Type 2 diabetes doesn’t necessarily lead to a loss of independence on its own. But diabetes complications such as vision loss, muscle weakness, and cognitive decline can make it harder to maintain your quality of life on your own.
Mitigating and avoiding these risks starts with blood sugar control and weight management, but good diabetes management can go a step further. Other solutions can include exercising, sleeping right, and even staying socially active.
1. Risk: Vision Loss
Eyesight can be an essential part of maintaining your quality of life. But poorly managed blood sugar increases your risk of diabetic retinopathy, damage to the blood vessels in your eye’s retina that can lead to vision loss and blindness.
When insulin isn’t working effectively, too much sugar stays in your bloodstream. Over time, this can damage blood vessels throughout the body, says Charles Barron Jr., MD, chief medical officer of Friend Health, a provider for medically underserved communities in Chicago.
“The eyes have very small blood vessels, and when we can’t get blood flow to them, cellular death starts to occur,” Dr. Barron says.
More than 9.5 million people in the United States have diabetic retinopathy, including 26 percent of people with diabetes. It threatens the vision of 1.84 million of those people, about 5 percent of people with diabetes.
About 1 in 14 people with diabetes also develop diabetes-related macular edema, swelling in the macula (the central part of your retina) that can lead to blindness.
It is the leading cause of vision loss among people with diabetes, says Jennifer Cheng, MD, chief of endocrinology at Hackensack Meridian Health in Neptune, New Jersey.
Solution: Get Your Blood Sugar and Blood Pressure Under Control
Managing your blood sugar effectively is key for reducing your risk of diabetes complications, and vision loss is no exception. If you have hypertension, or high blood pressure, lowering your blood pressure could slow the progression of vision issues.
Eating healthy foods, exercising regularly, losing excess weight, and taking prescribed medication can help.
Injections or lasers can also treat macular edema.
2. Risk: Muscle Weakness (Sarcopenia)
Age-related loss of muscle mass and function, or sarcopenia, affects more than half of people age 80 and older.
It can lead to depression, falls, and bone fractures, all of which can reduce your ability to get around on your own.
Type 2 diabetes can speed up this process, which makes it harder for you to control your blood sugar and to be physically active — leading to additional diabetes complications.
In fact, more than 22 percent of people age 50 and older with type 2 diabetes have sarcopenia, compared with 8.8 percent of people who do not have type 2 diabetes.
Dr. Cheng says that the following factors contribute to this increased risk of muscle breakdown:
- Insulin resistance
- Chronic inflammation
- Increased accumulation of harmful substances in muscle fibers caused by high blood sugar
Your risk may be greater if you have the following conditions:
- High blood pressure
- Low calcium levels
- Nerve damage
- Low amount of physical activity
Solution: Strength-Building Exercise
Regardless of your age, building strength can help maintain muscle mass and manage type 2 diabetes. Two or three resistance-training sessions each week can improve blood sugar control and help your body use insulin efficiently.
You don’t even need to go to the gym and use heavy equipment to get results. Barron recommends using a can of food as a dumbbell and performing flexing exercises (think curls or overhead presses) to maintain strength.
3. Risk: Foot Problems
People with type 2 diabetes have an increased risk of foot issues, from poor circulation to rare and serious conditions such as Charcot foot, that make it difficult or impossible to walk.
About 15 percent of people with diabetes get diabetic foot ulcers, usually on the bottom of the foot. Although often preventable, they can lead to amputation in 14 to 24 percent of cases.
Foot issues can be the result of nerve damage or peripheral artery disease, which can reduce blood flow in your feet and can make it harder for foot sores to heal.
“The toes have very small blood vessels, and when circulation is compromised, these areas are particularly vulnerable,” says Barron, adding that doctors typically check your toes and feet for sensation changes and look for evidence of decreased blood flow.
Solution: Daily Foot Care
Wear shoes or socks around the house, and avoid going barefoot or exposing your feet to extreme temperatures, Barron says. Check your feet every day to prevent small problems from becoming large ones. If you develop a foot sore or ulcer, preventing infection by keeping it clean, bandaged, and medicated (when prescribed) is your best bet to avoid complications. Your doctor may refer you to a podiatrist or wound-care specialist for additional treatment.
4. Risk: Severe Hypoglycemia
Medications that treat type 2 diabetes can lower blood sugar levels, but they can also cause levels to drop too low, known as hypoglycemia. These medications include sulfonylureas and insulin.
Symptoms include hunger, shakiness, and confusion. Though mild cases of hypoglycemia can be treated with a sugary snack or drink, severe cases of hypoglycemia cause a risk of losing consciousness, Barron says.
