Patients with diabetes are more likely to suffer many serious health issues besides foot wounds and amputations. This makes it imperative that they resolve to get their blood glucose levels under control.

All of the lawsuits I review have a common theme. The plaintiff suffers from a chronic wound and some degree of malnutrition and/or dehydration. I have started to notice that in addition to these problems, the plaintiff also quite often has diabetes. This trifecta of problems leads to pain, suffering, disability, and discontent.

People with diabetes are 10 to 20 times more likely to have a lower extremity amputation than those without diabetes.1 This is a scary statistic compounded by the fact that people with diabetes may not even notice a foot wound developing because they cannot feel it because of neuropathy. A foot ulcer is the initial event in more than 85% of major amputations that are performed on people with diabetes.2 Knowing this should provide enough motivation for patients to get their diabetes under control, but some people need even more reasons. Here are eight more consequences you can discuss with your patients. Hopefully, one will hit home.

Periodontal disease

Periodontal disease can lead to painful chewing difficulties and even tooth loss. Diabetes is associated with an increased risk of developing gingivitis and periodontitis. It also is likely that these oral problems are more severe and extensive in people who have diabetes. Periodontal disease can make diabetes more difficult to control, and uncontrolled diabetes greatly increases the risk of developing periodontal disease. It is a two-way street.

Frozen shoulder

Frozen shoulder affects 10% to 20% of people with diabetes, according to the American Academy of Orthopaedic Surgeons.3 Women are more likely to develop frozen shoulder than men, and it occurs most frequently in people between 40 and 60 years of age. It can render the shoulder so stiff that it’s almost impossible to button a shirt or get dressed. Ouch!


Diabetic retinopathy is the most common eye disease for individuals with diabetes and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. People who keep their blood sugar levels closer to normal are less likely to have retinopathy or milder forms of the disease.


Nearly two in three people with diabetes report having high blood pressure or taking prescription medications to lower their blood pressure. The heart has to work harder when blood pressure is high, and the risk for heart disease, stroke, and other problems goes up. Many people are sensitive to salt, so encourage herbs and spices for flavor instead of salt.

Kidney Disease

When blood sugar levels are high, the kidneys have to work much harder to filter the blood. After several years of this, the kidneys will start to leak and begin to excrete protein in the urine. Eventually, the kidneys are not able to effectively filter the blood, and toxins will build up. If the kidneys fail, the patient will require dialysis to survive or need a kidney transplant.


Gastroparesis is a disorder in which the stomach takes too long to empty its contents (delayed gastric emptying). The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged or stops working, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.4 Sometimes, damage occurs to the vagus nerve if blood glucose levels remain high over an extended period of time.


Cerebrovascular disease is a leading cause of morbidity and mortality in people with diabetes. Compared with patients who do not have diabetes, patients with diabetes have 1.5 times the risk for stroke, earlier onset of symptoms, and worse functional outcomes.5 Even prediabetes (defined as impaired glucose tolerance or a combination of impaired fasting glucose plus impaired glucose tolerance) is linked to a greater risk of stroke.6

Hearing Loss

According to the American Diabetes Association, of the 84 million adults in the United States who have prediabetes, the rate of hearing loss is 30% higher than in individuals with normal blood glucose. The exact relationship is not yet known, but it is theorized that high blood glucose levels cause damage to the small blood vessels in the inner ear, similar to the way in which diabetes can damage the eyes and the kidneys.7


  1. Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther. 2008;88(11):1254-1264. doi:10.2522/ptj.20080020.
  2. Brownrigg JR, Apelqvist J, Bakker K, Schaper NC, Hinchliffe RJ. Evidence-based management of PAD & the diabetic foot. Euro J Vasc and Endovasc Surg. 2013;45(6):673-681. doi:10.1016/j.ejvs.2013.02.014.
  3. American Diabetes Association®. Frozen shoulder. American Diabetes Association website. Updated March 30, 2017. Accessed January 8, 2018.
  4. American Diabetes Association. Gastroparesis. American Diabetes Association website. Updated October 16, 2017. Accessed January 8, 2018.
  5. American Diabetes Association. Stroke. American Diabetes Association website. Updated June 10, 2014. Accessed January 8, 2018.
  6. Lee M, Saver JL, Hong KS, Song S, Chang KH, Ovbiagele B. Effect of pre-diabetes on future risk of stroke: meta-analysis. BMJ. 2012;344:e3564. doi:10.1136/bmj.e3564.
  7. American Diabetes Association. Diabetes and hearing loss. American Diabetes Association website. Updated October 4, 2017. Accessed January 8, 2018.

Wound Care Education Institute® provides online and onsite courses in Skin, WoundDiabetic and Ostomy Management. Eligible clinicians may sit for the prestigious WCC®, DWC® and OMS national board certification exams through the National Alliance of Wound Care and Ostomy®(NAWCO®). For details, see

DISCLAIMER: All clinical recommendations are intended to assist with determining the appropriate wound therapy for the patient. Responsibility for final decisions and actions related to care of specific patients shall remain the obligation of the institution, its staff, and the patients’ attending physicians. Nothing in this information shall be deemed to constitute the providing of medical care or the diagnosis of any medical condition. Individuals should contact their healthcare providers for medical-related information.

Nancy Collins, PhD, RDN, LD, NWCC, FAND

Nancy Collins, PhD, RDN, LD, NWCC, FAND, is a wound care-certified, registered dietitian nutritionist with expertise in wound care, malnutrition and medico-legal issues. She strives to improve patient outcomes and patient satisfaction through better communication. Learn more about her at

Related Posts

Trimming Those Tricky Diabetic Toenails

By WCEI Content Team

You are getting ready to trim your diabetic patients toenails. What exactly does that all involve? Well, first you need the proper tools for diabetic toenails. A set of toenail nippers, nail file, and orange stick are typically used. Always follow your facility or healthcare’s settings policy for infection control. Single use disposable equipment is […]

What is Charcot Foot?

By Diana Ramirez-Ripp

What is Charcot Arthropathy? Charcot foot, as it is commonly referred to, is a chronic progressive disease of the bone and joints found in the feet and ankles of our diabetic patients with peripheral neuropathy. What leads to this Charcot foot? Having long standing diabetes for greater than 10 years is one contributing factor. Having […]

What do you think?