Key points
- Early eye, kidney and nerve damage usually causes no symptoms, so screening matters more than waiting for warning signs.
- Get a dilated eye exam, kidney tests (urine albumin and eGFR) and a foot check at least once a year.
- Bringing down sugar, blood pressure and cholesterol, and not smoking, lowers the risk of every complication.
- Look at your feet every day. Walking barefoot, cracked heels and hot surfaces are real risks in India.
Nobody likes reading about complications. But here is the hopeful part: complications are not inevitable, and the earlier a problem is found, the more can be done. A blocked foot wound caught in week one is a different story from one found in week six. A five-minute eye photo can save sight.
Why complications happen
Over years, high blood sugar damages the walls of blood vessels and the nerves they feed. Small vessels in the eyes, kidneys and nerves are affected first ("microvascular" complications). Large arteries to the heart, brain and legs are affected too, especially when high blood pressure, high cholesterol or smoking are added ("macrovascular" complications). This is why diabetes care is about more than sugar.
Your yearly screening checklist
These are based on the ADA Standards of Care 2026 for adults with type 2 diabetes. Your doctor may test more often if a problem is found.
| Check | Test | How often |
|---|---|---|
| Eyes | Dilated eye exam by an eye specialist, or retinal photographs | At diagnosis, then every 1–2 years if normal; at least yearly if any damage is found |
| Kidneys | Urine albumin-to-creatinine ratio (UACR) and eGFR from a blood creatinine | At least once a year |
| Feet | Full foot exam, including a monofilament test for sensation and checking pulses | At least once a year; at every visit if you are at high risk |
| Blood pressure | BP measurement | At every visit; many adults aim for below 130/80 |
| Cholesterol | Lipid profile | At diagnosis, then as your doctor advises |
| Mouth | Dental check-up | Every 6–12 months |
A practical tip: pick one month a year, perhaps your birthday month, and book all of these together. It is easier to remember than tracking separate dates.
Eyes: diabetic retinopathy
Diabetic retinopathy is damage to the tiny blood vessels at the back of the eye. In early stages there are no symptoms at all; vision can be perfect. Later, vessels can leak or bleed, and new fragile vessels can grow. Swelling at the centre of the retina (macular oedema) blurs reading vision.
Treatment such as laser and injections into the eye can stop or slow damage, which is why catching it early matters so much. Diabetes also raises the risk of cataract and glaucoma.
Note that blurred vision in the first weeks of starting treatment, when sugar is coming down quickly, is common and usually settles. Hold off buying new glasses until your sugar is stable.
Kidneys: diabetic kidney disease
Diabetes is one of the leading causes of kidney failure in India. The first sign is usually albumin, a protein, leaking into the urine, long before any swelling or tiredness. That is why the urine albumin test (UACR) is done even when you feel completely well. A UACR of 30 mg/g or more, confirmed on repeat, suggests kidney damage.
What protects the kidneys:
- Good control of blood sugar and especially blood pressure.
- Medicines your doctor may add for kidney protection, such as an ACE inhibitor or ARB for blood pressure, and an SGLT2 inhibitor.
- Not smoking.
- Avoiding regular use of painkillers like ibuprofen or diclofenac without your doctor's advice, as these can strain the kidneys.
Nerves and feet: neuropathy
Diabetic nerve damage usually starts in the toes and moves upward, in a "stocking" pattern. People describe tingling, burning, pins and needles, or a feeling of walking on cotton wool. Some feel nothing at all, and that is the dangerous part: a pebble in the shoe or a burn from hot sand can go unnoticed.
A small cut on a numb foot, combined with poor circulation and high sugar, can turn into an ulcer and infection. Diabetic foot problems are a leading cause of amputation, and most of these begin with a wound that could have been prevented or treated early.
Nerve damage can also affect the stomach (bloating, vomiting), bladder, sexual function, sweating and blood pressure on standing.
Daily foot care, Indian edition
International foot care guidelines are written for people who wear closed shoes most of the day. Life in India is different: we walk barefoot at home, at temples and gurdwaras, on hot terraces and beaches, and slippers are the default footwear for much of the year. Here is what that means for you:
- Look at both feet every day, including the soles and between the toes. Use a mirror on the floor, or ask a family member, if you cannot bend easily.
