Prevent Complications

Cardiovascular disease is the leading cause of early death among people with diabetes. Adults with diabetes are two to four times more likely than people without diabetes to die of heart disease or experience a stroke. Also, about 70% of people with diabetes have high blood pressure, a risk factor for cardiovascular disease.

See the following for more information:

• The Link Between Diabetes and Cardiovascular Disease from the National Diabetes Education Program
• Heart and Blood Vessel Problems from the CDC’s publication, Take Charge of Your Diabetes.

People with type 2 diabetes have high rates of cholesterol and triglyceride abnormalities, obesity, and high blood pressure, all of which are major contributors to higher rates of cardiovascular disease. Many people with diabetes have several of these conditions at the same time. This combination of problems is often called metabolic syndrome (formerly known as Syndrome X). The metabolic syndrome is often defined as the presence of any three of the following conditions: 1) excess weight around the waist; 2) high levels of triglycerides; 3) low levels of HDL, or "good," cholesterol; 4) high blood pressure; and 5) high fasting blood glucose levels. If you have one or more of these conditions, you are at an increased risk for having one or more of the others. The more conditions that you have, the greater the risk to your health.

To protect your heart and blood vessels, eat right, get physical activity, don’t smoke, and maintain healthy blood glucose, blood pressure, and cholesterol levels. Choose a healthy diet, low in salt. Work with a dietitian to plan healthy meals. If you’re overweight, talk about how to safely lose weight. Ask about a physical activity or exercise program. Quit smoking if you currently do. Get a hemoglobin A1C test at least twice a year to determine what your average blood glucose level was for the past 2 to 3 months. Get your blood pressure checked at every doctor’s visit, and get your cholesterol checked at least once a year. Take medications if prescribed by your doctor.

See the following for more information:

• Learn About Heart Disease from the Centers for Disease Control and Prevention (CDC)
• Heart Disease and Stroke Prevention
• Heart and Blood Vessel Problems from the CDC’s publication, Take Charge of Your Diabetes.
• Prevention of Diabetes Complications from the CDC’s National Diabetes Statistics Report
• Be Smart About Your Heart. Control the ABCs of Diabetes campaign from the National Diabetes Education Program
• Prevent Diabetes Problems: Keep Your Heart and Blood Vessels Healthy [PDF – 800KB], a fact sheet from the National Diabetes Information Clearinghouse

In diabetic eye disease, high blood glucose and high blood pressure cause small blood vessels to swell and leak liquid into the retina of the eye, blurring the vision and sometimes leading to blindness. People with diabetes are also more likely to develop cataracts – a clouding of the eye’s lens, and glaucoma – optic nerve damage. Laser surgery can help these conditions.

See the following for more information:

• Vision Health Initiative
• Diabetic Retinopathy, a professional journal article from the American Diabetes Association

There’s a lot you can do to prevent eye problems. A recent study shows that keeping your blood glucose level closer to normal can prevent or delay the onset of diabetic eye disease. Keeping your blood pressure under control is also important. Finding and treating eye problems early can help save sight.

It is best to have an eye doctor give you a dilated eye exam at least once a year. The doctor will use eye drops to enlarge (dilate) your pupils to examine the backs of your eyes. Your eyes will be checked for signs of cataracts or glaucoma, problems that people with diabetes are more likely to get.

Because diabetic eye disease may develop without symptoms, regular eye exams are important for finding problems early. Some people may notice signs of vision changes. If you’re having trouble reading, if your vision is blurred, or if you’re seeing rings around lights, dark spots, or flashing lights, you may have eye problems. Be sure to tell your health care team or eye doctor about any eye problems you may have.

See the following for more information:

• Eye Problems from the CDC’s publication, Take Charge of Your Diabetes.
• Prevent Diabetes Problems: Keep Your Eyes Healthy, a fact sheet from the National Diabetes Information Clearinghouse
• Vision Health Initiative

In diabetic kidney disease (also called diabetic nephropathy), cells and blood vessels in the kidneys are damaged, affecting the organs’ ability to filter out waste. Waste builds up in your blood instead of being excreted. In some cases this can lead to kidney failure. When the kidneys fail, a person has to have his or her blood filtered through a machine (a treatment called dialysis) several times a week, or has to get a kidney transplant.

See the following for more information:

• Basics about diabetes
• At risk for kidney disease?
• For people with diabetes or high blood pressure, get checked for kidney disease [PDF – 2.63MB]
• The National Kidney Disease Education Program Web site, raises awareness of the risks of kidney disease

There’s a lot you can do to prevent kidney problems. A recent study shows that controlling your blood glucose can prevent or delay the onset of kidney disease. Keeping your blood pressure under control is also important.

