Complications of diabetes (mainly type 1)

Hi everyone,

I know about the complications that come with being diabetic, but are these complications inevitable? Say I maintain an A1C under 7 for the rest of my life, exercise regularly and eat a proper diet- will I be able to avoid complications? I realize my pancreas doesn’t work, but my body still gets insulin.

Hi Laura,

The lower your A1c is the better. The closer to normal you can control BG, the less chance of complications. Daily numbers, without big swings between high & low, are important since an A1c is an average. Without logs of daily readings it’s hard to know how good an A1c really is, or if it’s good because the highs & lows are cancelling each other out.

A good diet & exercise help. There are no guarantees to not getting complications, but good control is our best shot. Injected insulin sure isn’t the same as a working pancreas. .

Hi Laura, doing the conversion you would be having an average Blood Sugar of 150 and it would be twice of what is a normal blood sugar of around 83-86 or A1C of 4.5 or 4.6. The higher the sugar level the greater the risks. Read Blood Sugar 101. That cleared up my thinking. One should strive to be in the 5’s. or 5% club for your A1C. Thats my target goal. I agree with Gerri too that your highs and lows are equally important. Good Luck

I agree with both Gerri and Pauly.
Don’t mind me. I get very direct sometimes. I started taking care of diabetes in other people in 1947. I’ve been known as a stickler for following the rules. The rules for avoiding complications have changed over time. Now, it’s:
Get your A1c below 6. From research, we know that there is still a percentage of those averaging 140 who get complications.
We also know that glucose causes simmering complications before we’ve even had a diagnosis.
Get rid of swings - those highs after a meal are not good for us; find a number of carb grams that never puts you above 140 after one hour and stick with it.
Use protein in every meal and snacking on a whim will be eliminated.
Know exactly what a gram puts you up. Do the numbers.
Increase the number of small meals if necessary to keep up weight.
We know that low cholesterol and less retinopathy go together.
Glad you shared the question that way.
There are a lot of us doing it with you! And none of us can promise anything. This is the best that research has given us.

I don’t know how that all works but after 34 years I have no complications and that was with the early years of no monitors and no pumps, no pens, just test urine. I never feel like I’m doing a good job and can swing from 32 to 400. It seems like I’m at 200 a lot and always have this horrible feeling I’m not in control BUT I also test a lot so as soon as it gets out of whack I can adjust. The problem with A1c is it is an average. If you are at 200 or 40 for 3 months you’ll average out at 120!! But we know that can’t be good. I agree with everyone, lower is better but you have to take into consideration the risk of dangerous lows. I can’t feel my lows coming on so it’s a real risk I take. Can’t remember all the way back but I think my A1c’s have always been around upper 5 to low 6 so I guess I fall into the “good control” for what ever reason. (Interesting fact; a normal BS used to be 130, then they changed it to 120 then 100 now they’r saying under 100! What the heck. So in 1976 if you read at 130 you’d be normal, now you’d be diabetic!) Eating right, exercising, and test like heck! Keeping that A1c as low as possible is definitely the way to go and to answer your question, complications are NOT inevitable. My Dr. has told me that if I’ve gone this long without complications, the chances are good I may never get them, at least not severely! Yaaa!!!

Nothing is inevitable. It is all in managing risk. The better you manage your diabetes, the lower your risk. Don’t forget even people without diabetes experience some of the same problems you’re concerned about (heart disease, circulatory problems, etc.) You might still wind up with complications even if you do very well in managing your diabetes, but the chances are much, much lower if you work hard at keeping your blood sugars low.

The A1C is a great measurement tool, but it’s only an average. If you’re over 200 1/2 the time and near 50 1/2 the time, you could still have a great A1C, but your control wouldn’t be very good. The key to good control is to minimize your time with a BG over about 150 and under 70. Both too high and too low are bad for you.

With that said, I’m 33 1/2 years T1 with no complications and I"ll be running my first marathon right after my 49th birthday this June. And when I started there was no BG testing, no A1C, and I only took 1 injection of Lente a day for many years, so you can be sure my control wasn’t always excellent. But I never went into extremely poor control. Once I started testing BG’s, pre-meal levels above 160 were rare. Now that I’m on the pump and testing 8+ times/day, I’m rarely over 160 even at my 2-hour post-meal tests. My A1C sticks around 6.0 (which is within the normal non-Diabetic range at my lab).

At your age, with current BG control methods, you should definitely be able to live a long healthy life with few, if any, complications directly related to T1.

I have 40 years w/o complications, other than a out a whack thyroid that is under control. The key for me has been an A1c of 6 or less and minimizing lows. Other helpful tools have been activity, MDIs, the pump and now he CGM.

Complications are not inevitable, but beating the odds is what I shoot for to be as “me” as I can be.