- Avoid walking barefoot, even indoors. Keep a pair of soft indoor slippers by the bed. On temple visits, step carefully, avoid hot stone in the afternoon, and check your feet afterwards.
- Protect from heat. Hot roads, sand, terraces and heaters can burn numb feet without pain. Test bath water with your elbow, not your foot.
- Choose footwear with a back strap and a cushioned sole rather than thin rubber slippers. New shoes should be worn for short periods first.
- Moisturise cracked heels daily, but not between the toes, where moisture encourages fungal infection.
- Do not cut corns yourself or use acid corn caps or blades. See a doctor or podiatrist.
- Cut nails straight across and file the edges. If your eyesight or reach is poor, ask for help.
- Dry your feet well after washing, especially between the toes, which tends to get missed in a humid monsoon.
Heart and blood vessels
Heart disease is the most common cause of death in people with diabetes. In diabetes, a heart attack may not cause classic chest pain; it may show up as breathlessness, sweating, nausea or unusual tiredness. Stroke and poor circulation to the legs are also more common.
The same things protect the heart that protect everything else: controlling blood pressure and cholesterol (most adults with diabetes over 40 are advised a statin), staying active, not smoking, and good sugar control. Some diabetes medicines also directly protect the heart; see our guide to diabetes medicines.
Gums, infections and other effects
- Gum disease is more common and can make sugar harder to control. Bleeding gums deserve a dental visit.
- Infections such as urine infections, boils, fungal skin infections and TB are more common. Get fevers checked rather than waiting.
- Fatty liver often goes with type 2 diabetes and is improved by weight loss.
- Hearing, mood and memory can also be affected. Mention changes to your doctor.
- Vaccines against flu, pneumococcus and hepatitis B are generally recommended for adults with diabetes; ask your doctor.
When to see a doctor quickly
- Any foot wound, blister or crack that does not start healing within a few days, or any wound with redness, swelling, pus or a bad smell.
- A foot that is suddenly hot, red and swollen, even without pain, or skin that turns blue or black.
- Sudden loss of vision, a curtain over your sight, or a shower of new floaters.
- Swelling of the feet or face, or passing much less urine.
- Chest pain, breathlessness, sweating, or weakness on one side of the body. Call 112.
Questions to ask your doctor
- When were my last eye, kidney and foot checks, and when are the next ones due?
- What were my UACR and eGFR results?
- Is my foot risk low, moderate or high?
- What are my blood pressure and cholesterol targets?
Frequently asked questions
Can diabetic eye damage be reversed?
Early changes can stabilise or improve when sugar, blood pressure and cholesterol are controlled, and treatments such as laser and eye injections can stop further damage. Vision already lost cannot always be restored, which is why yearly screening matters.
Which kidney test is most important in diabetes?
Two tests work together: the urine albumin-to-creatinine ratio (UACR), which picks up early leaks of protein, and eGFR from a blood test, which shows how well the kidneys filter. Both are recommended at least once a year.
Why do my feet burn at night?
Burning, tingling or pins and needles that is worse at night is a common sign of diabetic nerve damage. Other causes, such as low vitamin B12 (which can happen with long-term metformin) or thyroid problems, should be checked. Tell your doctor; there are treatments that help.
Can I walk barefoot if I have diabetes?
It is best avoided, even indoors, especially if you have reduced feeling in your feet. If you must go barefoot, for example at a temple, avoid hot surfaces and check your feet carefully afterwards.
Sources
- American Diabetes Association Professional Practice Committee. 12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2026. Diabetes Care 2026;49(Suppl 1).
- American Diabetes Association Professional Practice Committee. 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026. Diabetes Care 2026;49(Suppl 1).
- American Diabetes Association Professional Practice Committee. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026. Diabetes Care 2026;49(Suppl 1).
- Bus SA, et al. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev 2024;40(3):e3651.
- Anjana RM, et al. Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). Lancet Diabetes Endocrinol 2023;11(7):474–489.
This article is general information for adults in India and is not a diagnosis or a treatment plan. Always discuss results and any changes with your own doctor. Read our editorial policy.