# Symptoms and stages of diabetes with severe complications
Diabetes with severe complications does not progress in strict 'stages' like some other diseases. Instead, complications usually develop gradually alongside each other — some after years, others sooner — and they influence each other. This tab describes how these complications usually announce themselves, how they feel and what they mean in daily life.
Early signs: when complications begin to appear
Many complications begin without you noticing anything. This is why regular check-ups are important — blood tests, eye examinations, foot checks — to catch early changes before they become noticeable.
**Kidney damage (early stage)** can go unnoticed for years. Initially there are usually no symptoms; only blood tests (protein in urine, kidney function) show that the kidneys are changing. Only when kidney function decreases significantly do people notice symptoms such as fatigue, poor appetite or swollen ankles.
**Eye damage (early stage)** also begins without symptoms. Small blood vessels in the retina can start leaking or becoming blocked, visible on an eye examination, but your eyesight can feel normal for a long time. Only later may vague blurs in your visual field or loss of sharpness occur.
**Nerve damage (early stage)** usually starts in the feet: tingling, prickling or numbness that come and go. Many people only notice this when they walk barefoot or when they wake up in the morning.
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Stage 1: Beginning organ damage (without major complaints)
In this stage, many people have no complaints yet, but examinations show changes.
What happens
High blood sugar gradually damages fine blood vessels and nerves. This process usually begins years after diabetes started, but can accelerate rapidly if blood sugar is not well controlled or remains uncontrolled.
**Kidney changes:**
- Protein appears in the urine (microalbuminuria or macroalbuminuria)
- Kidney function gradually declines; blood tests (creatinine, estimated GFR) show this
- No noticeable symptoms; sometimes only fatigue that you attribute to other things
**Eye changes:**
- Small bleeds or fat deposits in the retina (visible on examination)
- Visual field still normal; you don't notice anything
**Nerve damage (peripheral, in limbs):**
- Tingling, prickling or 'numbness' in feet or toes, sometimes also hands
- Temperature sensation diminished (you feel heat or cold less well)
- Muscles feel weaker in feet
- Ankle tendons can become stiffer
**What this means for daily life: **
- For many people everything still feels normal; they only sometimes notice prickling
- Shoe choice may become more cautious (soft shoes, good fit becomes important)
- Possibly more attention to foot hygiene (nails, wounds)
- Regular check-ups (blood, urine, eyes, feet) become routine
Figures on this stage
Studies show that diabetic kidney disease can develop years after diabetes diagnosis. In Type 2 diabetes, approximately 20-30% at population level eventually develop kidney complications, but this depends heavily on blood sugar control, blood pressure and heredity. The speed varies greatly from person to person.
*Source: "Prevalence, Incidence and Mortality of Chronic Kidney Disease in Type 1 and Type 2 Diabetes — A Nationwide Danish Register-Based Cohort Study" (2026)*
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Stage 2: Moderate complications (noticeable complaints)
In this stage, complications become truly noticeable; they limit daily life and require more care.
Moderate kidney disease
**Symptoms:**
- Fatigue that persists and does not go away
- Poor appetite, nausea (especially in the morning)
- Swollen feet, ankles, hands (morning swelling)
- Itching that won't go away, especially in the evening
- Sometimes headaches
- More trips to the toilet at night; more frequent bathroom breaks during the day
**What this means for daily life: **
- Work or housework becomes difficult due to fatigue
- Eating pattern changes; certain foods feel heavy
- Feet and hands swollen; shoes fit differently, rings become tight
- Sleep disturbed by nighttime toilet visits
- Doctor visits more frequent; blood and urine samples regularly
Moderate eye damage (diabetic retinopathy)
**Symptoms:**
- Blurred vision, more specifically: vague streaks or black dots in vision
- Sometimes sudden flashes of light
- Harder to see sharply; colours seem paler or more yellow
- Visual field becomes funnel-shaped in corners
**What this means for daily life: **
- Reading and detailed work become more difficult
- Driving may feel unsafe; more difficulty with traffic
- Watching television, using mobile feels more strenuous
- More worries; eye checks become frequent
- Possibly first sign that you need to address blood sugar more urgently
Moderate nerve damage (diabetic neuropathy)
**Symptoms:**
- Feet feel numb or 'dead': you feel pricks, heat or cold less well or not at all
- Pain, burning sensation in feet and lower legs (especially in the evening/at night)
- Balance disturbed; less certain walking, risk of falling
- Muscle fatigue in legs
- Erectile problems (men), reduced sensitivity (women)
- Stomach complaints: feeling full after small meal, nausea
- Dizziness on standing (blood pressure drop)
**What this means for daily life: **
- Walking becomes more cautious; comfortable shoes essential
- Sleep disturbed by foot pain; pain relief needed
- Fear of falling increases; house may be rearranged differently
- Sexual functioning limited; can be relationally difficult
- Climbing stairs, housework feels riskier
- Foot care becomes critical: you don't always feel wounds
Cardiac consequences that become noticeable
**Symptoms:**
- Shortness of breath during exertion
- Fatigue sooner
- Pain or pressure on chest, sometimes feeling subtle
- Irregular heartbeat, pounding
- Legs or feet swollen
**What this means for daily life: **
- Able to do less without getting out of breath
- Climbing stairs, walking becomes more strenuous
- Quality of life suddenly feels smaller
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Stage 3: Severe complications (major daily impact)
At this stage, complications significantly limit daily life and require intensive care.