Diabetic kidney disease happens slowly and silently, so you might not feel that anything is wrong until severe problems have developed. Therefore, it is important to get your blood and urine checked for kidney problems each year.

Your doctor can learn how well your kidneys are working by testing every year for microalbumin (a protein) in the urine. Microalbumin in the urine is an early sign of diabetic kidney disease. Your doctor can also do a yearly blood test to measure your kidney function.

Go to the doctor if you develop a bladder or kidney infection; symptoms include cloudy or bloody urine, pain or burning when you urinate, an urgent need to urinate often, back pain, chills, or fever.

See the following for more information:

• Chronic Kidney Disease Initiative
• Keeping your kidneys healthy
• Staying healthy with diabetes

Having high blood glucose for many years can damage the blood vessels that bring oxygen to some nerves, as well as the nerve coverings. Damaged nerves may stop sending messages, or send messages too slowly or at the wrong times. Numbness, pain, and weakness in the hands, arms, feet, and legs may develop. Problems may also occur in various organs, including the digestive tract, heart, and sex organs. Diabetic neuropathy is the medical term for damage to the nervous system from diabetes. The most common type is peripheral neuropathy, which affects the arms and legs.

An estimated 50% of those with diabetes have some form of neuropathy, but not all with neuropathy have symptoms. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater the risk. The highest rates of neuropathy are among people who have had the disease for at least 25 years.

Diabetic neuropathy also appears to be more common in people who have had problems controlling their blood glucose levels, in those with high levels of blood fat and blood pressure, in overweight people, and in people over the age of 40.

See the following for more information::

• Nerve Damage from the CDC’s publication, Take Charge of Your Diabetes
• Diabetic Neuropathies: The Nerve Damage of Diabetes, a fact sheet from the National Diabetes Information Clearinghouse

You can help keep your nervous system healthy by keeping your blood glucose as close to normal as possible, getting regular physical activity, not smoking, taking good care of your feet each day (see below), having your health care provider examine your feet at least 4 times a year, and getting your feet tested for nerve damage at least once a year.

See the following for more information::

• Prevent Diabetes Problems: Keep Your Nervous System Healthy, a fact sheet from the National Diabetes Information Clearinghouse

Nerve damage, circulation problems, and infections can cause serious foot problems for people with diabetes. Sometimes nerve damage can deform or misshape your feet, causing pressure points that can turn into blisters, sores, or ulcers. Poor circulation can make these injuries slow to heal. Sometimes this can lead to amputation of a toe, foot, or leg.

See the following for more information:

• Foot Problems from the CDC’s publication, Take Charge of Your Diabetes
• Lower Extremity Amputation in People with Diabetes. Epidemiology and Prevention a professional journal article from the CDC

Look for cuts, cracks, sores, red spots, swelling, infected toenails, splinters, blisters, and calluses on the feet each day. Call your doctor if such wounds do not heal after one day.

If you have corns and calluses, ask your doctor or podiatrist about the best way to care for them.

Wash your feet in warm—not hot—water and dry them well.

Cut your toenails once a week or when needed. Cut toenails when they are soft from washing. Cut them to the shape of the toe and not too short. File the edges with an emery board.

Rub lotion on the tops and bottoms of feet—but not between the toes—to prevent cracking and drying.

Wear shoes that fit well. Break in new shoes slowly, by wearing them 1 to 2 hours each day for the first 1 to 2 weeks.

Wear stockings or socks to avoid blisters and sores.

Wear clean, lightly padded socks that fit well; seamless socks are best.

Always wear shoes or slippers, because when you are barefoot it is easy to step on something and hurt your feet.

Protect your feet from extreme heat and cold.

When sitting, keep the blood flowing to your lower limbs by propping your feet up and moving your toes and ankles for a few minutes at a time.

Avoid smoking, which reduces blood flow to the feet.

Keep your blood sugar, blood pressure, and cholesterol under control by eating healthy foods, staying active, and taking your diabetes medicines.

See the following for more information:

• Prevent Diabetes Problems: Keep Your Feet and Skin Healthy, a fact sheet from the National Diabetes Information Clearinghouse
• Feet Can Last a Lifetime: A Healthcare Provider’s Guide to Preventing Diabetes Foot Problems [PDF–388 KB], a publication of the National Diabetes Education Program
• Preventive Foot Care in People with Diabetes, a professional journal article from the American Diabetes Association

Gastroparesis, otherwise known as delayed gastric emptying, is a disorder where, due to nerve damage, the stomach takes too long to empty itself. It frequently occurs in people with either type 1 or type 2 diabetes.

