  medication, such as  hydrocortisone, may help.

Itching and infections

• Bacterial infections: There are different kinds of bacterial infections affecting the skin. Skin infections with the bacteria known as Staphylococcus are more common and more serious in people with diabetes which is not under control. These bacteria can result in a "boil", an inflamed nodule from a  hair follicle, which can occur in areas where  hair follicles can be irritated. Other infections include styes, which are infections of the glands of the eyelids, and bacterial nail infections. Most bacterial infections require treatment with  antibiotics in the form of pills and/or creams.
• Fungal infections: A yeast-like fungus called "Candida albicans" is responsible for many of the fungal infections affecting people with diabetes. Other commonly seen areas of infection include the corners of the  mouth with what is known as "angular cheilitis", which feels like small cuts on the corners of the  mouth. Fungus also can occur between the  toes and fingers and in the  nails ( onychomycosis). This fungus creates itchy, bright red rashes, often surrounded by tiny blisters and scales. These infections most often occur in warm, moist folds of the skin. Three common fungal infections are: jock itch (red, itchy area in the groin, on the genitals and the inside of the thighs),  athlete's foot (affects the skin between the toes), and  ringworm (ring-shaped, scaly patches that can itch or blister and appear on the feet, groin, chest and abdomen, scalp or  nails). Medicines that kill the fungus are usually needed to treat these infections. A potentially fatal fungal infection with Mucormycosis is seen in people with diabetes. The infection usually starts in the nasal  cavities and can spread to the eyes and  brain.
• Itching: Itching skin, also called  pruritus, can have many causes, such as a  yeast infection, dry skin or poor blood flow. When itching is caused by poor blood flow, the lower legs and feet are most often affected. Using lotion can help to keep your skin soft and moist, and prevent itching due to dry skin.

Diabetes eye problems

If you have  diabetes, regular  eye examinations are important to detect and treat  eye problems. These should be arranged by your  diabetes health team as part of regular tests and screening.

High blood sugar (glucose) increases the risk of diabetes eye problems. In fact,  diabetes is the leading cause of blindness in adults aged 20 to 74.

Blurred vision can be a symptom of more serious  eye problems with diabetes. The three major  eye problems that people with diabetes may develop and should be aware of are  cataracts,  glaucoma, and retinopathy.

Cataracts and diabetes

A cataract is a clouding or fogging of the normally clear lens of the eye. The lens is what allows us to see and focus on an image just like a camera. Although anyone can get  cataracts, people with diabetes get these eye problems at an earlier age than most and the condition progresses more rapidly than in people without diabetes.

If you have a cataract with diabetes, your eye cannot focus light and your  vision is impaired. The symptoms of this eye problem in diabetes include blurred or glaring vision.

The treatment for cataracts is usually surgery to extract the lens, followed by insertion of a lens implant, with glasses or  contact lenses as needed to further correct  vision.

Glaucoma and diabetes

When fluid inside the eye does not drain away properly, a build-up of pressure inside the eye can lead to a condition called glaucoma. The pressure damages nerves and the vessels in the eye, causing changes in vision.

In the most common form of glaucoma, there may be no symptoms of this eye problem at all until the disease is very advanced and there is significant vision loss. In the less common form of this eye problem, symptoms can include  headaches, eye aches or  pain, blurred vision, watering eyes, halos round lights and loss of vision.

Treatment of this eye problem in diabetes can include special  eye drops, laser procedures, medication or surgery. You can prevent serious eye problems in diabetes by getting an annual glaucoma screening from your  optometrist.

Diabetic retinopathy

The retina contains a group of specialised cells that convert light as it enters though the lens into visual signals. The eye nerve or optic nerve transmits visual information to the  brain.

Diabetic retinopathy is one of the vascular ( blood-vessel related) complications related to diabetes. This diabetes eye problem is due to damage of small vessels and is called a "microvascular complication."  Kidney disease and  nerve damage due to diabetes are also microvascular complications. Large blood vessel damage (also called macrovascular complications) includes complications like  heart disease and  stroke.