No, complications are not inevitable. They may not even be probable for the majority of Type 1s. No way to tell in advance, though, if you will develop complications. No way to tell in advance if you will suffer a heart attack unrelated to D either. You are on the right track. New advances in D care will hit the market, making D much easier to manage. Hang in there and I think you will be just fine! There are tight guidelines listed in some of the other posts you can strive to meet, but some of the guidelines are unattainable for some people. An A1c under 6 and postprandials under 140, I cannot meet these guidelines for my DN who is 12. We do have A1cs in the low 6s. We still try to get the postprandials down if she is home as much as possible. Get as close as you can. Then try to tighten up further as much as possible.

I can’t answer your question about complications being inevitable or not, but I can say that more important than a great A1C is a steady A1C (or at least steady BG numbers). Studies have shown that people with perfect A1Cs but wildly fluctuating BG numbers were at a much higher risk for complications than people with abysmal A1Cs but steady numbers. In other words, if you’re constantly swinging between 70 and 300 (for example) but spend most of your time in the high range (or low) you’re at greater risk than if you maintained a constant 300 all the time. Mind you that’s for complications down the road. DKA, a more immediate complication of high BG, is obviously a higher risk if you are constantly 300.
So the key is not just great A1Cs but steady numbers in the good range.

I do know what you mean though. I’ve heard doctors telling me about complications all my life as if they were inevitable (the percentages they give simply seem to high to believe otherwise) but I have heard very few people say that they have any complications (including some of the members here who’ve been diabetic for a very long time and especially those who were diabetic way before any of the technology we have today).

It might help to know that they’ve recently done a follow-up to the DCCT and found the incidence of complications after 30 years of type 1 in the intensively-controlled group to be MUCH lower than the percentages often cited. The incidence was well below 20% for each major complication, and the incidence of serious life-altering complications like kidney failure or blindness was only 1%. The numbers frequently cited (such as “90% of people will have retinopathy after 20 years” etc.) are from people who had type 1 back in the 50s and 60s when there were no glucose meters. Even the study just done with DCCT participants is on people who had diabetes in the 70s and 80s with technology that is crude compared to today’s tools. I think people who have been diagnosed since the 90s and especially those who have been diagnosed since the advent of long-acting and rapid-acting insulin analogues, pumps, and continuous glucose monitors will have an even lower incidence of complications.

A1C is a very good predictor of complications for large groups but not for individuals. There is always the D with 6% A1C who has complications and the other D with 8% A1C who does not have any complications. Improving A1C only improves the odds. I consider it worthwhile to aim for an A1C below 6%.

Let’s see…

Dx’d as T2 in July 09 at “only” 6.8.
Three months later 5.5
Pretty much never over 130, even better, always at or under 100 two hours after meals. Guaranteed I haven’t hit 200 but for my initial fasting glucose test, which was 220.
Morning fast numbers in the 80’s, some low 90’s
No meds, just lifting weights and walking several miles per day, but not anymore :frowning:
Dropped 30 lbs, now 209 at six foot tall.
BP at rest 110/65

Since first week of December 09, debilitating neuropathy from the tips of my toes, now up to my knees and still moving up, so I cannot walk more than a few feet at a time. Don’t even know how to get to the lab for scheduled A1c test on Tuesday.

Sorry if that is not positive, or uplifting information, or is upsetting, but its the truth.

Don’t believe everything you read…



Sorry for your bad luck. Don’t give up hope yet. Some nerve damage reverses. It might take a couple, three years. Keeping up your excellent bg control is your best bet.

Thanks Helmut,

I see no reason to keep up the good work. I realize it will never go away, and I cannot find a reason to bother caring anymore. Three years of this is too much. I don’t have anything to make me want to live that long this way. Its too hard to accept that even tho I -never- had very high BG, and have been well controlled for the seven months since I have known, I am basically disabled.

Kind of hard to find work when you can’t walk. Kind of hard to pay the bills when you have no income. Kind of hard to keep my house when I have no way to make the payment, and way to pay the doctor bills, and no way to pay for all the meds I now have to take.

I don’t see any good is just hanging around for three more years, so I can just be an old man with nothing, no money, and no home.

Thanks for the encouraging words, but I quit.


Thanks for all the information and shared experiences everyone!
It was really encouraging to hear that there are so many people who have lived with diabetes for years now with little or no complications. I guess all I can do is just keep up with the monitoring, adjusting and diet/exercise.
Thanks again, and I wish you all good health for the future!

I like to keep in mind that no one (diabetes or not) is free from risk of health complications or other potential accidents. Everyone could fear that their health would take a turn for the worst or that something horrible will happen. In the end, we should keep living, try to stay healthy, and don’t let worries about the future take over our ability to enjoy the present.

Keeping stable blood sugars is definitely worth it – not only will you give yourself the best chances for the future, you will feel the best in the PRESENT. So keep on doing your best!

Here, here.

That’s a good point Kristin, and it really helps to put things into perspective

I have had type 1 for 33 years with no major compilations. I believe that tight control and doing your best is part of the key. When the insulin pump came out in the early 1980’s I knew right away that it was for me and have been on the pump ever since. Don’t beat yourself over the head if you have a bad day as we all do.