Taking good care of your diabetes every day will help keep your blood sugar from going too high or too low. Taking good care of your diabetes every day will also help prevent other health problems that diabetes may cause over the years. We tell you about them not to scare you, but so you will know how to try to prevent them from happening.

The first and most important rule in preventing these problems is:

Follow your doctor's advice every day about trying to keep your blood sugar in the range that is best for you.

1. Eat healthy food every day.
2. Get regular exercise.
3. Take your diabetes medicine every day.
4. Test your blood sugar every day.

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The biggest problem for people with diabetes is heart and blood vessel disease. Heart and blood vessel disease can lead to heart attacks, strokes, and high blood pressure. It also causes poor blood flow (circulation) in the legs and feet.

To check for heart and blood vessel disease, the doctor will do some tests. Once a year, you should have an EKG (electrocardiogram) to check your heart and a blood test (called a cholesterol test) to check how much fat is in your blood vessels. The doctor should take your blood pressure at every visit. The doctor may also check pulse rates in your feet and legs to see if you have good circulation.

The best way to prevent heart and blood vessel disease is to take good care of yourself and your diabetes. Other ways to prevent this disease are:

1. Eat foods that are low in fat and salt.
2. Take your high blood pressure medicine.
3. Don't smoke.
4. Get regular exercise.
5. Lose weight, if you need to.
6. Limit your drinking of beer, wine, or other alcohol.

Profile: "Rose" is 55 years old and teaches junior high school on a Native American reservation in New Mexico. Rose has had noninsulin-dependent diabetes for almost 10 years. When she first found out she had diabetes, she weighed too much and didn't get much exercise. With the approval of her doctor, Rose began an exercise program. She lost weight, and her blood sugar began to come down. She felt better, too. Now in her spare time, Rose teaches an exercise class for women.

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Diabetes is the main cause of blindness in adults in the United States. You should have your eyes checked once a year. You may have eye problems and not know it. Treating eye problems early can help prevent blindness.

High blood sugar can cause the blood vessels in the eyes to bleed. This bleeding can lead to blindness. You can help prevent eye damage by keeping your blood sugar level as close to normal as possible. If your eyes are already damaged, an eye doctor may be able to save your sight with laser treatments or surgery.

The best way to stop eye disease is to have a yearly eye exam. In this exam, the doctor or nurse puts drops in your eyes to make your pupils get bigger (dilate). This is called a "dilated eye exam." The drops make the pupils big so that the doctor can see into the back of the eye. The exam does not hurt. If you have never had an eye exam like this, you should have one now. Do this even if you have no trouble with your eyes.

Here are some other rules for taking care of your eyes:

• For people with insulin-dependent diabetes: Have your eyes examined when you have had diabetes for 5 years and every year after that first eye exam. (Children should have an eye exam in their early teens).
  
  
• For people who got diabetes as an adult: Have an eye exam right away and then once a year after the first eye exam.
  
  
• For women planning to have a baby: Have an eye exam before becoming pregnant.

Tell your doctor right away if you have any problems with your eyes. These problems include blurry sight or seeing dark spots, flashing lights, or rings around lights. See your eye doctor for an eye exam with dilated pupils every year. Early treatment of eye problems can help save your sight.

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Your kidneys help clean waste products from your blood. They also work to keep the right balance of salt and fluid in your body.

Too much sugar in your blood is very hard on your kidneys. After a number of years, high blood sugar can cause the kidneys to stop working. This condition is called kidney failure. Diabetes is the main cause of kidney failure.

Your doctor should test your urine once a year for signs of kidney damage. A blood pressure medicine (called an ACE inhibitor) can help prevent kidney damage. Ask your doctor if this medicine might help you.

Other ways to help prevent kidney problems:

• Take your high blood pressure medicine.
  
  
• Ask your doctor or your dietitian if you should eat less meat, eggs, cheese, milk, and fish.
  
  
• See your doctor right away if you get a bladder or kidney infection.

