In the advanced stages, diabetes often manifests with the following symptoms:

1. Chronic Non-Healing Wounds (Diabetic Ulcers):

   • High blood sugar damages blood vessels and nerves, impairing circulation and the body's ability to heal wounds.
   • Symptoms include open sores, especially on the feet (diabetic foot ulcers), which can lead to infections and even amputations if untreated.

2. Severe Fatigue:

   • Persistent high blood sugar levels disrupt energy metabolism, leaving patients feeling weak and fatigued.
   • Fatigue may also result from complications such as anemia, kidney dysfunction, or cardiovascular issues.

3. Kidney Failure (Diabetic Nephropathy):

   • Diabetes is a leading cause of kidney disease. In advanced stages, the kidneys lose their ability to filter waste, resulting in swelling (edema), high blood pressure, and reduced urine output.
   • Symptoms include foamy urine, fluid retention, and a general feeling of unwellness.

4. Vision Loss (Diabetic Retinopathy):

   • Prolonged high blood sugar damages the blood vessels in the retina, leading to vision problems such as blurriness, dark spots, or even blindness.
   • Advanced stages of retinopathy can involve retinal detachment or glaucoma.

5. Severe Neuropathy (Nerve Damage):

   • Nerve damage caused by diabetes can result in severe pain, numbness, or tingling in the extremities (hands and feet).
   • Autonomic neuropathy may also affect organs, causing digestive issues, sexual dysfunction, and irregular heartbeats.

These symptoms indicate that diabetes has caused widespread damage to multiple organ systems, requiring immediate medical attention.

---

2. Why Do These Symptoms Develop?

Advanced diabetes symptoms result from prolonged exposure to high blood sugar levels, which lead to:

• Blood Vessel Damage: Hyperglycemia damages small and large blood vessels, reducing blood flow to critical organs and tissues.
• Nerve Damage: Persistently high blood sugar interferes with nerve function, leading to pain, numbness, or organ dysfunction.
• Weakened Immunity: Diabetes impairs the immune system, making it harder for the body to fight infections.
• Chronic Inflammation: Systemic inflammation exacerbates tissue damage and accelerates disease progression.

---

3. Risks Associated with Advanced Diabetes

The final stage of diabetes carries significant risks, including:

• Amputations: Non-healing wounds and severe infections can necessitate limb amputations, reducing mobility and quality of life.
• End-Stage Kidney Disease (ESKD): Without treatment, kidney failure may require dialysis or transplantation.
• Blindness: Vision loss can be irreversible if diabetic retinopathy is not treated early.
• Heart Disease and Stroke: Advanced diabetes increases the risk of heart attacks and strokes due to vascular damage.
• Premature Death: Untreated complications can lead to multi-organ failure, significantly reducing life expectancy.

---

4. Preventing the Progression to Advanced Diabetes

Preventing the onset of advanced diabetes involves proactive management and lifestyle changes:

1. Blood Sugar Control:

   • Monitor blood sugar levels regularly and follow your doctor’s recommendations for medication, diet, and exercise.
   • Aim for an HbA1c level below 7% (or as advised by your healthcare provider).

2. Regular Medical Checkups:

   • Schedule routine screenings for complications such as kidney function tests, eye exams, and foot checks.
   • Early detection of complications can prevent irreversible damage.

3. Healthy Diet:

   • Focus on a balanced diet rich in whole grains, lean proteins, healthy fats, and non-starchy vegetables.
   • Limit sugar, refined carbohydrates, and processed foods.

4. Exercise:

   • Engage in regular physical activity, such as walking, cycling, or strength training, to improve blood sugar control and cardiovascular health.

5. Quit Smoking and Limit Alcohol:

   • Smoking and excessive alcohol consumption worsen diabetes complications and should be avoided.

6. Mental Health Support:

   • Living with diabetes can be stressful. Seek support from healthcare providers, counselors, or support groups to manage emotional well-being.

---

5. When to Seek Immediate Medical Attention

If you or someone you know experiences the symptoms of advanced diabetes, seek medical help immediately. Delayed intervention increases the risk of severe complications and decreases the chances of recovery.

Signs that require urgent attention include:

• Persistent wounds that do not heal.
• Sudden vision changes or blindness.
• Severe swelling or reduced urine output.
• Unexplained, debilitating fatigue.
• Uncontrolled pain or numbness in the extremities.