Type 1 Diabetes: Living With Complications

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
	References
	Credits

Is this topic for you?

This topic provides information for people who have complications from diabetes, such as eye, kidney, heart, nerve, or blood vessel disease. If this doesn't meet your needs, see:

• Type 1 Diabetes, if you want to learn about type 1 diabetes but do not have it.
• Type 1 Diabetes: Recently Diagnosed, if you have been told recently that you or your child has type 1 diabetes.
• Type 1 Diabetes: Living With the Disease, if you or your adolescent has type 1 diabetes. If you have not read the topic Type 1 Diabetes: Recently Diagnosed, you may want to read it first.
• Type 1 Diabetes: Children Living With the Disease, if your child age 11 or younger has type 1 diabetes. If you have not read the topic Type 1 Diabetes: Recently Diagnosed, you may want to read it first.
• Diabetic Retinopathy, Diabetic Nephropathy, or Diabetic Neuropathy, if you want more information on these complications of diabetes.

What are the complications from diabetes?

You may have one or more complications from type 1 diabetes.

• Macrovascular complications
  • Heart or large blood vessel disease can damage vessels that supply blood to the heart and brain. It can also block or decrease blood flow in the large blood vessels of your legs (peripheral arterial disease). Without proper blood flow, you could have a heart attack or stroke.

• Microvascular complications
  • Eye disease (diabetic retinopathy) can cause poor eyesight or blindness.
  • Kidney disease (diabetic nephropathy) may require dialysis or a transplant.
  • Nerve disease (diabetic neuropathy) can change how you feel sensations, particularly in your legs and feet. Nerve damage can also harm your internal body functions. This could lead to trouble with digestion and sexual functioning.

What causes complications?

Complications from type 1 diabetes are caused by damage to either your blood vessels or nerves, or both. Excess sugar (glucose) in your body causes changes that damage these tissues.

Diabetes is associated with damage to the lining of the blood vessels throughout the body. This damage blocks blood vessels with hard, fatty deposits called plaques. This process is called atherosclerosis.

Diabetes is also associated with damage to the nerves so that the movement of impulses through the organs, legs, arms, and other parts of the body is decreased or completely blocked.

What are the symptoms?

Your symptoms will vary depending on the complication.

• Eye disease symptoms are not present in the early stages of the disease. Later symptoms may include blurred or distorted vision or difficulty reading that does not go away when high blood sugar is corrected. You might see floaters or flashes of light. And you could experience partial or total loss of vision or pain in your eye.
• Kidney disease symptoms are not present in the early stages of the disease. As the disease goes on, you may notice swelling (edema) in your feet and legs and later throughout your body. Your blood pressure may go up. Late-developing symptoms can include fatigue, poor appetite, and decreased mental sharpness.
• Heart and large blood vessel disease symptoms may not be noticeable until you have a heart attack or stroke. You may have chest pain (angina). You may also have leg pain when you exercise. However, a heart attack can be painless or "silent" because of nerve damage.¹
• Nerve disease symptoms occur when nerves that transmit sensation are damaged. These symptoms include tingling, numbness, tightness, burning, or shooting or stabbing pain in the feet, hands, or other parts of your body. When the nerves that control your internal organs are damaged, you may have digestive problems; profuse or reduced sweating; difficulty sensing when your bladder is full; sexual problems; dizziness, weakness, or fainting when you stand up; or difficulty knowing when your blood sugar is low (hypoglycemia unawareness).

What can happen?

Complications from type 1 diabetes can lead to kidney failure or blindness, or death from a severe heart attack or stroke. If the small blood vessels around your joints and connective tissue are affected, you can develop bone and joint deformities, such as Charcot foot. If you have nerve damage, you may not notice a minor injury, especially one on your foot, until it turns into a severe infection. These infections can spread up your leg and infect the bones, possibly leading to amputation.

Am I at risk for more complications?

Having one complication increases your risk for others. For example, damage to the small blood vessels in your body can cause eye and kidney disease. As a result, these complications are likely to occur together. Also, the longer you have diabetes, the greater your risk for having complications.

