Diabetes: The Basics—Reducing Risks

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Diabetes: The Basics - Reducing Risks

Table of Contents

  1. Reducing Risks of Complications
  2. Tests That Show Diabetes Control
  3. Foot Care
  4. Illness and Sick Days

Reducing Risks for Diabetes Complications

People who have diabetes can live long and healthy lives. It is true that there are many long term health problems or complications that can happen to people as a result of diabetes. However, it is also true that diabetes complications can be prevented. By knowing how to reduce risks, you have a good chance of avoiding complications and staying healthy throughout your life. Why do complications happen? Diabetes complications happen when blood sugar is high for a long periods of time. The high levels of sugar damage the body especially the blood vessels and the nerves. Many people with diabetes also have high blood pressure and high cholesterol in their blood. Each of these conditions can damage the body by themselves. When they are combined with high blood sugar, the damage can happen sooner and can be more serious.

What are the most common diabetes complications?

Eye Problems

Diabetes can cause problems in the tiny blood vessels in the eyes. This damage is called diabetic retinopathy. These blood vessels can become weak and can bleed. The person might have no warning signs until vision is already blurred. If not treated, diabetic retinopathy can lead to permanent loss of vision. Diabetes can also cause other eye diseases such as cataracts and glaucoma, heart attack, stroke and blood vessel problems. Diabetes can damage the large blood vessels in the body causing blockages. This can lead to heart attack and stroke as well as poor circulation in the legs and feet.

Kidney Problems

Diabetes can damage the small blood vessels running through the kidneys. This damage is called nephropathy. In the early stages, damaged kidneys do not filter everything out of the urine very well so the urine contains protein. In late stages, the kidneys are so damaged the person needs to have dialysis or a kidney transplant to live.

Problems with the Nerves

The nerves all over the body can be damaged by diabetes. This damage is called neuropathy. When the nerves to the feet or hands are damaged, the person can feel tingling, numbness or pain in the feet or hands. Nerves can also be damaged in the stomach and intestines, heart, lungs, bladder or sex organs, causing problems with the function of these parts of the body.

Foot Problems

Damage to the blood vessels and the nerves can lead to major problems in the feet. A small cut or blister may not heal well because of poor circulation and can then become infected. If the feet are numb, the person may not know anything is wrong until the infection is very deep and hard to heal. If untreated, this can lead to amputation.

Gum Disease

High blood sugar levels can also lead to gum disease leading to infections in the mouth and loss of teeth.

How can these complications be prevented?

To reduce the risks for diabetes complications, you can keep your blood sugar, blood pressure, and cholesterol as close to normal as possible. Do not smoke. Smoking can damage circulation by itself and it makes the damage for high blood sugar even worse. See your diabetes doctor for a check up every 3 to 6 months. Your blood pressure and A1C should be checked at every diabetes visit. Every year, your diabetes doctor should check your cholesterol level and also check your urine for protein. At least once a year, get your eyes checked by an eye doctor called an ophthalmologist. You need to have a dilated eye exam so the eye doctor can see the blood vessels in the eyes. Check your own feet regularly and see a foot doctor if there are any problems. At least every year, have a complete foot exam done by a podiatrist or your diabetes doctor. See your dentist to have your teeth and gums checked at least every 6 months. If any of these check ups show that diabetes complications are beginning to develop, talk with the doctor who found the problem about what you can do. Diabetes complications usually develop gradually. If you have early diabetes complications, you will probably be able to do something to keep the problem from getting worse.

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Tests that Show Diabetes Control

Why do I have to have so many tests?

Diabetes is a complicated disease. Over time, diabetes can cause changes in your heart, blood vessels, kidneys and nerves. The more you and your health care team know about your body, the easier it is to treat your diabetes. Some of these tests tell whether your blood glucose and cholesterol are in control. Some tell whether you have early signs of diabetes complications. You and your health care team can use these tests to decide if you need to change your medicines, insulin or diet.

Common Tests

Blood Glucose

Everyone with diabetes should test their own blood glucose at home. This tells you what your blood glucose is right away. Knowing your blood glucose level can help you make decisions about food and exercise everyday. If you don%27t know how often to test your own blood glucose, ask your doctor or diabetes educator.

Guidelines for Good Control of Blood Glucose are:

  • Fasting & Before Meals - under 110 mg/dl (desolator)
  • 1-2 hours after a meal - under 140mg/dl (desolator)
  • At bedtime - between 110-140 mg/dl (desolator)

Hemoglobin A1C or HBA1C or simply A1C

This test shows what your blood glucose has been over the last 3 months. It gives the health care team information so you can plan for the next step in your diabetes care. This test should be done about every 3-6 months.

Micro Albumin

This is a urine test to check how your kidneys are working. It checks for small amounts of protein in your urine which is an early sign of kidney damage. It should be done once a year. If a kidney problem is found early, it can be treated.

Lipid Profile

This blood test checks the amount and types of fat in your blood. It checks total cholesterol, Hdl or good cholesterol, ldl or bad cholesterol and triglycerides. Keeping these fats at healthy levels can help you reduce your risk for diabetes complications. You should have a lipid profile once a year. Of all the fats measured in the lipid profile, the most important one is ldl cholesterol. That should be less than 110mg/dl(desolator). It is also good if these levels are met. Hdl cholesterol over 50 mg/dl (desolator) and triglycerides less than 150mg/dl (desolator).