Symptoms of gastroparesis include heartburn, nausea, vomiting of undigested food, an early feeling of fullness when eating, weight loss, abdominal bloating, erratic blood glucose levels, lack of appetite, gastroesophageal reflux, and spasms of the stomach wall.

See the following for more information:

• Gastroparesis and Diabetes, a fact sheet from the National Digestive Diseases Information Clearinghouse
• Prevent Diabetes Problems: Keep Your Nervous System Healthy, a fact sheet from the National Diabetes Information Clearinghouse

Because of high blood glucose, people with diabetes are more likely to have problems with their teeth and gums. And like all infections, dental infections can make your blood glucose go up. Sore, swollen, and red gums that bleed when you brush your teeth are a sign of a dental problem called gingivitis. Another problem, called periodontitis, happens when your gums shrink or pull away from your teeth.

People with diabetes can have tooth and gum problems more often if their blood glucose stays high. Also, smoking makes it more likely for you to get a bad case of gum disease, especially if you have diabetes and are age 45 or older.

People with diabetes are also prone to other mouth problems, like fungal infections, poor post-surgery healing, and dry mouth.

See the following for more information::

• Dental Disease from the CDC’s publication, Take Charge of Your Diabetes
• Diabetes and Oral Health from the National Institute of Dental and Craniofacial Research

You can help maintain your oral health by keeping your blood glucose as close to normal as possible, brushing your teeth at least twice a day, and flossing once a day. Keep any dentures clean. Get a dental cleaning and exam twice a year, and tell your dentist that you have diabetes. Call your dentist with any problems, such as gums that are red, sore, bleeding, or pulling away from the teeth; any possible tooth infection; or soreness from dentures.

See the following for more information: Prevent Diabetes Problems: Keep Your Teeth and Gums Healthy from the National Institute of Dental and Craniofacial Research

Many people with diabetic nerve damage have trouble having sex. For example, men can have trouble maintaining an erection and ejaculating. Women can have trouble with sexual response and vaginal lubrication. Both men and women with diabetes can get urinary tract infections and bladder problems more often than average.

See the following for more information:

• Nerve Damage from the CDC’s publication, Take Charge of Your Diabetes
• Sexual and Urologic Problems of Diabetes, a fact sheet from the National Kidney and Urologic Diseases Information Clearinghouse

Several studies suggest that diabetes doubles the risk of depression, although it’s still unclear why. The psychological stress of having diabetes may contribute to depression, but diabetes’ metabolic effect on brain function may also play a role. At the same time, people with depression may be more likely to develop diabetes.

The risk of depression increases as more diabetes complications develop. When you are depressed, you do not function as well, physically or mentally; this makes you less likely to eat properly, exercise, and take your medication regularly.

Psychotherapy, medication, or a combination of both can treat depression effectively. In addition, studies show that successful treatment for depression also helps improve blood glucose control.

See the following for more information:

• Feeling About Having Diabetes from the CDC’s publication, Take Charge of Your Diabetes

Being sick by itself can raise your blood glucose. Moreover, illness can prevent you from eating properly, which further affects blood glucose.

In addition, diabetes can make the immune system more vulnerable to severe cases of the flu. People with diabetes who come down with the flu may become very sick and may even have to go to a hospital. You can help keep yourself from getting the flu by getting a flu shot every year. Everyone with diabetes—even pregnant women—should get a yearly flu shot. The best time to get one is between October and mid-November, before the flu season begins.

See the following for more information:

• Diabetes and the Flu

Be sure to continue taking your diabetes pills or insulin. Don’t stop taking them even if you can’t eat. Your health care provider may even advise you to take more insulin during sickness.

Test your blood glucose every four hours, and keep track of the results.

Drink extra (calorie-free) liquids, and try to eat as you normally would. If you can’t, try to have soft foods and liquids containing the equivalent amount of carbohydrates that you usually consume.

Weigh yourself every day. Losing weight without trying is a sign of high blood glucose.

Check your temperature every morning and evening. A fever may be a sign of infection.

Call your health care provider or go to an emergency room if any of the following happen to you:

• You feel too sick to eat normally and are unable to
  keep down food for more than 6 hours.
• You’re having severe diarrhea.
• You lose 5 pounds or more.
• Your temperature is over 101 degrees F.
• Your blood glucose is lower than 60 mg/dL or
  remains over 300 mg/dL.
• You have moderate or large amounts of ketones in
  your urine.
• You’re having trouble breathing.
• You feel sleepy or can’t think clearly.

See the following for more information:

• Sick days
• Taking Care of Your Diabetes at Special Times: When You Are Sick from the National Diabetes Information Clearinghouse fact sheet, Your Guide to Diabetes: Type 1 and Type 2