If your diabetes is well managed and you look after your general health, you can significantly reduce your risk of diabetes-related complications. However, high glucose levels in your blood over a long period of time can cause damage to your large and small blood vessels and nerves, and this puts you at a greater risk of developing complications. The most common complications of diabetes relate to problems with your heart, eyes, mouth, hearing, and kidneys, as well as issues with your circulation and the feeling in your 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.

Frozen shoulder, known medically as ‘adhesive capsulitis’

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 of an older age
• Have had a heart attack, or who have the microvascular complications of diabetes
• Have retinopathy and nephropathy
• Have a shoulder injury, surgery, inflammatory conditions, or 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.

Stiff hand syndrome known medically as ‘diabetic cheiroarthropathy’

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 you have diabetes the greater the risks of developing this. It is caused by blockages in your small blood vessels. If you have problems such as nephropathy (kidney disease) or retinopathy (eye disease) you are at higher risk of getting this condition.

Keeping your blood glucose level as close to your target range as possible can help to reduce your risk; however, once you have the damage 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.

Trigger finger, known medically as ‘Stenosing Tenosynovitis’

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 (nerve damage). Other risk factors include repetitive hand movements and rheumatoid arthritis.  

Treatments include:

• Rest
• Splinting 
• Steroid injections
• Surgery

Hammertoe

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

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

Reduce your risks of foot problems:

• Keep your glucose, cholesterol, and blood pressure in your target ranges
• Attend an annual diabetes foot examination to identify problems early and find out how to care for your 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:

• The FootForward website
• Your podiatrist.

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 you have lived with diabetes and if you 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. Do make sure you are looking after your diabetes by attending your annual cycle of care and all your health checks.

If you have questions about anything raised in this article, you can call the NDSS helpline on 1800 637 700 and ask to receive a call back from a credentialled diabetes educator, an accredited practicing dietitian, or an accredited exercise physiologist.

For more information see the Diabetes Related Complications fact sheet.

By Monica McDaniel-Wong, Credentialled Diabetes Educator