Lesser-known diabetes-related complications

High glucose levels in the blood over a long period of time can cause damage to the large and small blood vessels and nerves, which puts people at a greater risk of developing complications. The most common complications relate to problems with the heart, eyes, mouth, hearing, and kidneys, as well as issues with circulation and neuropathy in hands or feet. Unfortunately, in addition to the more commonly-experienced complications, there are also some lesser-known ones that it is important to look out for. In some cases early detection can assist in treatment.

Adhesive capsulitis (frozen shoulder)

Frozen shoulder causes pain, stiffness and limited mobility in the shoulder.

It is more common in people who:

• Have had diabetes for a long time
• Are older
• Have had a heart attack
• Are experiencing complications of diabetes in the small blood vessels (also known as microvascular complications), which can lead to problems in the eyes, kidneys and with nerves
• Have retinopathy and nephropathy
• Have a shoulder injury
• Have inflammatory conditions
• Are inactive

This condition can be divided into three stages:

• Painful stage – where there is pain and stiffness lasting three to eight months. It can start out as a generalised ache that progresses to more severe pain and a restriction of movement
• Adhesion stage – increasing stiffness but decreased pain lasting four to six months
• Recovery stage – is ongoing. Pain may be minimal and there is a gradual improvement in movement and stiffness.  A few people lose some range of movement in the shoulder. Very few people have severe ongoing problems.

Treatment includes:

• Alternating heat and ice packs in the painful stage
• Painkillers to reduce inflammation
• Physiotherapy to improve movement. It is important to persist with physio as recovery can be gradual and slow
• Steroid injections
• Surgery may be needed in rare cases.

Diabetic cheiroarthropathy (Stiff hand syndrome)

This is a condition where the joint loses normal flexibility. Although most common in the hands, it can affect wrists, elbows, shoulders, knees, ankles, neck, and lower back. The longer an individual has diabetes the greater the risks of developing this. It is caused by blockages in the small blood vessels. If a person has problems such as nephropathy (kidney disease) or retinopathy (eye disease) they are at higher risk of getting this condition.

Keeping blood glucose level as close to their target range as possible can help to reduce the risk; however, once the damage is done there is no known way to reverse the effects.

Seeing a physiotherapist and/or occupational therapist is important to maintain hand mobility and prevent loss of movement. Steroid injections may also be helpful.

Dupuytren’s contracture

Dupuytren’s contracture causes the fingers, particularly the ring and little finger, to bend towards the palm. They cannot be straightened. It typically includes thickening or puckering of the skin on the palm. It is usually painless.

It is more common in:

• Men
• People with a family history
• Those who have had diabetes for a long time with small blood vessel damage
• Older people.

If severe, treatment can include:

• Injections to dissolve the collagen
• Surgery.

Stenosing tenosynovitis (trigger finger)

Trigger finger is a painful condition that affects the tendons in the hand. The inflamed swollen tendon causes the finger or thumb to lock. The tendon gets stuck and the finger clicks, or locks, in either the bent or straight position. It is most common in the ring finger.

It is more common in:

• People who have had diabetes for a long time
• Older people
• Those who have retinopathy or nephropathy.

The underlying cause is thought to be due to multiple factors. Contributing factors include collagen problems, diabetic microangiopathy (abnormal growth and leakage of small blood vessels), and diabetes neuropathy. Other risk factors include repetitive hand movements and rheumatoid arthritis.  

Treatments include:

• Rest
• Splinting 
• Steroid injections
• Surgery

Hammer toe

Toe deformities, such as claw toe and hammer toe, happen when the tendons that move the toes get too tight or out of balance, bending the toe. The affected toe can rub on other toes and on the inside of a person’s shoe, causing pressure and pain.  

Having diabetes can lead to nerve damage, commonly in the feet.  While nerves control muscle movement and sensation, neuropathy can break communication between the nerves, muscles and tendons in the feet, which can make the soft tissues shrink and contract. 

Reduce the risks of foot problems:

• Keep glucose, cholesterol, and blood pressure in target ranges
• Attend an annual diabetes foot examination to identify problems early and find out how to care for feet
• Get early treatment to reduce the severity of the problem
• Wear properly fitted shoes. Tight shoes squeeze the toes and worsen hammertoes
• If needed, use pads and insoles.

For more information about looking after your feet see:

• FootForward

Carpal tunnel syndrome

The symptoms of carpal tunnel syndrome include pain, burning, numbness or pins and needles in the hand and wrist, particularly the thumb, forefinger, and middle finger. The pain is often worse at night.

The condition occurs when one of the major nerves to the hand is squeezed or compressed as it travels through the wrist. 

Those living with diabetes are at higher risk. The risk increases the longer an individual has lived with diabetes and if they have peripheral vascular disease and neuropathy.

Treatments include:

• Rest
• Splinting the wrist
• Steroid injections
• Surgery.

Prevention and early intervention

Prevention and early intervention are best. Encourage your clients to undertake their annual cycle of care and all your health checks.

For more information see the Diabetes Related Complications fact sheet.

By Monica McDaniel-Wong, Credentialled Diabetes Educator