Signs of bladder or kidney infections are

• cloudy or bloody urine
• pain or burning when you urinate
• having to urinate often or in a hurry.
• Back pain, chills, and fever are also signs of kidney infection.

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Profile: "Mike" is a migrant farm worker with noninsulin-dependent diabetes and high blood pressure. Mike, 47, is married and he and his wife have three children. The family is often on the move, depending on where the work is. Mike has his blood pressure and kidneys checked at clinics in migrant worker camps. Some of the clinics offer diabetes classes. Whenever they can, Mike and his wife attend these classes. They especially like the cooking classes because they can learn how to prepare low-cost, healthy meals for the whole family.

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Over time, high blood sugar can harm the nerves in your body. Nerve damage from diabetes can cause you to lose feeling in your feet or have painful, burning feet. It can cause pain in your legs, arms, or hands. Nerve damage can also cause problems with eating, going to the bathroom, or having sex.

Profile: "Joe" is a 55-year-old retired postman with noninsulin-dependent diabetes. Every time he visits his doctor, he takes off his shoes and socks so that his doctor can check his feet for sores, ulcers, and wounds. The doctor also checks the sense of feeling in his feet. Joe and his doctor talk about ways to prevent foot and nerve problems. Since Joe has lost some feeling in his toes, the doctor also talks to him about the importance of good foot care and keeping his blood sugar levels in a good range.

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There's a lot you can do to prevent problems with your feet. Keeping your blood sugar in good control and taking care of your feet can help protect them.

1. Check your bare feet every day. Look for cuts, sores, bumps, red spots. Use a mirror or ask a family member for help if you have trouble seeing the bottoms of your feet.
   
   
2. Wash your feet in warm--not hot--water every day. Use a mild soap. Do not soak your feet. Dry your feet with a soft towel. Dry between your toes.
   
   
3. Cover your feet with a lotion or petroleum jelly after washing them, before putting on your shoes and socks. Do not put the lotion or jelly between your toes.
   
   
4. Cut your toenails straight across. Do not leave sharp edges that could cut the next toe.
   
   
5. Use a dry towel to rub away dead skin.
   
   
6. Do not try to cut calluses or corns yourself with a razor blade or knife. Do not use wart removers on your feet. If you have warts or painful corns or calluses, see a doctor who treats foot problems. This kind of doctor is called a podiatrist.
   
   
7. Wear thick, soft socks. Do not wear mended stockings or stockings with holes or seams that might rub into your feet.
   
   
8. Check your shoes before you put them on to be sure they have no sharp edges or objects in them.
   
   
9. Wear shoes that fit well and let your toes move. Break in new shoes slowly. Do not wear flip-flops, shoes with pointed toes, or plastic shoes. Never go barefoot.
   
   
10. Wear socks if your feet are cold at night. Do not use heating pads or hot water bottles on your feet.
    
    
11. Have your doctor check your bare feet at every visit. Take off your shoes and socks when you go in the exam room. This will remind the doctor to check your feet.

See a podiatrist for help if you can't take care of your feet yourself.

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Diabetes can lead to infections of the gums and bones that hold your teeth in place. Like all infections, gum infections can cause blood sugar to rise, making the problem worse. Without treatment, teeth may become loose and fall out.

• See your dentist twice a year.
• Tell your dentist that you have diabetes.
• Brush and floss your teeth twice a day.

Keeping your blood sugar in a good range, daily brushing and flossing of teeth, and regular dental checkups are the best ways to prevent gum and teeth problems when you have diabetes.

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Profile: "James" runs a family-owned bookstore in California. He is 35 years old and has had insulin-dependent diabetes for 15 years. James takes good care of his teeth and sees his dentist twice a year. He makes his appointments in the morning, after breakfast, so he won't get low blood sugar while at the dentist. He also carries glucose tablets and wears an identification necklace that has the name and telephone number of his doctor.

Doctors Corner acknowledges the NIDDK as a primary source for this publication. This webpage has been modified by Doctors Corner to enhance readability and provide additional information of importance to our readers.

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