If you are at least 70 years old and have type 2 diabetes, you have an increased risk of being hospitalized for severe hypoglycemia while taking insulin or sulfonylureas. The risk increases with age.
Solution: More Blood Sugar Testing
Testing blood sugar more frequently helps you make better decisions about medication.
Barron says that doctors may monitor your blood sugar levels remotely to gauge blood sugar control more accurately. Continuous glucose monitors give you real-time updates and alarms so you can learn quickly if you have hypoglycemia.
5. Risk: Chronic Fatigue
“Chronic fatigue is a prevalent and often overlooked symptom in type 2 diabetes, significantly eroding quality of life,” Cheng says.
This is because high blood sugar from untreated type 2 diabetes affects your ability to convert sugar into energy. The buildup of sugar also causes your kidneys to work harder, leading to frequent urination that can interrupt your sleep.
Being overweight or having obesity can contribute to fatigue, as your body may have to work harder to perform everyday tasks.
Sleep comes into play, as well. People with type 2 diabetes often sleep poorly and wake frequently during the night, Barron says. These sleep issues, including obstructive sleep apnea and insomnia, can contribute to fatigue.
Solution: Good Sleep Hygiene
Prioritize habits that lead to better sleep:
- Don’t use electronic devices before bed.
- Exercise during the day.
- Keep blood sugar and blood pressure levels consistent.
- Limit daytime naps of more than 30 minutes.
- Create a comfortable sleep environment, free of light and noise.
In addition, talk to your doctor about getting tested and potentially treated for sleep apnea, a condition in which your airway is completely or partially obstructed during sleep. About 7 in 10 people with type 2 diabetes have obstructive sleep apnea, which your healthcare team can help you treat.
6. Risk: Cognitive Decline
Losing mental function, such as memory, language, reasoning, and judgment, can limit your ability to do things on your own. Cognitive impairment increases as you age, and it is more common in people with type 2 diabetes, especially those age 65 and older. Risk factors may include obesity, chronic inflammation, and cardiovascular complications of diabetes.
Informally, the progressive brain disorder Alzheimer’s disease is sometimes called type 3 diabetes. The long-term blood sugar problems linked to diabetes may increase the risk of Alzheimer’s and speed memory loss by interfering with how brain cells function.
“Insulin resistance can impair brain cell function and communication,” Cheng says. “If there is not enough sugar in the brain, then there could be damage, especially with severe hypoglycemia.”
Solution: Brain Stimulation
Maintaining stable blood sugar and staying mentally active can support brain health and functional independence, Barron says. Stimulating activities for your brain include playing cards or board games, learning a new language, trying a new recipe, visiting a new vacation spot, and even planning a dinner party. Trying new things can help your brain form new connections.
7. Risk: Social Isolation
Loneliness can affect quality of life and independence in many ways: Not only can it increase the risk of cognitive decline and conditions such as type 2 diabetes but it also affects mental health — with lonely people being twice as likely to get depressed.
People with type 2 diabetes are especially vulnerable to loneliness and social isolation, with nearly 20 percent of people with the condition also experiencing intense loneliness.
“From a social perspective, people may decline to go out because they feel like they’re not going to be able to eat freely, they’re embarrassed because they may have to check blood sugar, or [they experience] different social aspects that can impact whether they want to spend time with others,” Barron says.
People who feel isolated or lonely are more likely to develop diabetes-related problems such as kidney disease, nerve damage, and eye damage than those who are more socially connected. In fact, the risk is about as strong as those associated with smoking, high blood pressure, and low physical activity.
Solution: Explore and Expand Your Community
To get a sense of belonging, take a class to learn something new with others, schedule time each day to stay in touch with family or friends, consider adopting a pet if you can care for one, introduce yourself to your neighbors, or join a community cause to get involved.
It’s also important to educate your family members and friends about type 2 diabetes so they can help you navigate certain situations, without putting pressure on you to do something you can’t because of the disease, Barron says.
The Takeaway
- Effective management of type 2 diabetes, including control of your blood sugar level and weight, can substantially reduce the risk of complications that threaten your independence.
- If you do not control your blood sugar well, you may risk changes to your vision, muscle mass, and cognitive abilities, as well as foot problems, hypoglycemia, and fatigue.
- In addition to good blood sugar control and metabolic health, solutions such as ensuring that your blood pressure is under control, exercising, and even staying socially active can help mitigate risks of complications.
- Talk to your healthcare team about the best ways to manage your type 2 diabetes and what change you can make to maintain and improve your quality of life.