Severe kidney disease (kidney failure/kidney insufficiency)
**Symptoms:**
- Severe, persistent fatigue
- Severe nausea and vomiting
- Loss of appetite; food tastes strange
- Bad taste in mouth
- Severe itching
- Swollen face, feet, hands
- Shortness of breath
- Difficulty concentrating; 'brain fog'
- Possible accumulating fluid retention
**What this means for daily life: **
- Stopping work is often necessary; many people can no longer work
- Household chores largely impossible
- Hospital visits frequent
- Dialysis may begin: 3x per week at least 4 hours on the machine, or home dialysis every day
- Strict diet (little salt, potassium, phosphate, fluid restriction)
- Medication list grows; many tablets per day
- Uncertainty about the future increases
**Warning:** At this moment kidney transplantation (transplant) becomes an option to discuss with your healthcare provider, if you are suitable for it. This can improve quality of life, but is not possible for everyone.
Severe eye damage (advanced diabetic retinopathy, possible glaucoma)
**Symptoms:**
- Severe blurred vision; sometimes sudden blindness in one eye
- Large blind spots in visual field
- Light feels painful
- Visual field restricted to the periphery
- Colors unrecognizable
- Night vision nearly impossible
**What this means for daily life: **
- Driving impossible
- Reading only with strong aids or not at all
- Risk of falls greater; moving more carefully
- Independence severely limited
- Possible institutional care needed
- More dependent on others for daily tasks
Severe nerve damage and foot problems
**Symptoms:**
- Large feet are numb; you feel nothing at all
- Burning pain that worsens at night
- Severe muscle weakness in legs; difficult to walk
- Balance severely disrupted; high risk of falls
- Foot ulcers (open wounds): start small, can become deep, easily infected
- Infections can become serious (cellulitis, osteomyelitis)
- Sometimes necessary: amputation of toe, foot or part of leg
**What this means for daily life: **
- Walking possible only with aids (crutch, walker, wheelchair)
- Foot care professional; cannot be done yourself
- Wound care intensive; frequent hospital visits
- High infection risk; fever, redness, pus must be checked urgently
- Fear of amputation is real
- Institutional care regularly needed
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Stage 4: Terminal kidney disease and multiple organ failure
In this stage, multiple organs no longer function; the situation is serious and requires intensive medical care.
End-stage kidney disease
**Symptoms:**
- Dialysis has become essential (no longer optional)
- Severe poisoning felt: confused mind, restlessness, possible delirium
- Irregular heart rhythm, risk of cardiac arrest
- Severe blood pressure problems
- Eating almost impossible; everything feels toxic
- Possible coma threatening
**What this means for daily life: **
- Completely dependent on dialysis 3-6 hours, 3 times per week, or continuous at home
- Virtually no independence left
- Hospital is second home
- Supportive care 24/7 needed
Combination of multiple organ complications
At this point, kidneys, eyes, nerves and heart are all functioning poorly:
**Symptoms:**
- Everything from previous stages at the same time, but worse
- Heart failure with shortness of breath
- Kidney failure with poisoning
- Blindness or near-blindness
- Inability to function independently
- Possible sepsis (blood poisoning) from foot infection
- High risk of stroke, heart attack
**What this means for daily life: **
- Hospital admission regularly
- Palliative care (comfort, pain relief) takes priority
- Family intensively involved
- Quality of life severely limited
- Conversations with doctor about what you still want and expect
Figures on serious complications
In large population studies, the risk of dialysis or transplant increases