Eye Exam

People with diabetes need to see an eye doctor or ophthalmologist every year for a dilated eye exam. The doctor will use eye drops to dilate or open the pupil and will use a special machine to see in the back of the eye. People with diabetes can get damage to the blood vessels in the back of the eye. This damage is called retinopathy. If the doctor finds retinopathy early, it can be treated so the damage will stop. If retinopathy is left untreated, it can cause blindness. If you don%27t have an eye doctor, you can ask your doctor or diabetes educator to help you find one.

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Foot Care

Over time, diabetes can damage many parts of the body. When you blood sugar is higher than normal on a regular basis, you have a greater chance of damage to the nerves and blood vessels in your legs and feet. This can lead to many different problems. Neuropathy is the name for nerve damage to the legs and feet cause by high blood sugar levels. It might cause pain, burning or tingling in your feet. These feelings may be worse at night while resting. Your feet may also feel numb. If your feet are numb, you may not be able to feel pain, heat or cold. If you do not have a lot of feeling in your feet, you may not know that you have a cut, blister or burn on your foot. It could get worse and become infected. Talk to your doctor if you have pain, burning, tingling or numbness in your feet. There are special pain medicines that may help. Peripheral Vascular Disease or PVD is the name for damage to the small blood vessels to the legs and feet. This causes poor blood flow which makes it harder for a sore or infection to heal. If you have PVD, you may have some of these symptoms in your feet and legs - coldness, swelling or changes in skin color that make them look pale white, red, blue or purple. You might feel while walking or even at night while you are resting. Smoking can also cause PVD and make it worse. Talk to your doctor if you notice these changes. Supervised exercise, medicine and sometimes surgery may help PVD.

Do these things to keep your feet healthy: Stop smoking. Keep blood sugar levels in your target range as much as you can. Wash your feet everyday with warm water and mild soap. Then gently pat your feet dry. Always dry between your toes. Rub a lotion on your feet everyday but never put the lotion between the toes or over breaks in the skin. Look at the tops, bottoms, and sides of your feet everyday. If you see red areas, blisters, cuts, scratches, bruises, or changes in the shape of your feet that stay for more than one or two days, call your doctor. Do not wait. Wear socks or stockings without bulky seams at the toes. Make sure the elastic at the top of the sock is not too tight. Always wear shoes and socks. Shoes made out of leather or canvas are best. Wear shoes or slippers inside your house. Be sure they have a sole that will protect your feet so nothing can poke through. When you visit the doctor, take your shoes and socks off and ask the doctor to look at your feet. Visit a podiatrist every year. This is a doctor who takes special care of the feet.

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Illness and Sick Days

Being ill can cause your blood glucose levels to be higher or lower than normal. It is important to be prepared since high levels can lead to life threatening conditions such as severe dehydration or coma.

When to Call your Health Care Team

During an illness, you may need to call your doctor if you:

  • are sick or have had a fever for more than two days and you are not getting better
  • have blood glucose levels over 240mg/dl
  • have moderate or large amounts of ketones in your urine
  • have had vomiting or diarrhea for six hours
  • have abdominal pain, trouble breathing, chest discomfort, dry lips or tongue or a fruity smell to your breath

Keep a card with your doctor%27s phone number with your diabetes medicine so you can find it quickly if you need it.

Sick Day Plan

Talk to your diabetes team before you become ill to develop a sick day plan. Having this plan in place will help you manage your diabetes when you are ill.

Glucose Testing

If you have Type 1 diabetes, you should test your blood glucose every four hours when you are sick. If you have Type 2 diabetes, testing your blood glucose levels four times each day may be enough.

Ketone Testing

If you are not able to use glucose for energy, then your body will burn fat for energy. Burning fat can cause a build up of acids or ketones in the blood which can be dangerous. If you have Type 1 diabetes, you should check your urine for ketones every four hours while ill. People who have Type 2 diabetes should check their urine for ketones if they have a blood glucose levels over 300 mg/dl. You can buy ketone test strips at the pharmacy without a prescription. Follow the directions for the correct method of testing. Be sure to check the expiration date. It is important that the strips are not outdated.

Fluids or Liquids

When your blood glucose levels are high, you will urinate more. If you do not take in fluids, you can become dehydrated. Take frequent sips of calorie free, caffeine free liquids such as water, diet soda, sugar free gelatin or broth. Drink at least 6-8 ounces or about one cup every hour.

Food

If possible, follow your regular meal plan. If you cannot eat solid food, try to have about 50 grams of carbohydrates every three to four hours.

The following foods and beverages contain approximately 15 grams of carbohydrate and are good for sick day use. Eat three of these for about 50 grams:

  • 1/2 cup regular gelatin
  • 1 cup broth soup with noodles or rice
  • 6 saltine crackers
  • 1/2 cup ice cream
  • 1 quarter cup sherbet
  • 1 twin popsicle
  • 1/2 cup cooked cereal
  • 1/2 cup apple juice
  • 1/2 cup regular soda

Medications

Illness can cause your blood sugar levels to be higher so it is important that you take all of your diabetes medications when sick even if you cannot eat. If you take insulin, talk with your physician to see if you need to take extra during your illness. People who take oral medications for Type 2 diabetes may need insulin for a short time if their blood glucose levels are too high. Be cautious about taking over the counter medications like cough syrup or cold medicines when you are sick. Talk to your pharmacist before you take any of these since some of them can affect your blood glucose levels.

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Personal Stories

  • Vivian: Living with Diabetes and Visual Impairment
    Vivian was diagnosed with diabetes twenty years ago, at age 58. Ten years later, she was diagnosed with diabetic retinopathy and spinal stenosis. She talks about how she is living and coping with her diabetes and some of the tools and techniques she uses.

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