The microvascular complications have, in numerous studies, been shown to be related to high  blood sugar levels. You can reduce your risk of these eye-related diabetes complications by improving your  blood sugar control.

Diabetic retinopathy is the leading cause of irreversible blindness in industrialised nations. The duration of diabetes is the single most important risk for developing retinopathy. So the longer you have diabetes, the greater the risk of this very serious eye problem. If retinopathy is not found early or is not treated, it can lead to blindness.

People with  type 1 diabetes rarely develop retinopathy before puberty. In adults with type 1 diabetes, it is also rare to see retinopathy before five years' duration of diabetes. The risks of retinal damage increase with progressive duration of diabetes. Intensive control of blood sugar levels will reduce your risks of developing retinopathy. The Diabetes Control and Complications Trial, a large study of people with type 1 diabetes, showed that people with diabetes who achieved tight control of their blood sugars with either an  insulin pump or multiple daily injections of insulin were 50%-75% less likely to develop retinopathy, nephropathy (kidney disease), or nerve damage (all microvascular complications).

People with  type 2 diabetes often have signs of eye problems when diabetes is diagnosed. In this case, control of blood sugar,  blood pressure, and blood cholesterol have an important role in slowing the progression of retinopathy and other eye problems.

Types of retinopathy in diabetes:

• Background retinopathy. Sometimes the blood vessel damage exists, but there is no vision problem. This is called background retinopathy. It's important to carefully manage your diabetes at this stage to prevent background retinopathy from progressing to more serious eye disease.
• Maculopathy. In maculopathy, the person has developed damage in a critical area called the macula. Because this occurs in an area that is critical to vision, this type of eye problem can significantly reduce vision.
• Proliferative retinopathy. New blood vessels start to grow in the back of the eye. Because retinopathy is a microvascular complication of diabetes, a disease of small vessels, this type of retinopathy develops because of an increasing lack of oxygen to the eye from  vascular disease. Vessels in the eye are thinned and occluded and they start to remodel.

Here, it is important to address the risks factors that can worsen the occluded vessels.  Smoking cessation,  high blood pressure control,  cholesterol management, and blood sugar control must take place in order to stop the damage to blood vessels and progression of new vessels from growing into the eye. These are fragile vessels that can bleed and eventually cause a clot to form in the retina, which scars and may cause detachment of the retina. This can eventually lead to irreversible vision loss.

Treatment of diabetic retinopathy may involve laser procedures or surgery. In a study of people with diabetes with early retinopathy, laser therapy to burn the fragile vessel resulted in a 50% reduction of blindness.

To prevent damage from retinopathy it’s important to have eye screening annually, or more frequently if recommended. Women with diabetes who later become pregnant should have a comprehensive eye examination during the  first trimester and close follow-up with an eye specialist during the rest of their  pregnancy to avoid serious eye problems with diabetes. (This recommendation does not apply to women who develop  gestational diabetes, since they are not at risk of retinopathy.)

When to seek medical advice about eye problems in diabetes

If you have diabetes,  seek medical advice about any eye problems if any of the following occur:

• Black spots in your vision.
• Flashes of light.
• “Holes" in your vision.
• Blurred vision.

Eye care for people with diabetes

Eye care is especially important for people with diabetes because they are at increased risk of developing eye complications from the disease. Retinopathy (damage to the retina at the back of the eye) is a common complication of diabetes. If left untreated, it can get worse and cause some loss of vision, or blindness in severe cases. All people with diabetes should take precautions to help reduce their risk of developing eye problems. Here are some eye care tips:

• Book regular appointments with your optometrist so that any eye problem can be detected early and treated
• Maintain control of your blood glucose levels
• Keep your  blood pressure under control. High blood pressure by itself can lead to eye disease, so if you have high blood pressure as well as diabetes, it is especially important that you take steps to control both conditions
• Get your blood  cholesterol levels under control
• Eat a healthy  diet
• Avoid  smoking
• Exercise regularly