/publications/issue/2004/2004-01/2004-01-7594

Managing Complications of Diabetes

Author: Rebecca Sasser, PharmD, CPP, CDE

    Diabetes can cause early death from heart attack and stroke. It also can cause kidney failure, blindness, nerve damage, amputations, and problems with sex. With your medical provider and diabetes educator or pharmacist's help, you can minimize your risk for these types of complications.

    There are many ways to control diabetes: eating a healthy diet, exercising, staying at your appropriate weight, taking your medicines as prescribed, and visiting your doctor regularly. If you already have 1 or more diabetes-related complications, taking good care of yourself by following some of the same prevention strategies is important.

Heart Attack and Stroke

    Diabetes and high cholesterol increase a patient's risk for heart attack and stroke. It is important to limit the amount of cholesterol you take in. Cholesterol is in fried foods, fast foods, meats, and dairy products. Choose baked or broiled meats, limit fast foods and processed foods, and choose low-fat dairy products such as 1% or skim milk. Fresh vegetables and fruits are a healthy alternative to high-fat foods. They are a good source of fiber as well.

    High blood pressure also increases the risk of heart attack and stroke. Avoid foods high in sodium (salt), and limit alcohol intake to 1 or 2 drinks a day.

    Staying at your ideal weight can improve blood sugar control and decrease cholesterol and blood pressure. Limit the calories you eat, and exercise. If you do not regularly exercise now, start gradually, and work up to 30 minutes 4 to 5 days a week. Easy ways to incorporate more exercise into your day are to park farther away from the store or to take the stairs instead of the elevator. Visit your doctor regularly, and always take medications that are prescribed to you for high cholesterol and blood pressure, as well as your diabetes medications (see Table).

    Aspirin, which helps thin the blood, also can help prevent heart attacks and strokes. Most people with diabetes should take an aspirin every day, but only after they discuss it with their medical provider. Smoking is a risk factor for heart attack and stroke, so, if you smoke, stop. Talk to your doctor or pharmacist about the products available to help you stop smoking.

Eye Disease

    Diabetes is the leading cause of blindness in adults in the United States. An eye doctor can detect problems early when they still can be treated. Controlling your blood sugars and blood pressure are 2 ways to prevent retinopathy and other eye problems associated with diabetes. Get an eye examination at least once a year by an ophthalmologist.

Kidney Disease

    Uncontrolled diabetes and/or high blood pressure can cause kidney damage. Controlling your diabetes and blood pressure will help protect your kidneys from the harmful effects of diabetes. Checking for protein in your urine once a year will determine how your kidneys are working. This is done at your doctor's office. You may be started on a type of blood pressure medication called an ACE inhibitor that protects the kidneys in addition to lowering blood pressure.

Foot Problems

    People with diabetes sometimes lose feeling in their feet because high blood sugars have damaged tiny nerves. This is called neuropathy. Diabetes also puts people at risk for having poor blood flow to their feet. This is called peripheral vascular disease. Diabetes patients with neuropathy and poor blood flow may not feel if they have a sore on their foot, and it may not heal as quickly as it should. This can lead to an ulcer and possibly to the need for an amputation. It is important to check your feet every day. Look for cuts or sores and signs of infection.

    Do not go barefoot, and make sure that your shoes fit properly. Ask your doctor about special shoes for people with diabetes. Have your doctor look at your feet every time you are in the office.

    Podiatrists, or foot doctors, specialize in taking care of people's feet, especially those with diabetes. If you have trouble cutting your toenails, the foot doctor will be able to do it for you. Your toenails should be trimmed to the shape of your toe, and the edges should be filed with an emery board. The podiatrist also will look for anything unusual on your feet and treat those problems.

    Do not use any products on your feet without checking with your doctor first, other than lotion to keep them from getting dry. Do not apply lotion between your toes, which could increase your risk for a fungal infection. Controlling your diabetes, blood pressure, and cholesterol and not smoking will help prevent nerve and blood vessel damage that could lead to amputations.

Gum Disease

    People with diabetes are at a higher risk for developing gum problems. Diabetes may weaken your ability to fight off germs in your mouth, and having gum disease may worsen diabetes control. You should brush your teeth twice a day, floss once a day, and visit your dentist twice a year.

Impotence

    Many men with diabetes have a problem with erections and sexual activity, called erectile dysfunction (ED). There are many treatments for ED, and you should discuss these with your medical provider if you are having this problem. ED can be prevented by controlling your diabetes and blood pressure and by not smoking.

Immunizations

    All people with diabetes should receive a flu shot every year. Diabetes patients should also get a vaccine to protect them from getting pneumonia. This is given once or twice in a lifetime, depending on your age when you first received it. Ask your doctor about receiving these 2 vaccinations.

Summing Up

    You can prevent many of the problems associated with diabetes. Become active in your diabetes care. Check your blood sugar regularly, exercise, and maintain an ideal body weight. Take your medications as prescribed, and ask your medical provider about your blood work results. Choosing healthy ways of living can lead to great benefits now and in the future. Talk to your doctor, diabetes educator, or pharmacist about ways that you can control your diabetes.