Another risk for most complications is if your blood sugar levels remain high over months or years. Smoking, high blood pressure, high cholesterol, and a family history of heart disease or peripheral arterial disease can also increase your risk.

What is the treatment for diabetic complications?

Treatment for diabetic complications focuses on stopping or at least slowing damage. Your treatment may involve medicine, surgery, or other therapies.

The best way to slow or stop the progression is to keep your blood sugar levels as near normal as possible. The near-normal target may be a lower blood sugar level than you tried to achieve before you had complications. Tight control of blood sugar is especially likely to help people who have early, rather than advanced, complications. See your health professional every 3 to 4 months, or more often if you're having problems. Have exams and tests that monitor your complication(s), and screen for other complications regularly.

If you have high blood pressure or high cholesterol, get regular treatment for those conditions. Do not smoke. These actions can also help prevent other diabetic complications.

What can I do?

Keep your blood sugar levels within a normal to near-normal range. This is the key to slowing or reversing complications, and it helps prevent new complications. You can spread carbohydrate intake throughout the day, get regular physical exercise, and take insulin as prescribed. All these activities help keep your blood sugar under control.

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

	Actionsets are designed to help people take an active role in managing a health condition.
	Foot care for people with diabetes

Complications from type 1 diabetes are caused by one or both of the following:

• Damage to the lining of the blood vessels throughout your body, causing them to become clogged with hard, fatty deposits called plaques. This process is called atherosclerosis.
• Damage to the nerves (neuropathy) that reduces or blocks their ability to send messages to your organs, legs and arms, and other parts of your body.

This damage results from excess sugar (glucose) in your body.

Your symptoms depend on which complication type 1 diabetes has caused.

Eye disease

Symptoms of diabetic retinopathy are not present in the early stages of this eye disease. Symptoms that are noticed in later stages of the disease include:

• Blurred or distorted vision or difficulty reading that does not go away. Macular edema or other changes in the retina cause these symptoms. Temporary vision problems can crop up when your blood sugar level is high.
• Floaters or flashes of light in your field of vision. Retinal detachment or bleeding into the fluid within the eye (vitreous gel) causes these symptoms.
• Partial or total loss of vision, or a shadow or veil across your field of vision. Retinal detachment or bleeding into the vitreous gel also causes these symptoms.
• Pain in your eye. Neovascular glaucoma can cause this problem.

For more information, see the topic Diabetic Retinopathy.

Kidney disease

The only sign of diabetic nephropathy in its early stage is tiny amounts of protein in your urine (microalbuminuria). A urine test for protein is the only way to identify this problem. Frothy or foamy urine can be a sign of excess protein. As kidney disease gets worse, you may have:

• Swelling (edema) in your feet and legs and later throughout your body.
• Increasing blood pressure.
• Large amounts of protein leaking into your urine (macroalbuminuria).
• High levels of cholesterol and triglycerides in your blood.
• An increased risk of developing blood clots.

Kidney damage affects your body's ability to rid itself of excess insulin. This results in low blood sugar levels. It also may mean that your health professional may want to adjust your insulin dose. As the disease gets worse, kidney failure develops. You may be tired, lose your appetite, and lose weight.

For more information, see the topic Diabetic Nephropathy.

Heart and large blood vessel disease

You may have chest pain (angina) or leg pain during exercise if you have macrovascular disease. However, you may not have any symptoms until you have a heart attack, stroke, or develop peripheral arterial disease. Because diabetes can affect the nerves, you may have no pain during a heart attack. This is called a "silent heart attack."¹

For more information, see the topics:

• High Blood Pressure (Hypertension).
• Coronary Artery Disease.
• Heart Attack and Unstable Angina.
• Peripheral Arterial Disease of the Legs.
• Stroke.

Nerve damage

Symptoms of peripheral neuropathy include:

• Tingling, numbness, tightness, burning, or shooting or stabbing pain in the feet, hands, or other parts of your body. Usually, symptoms start in the toes and are worse in the evening. Bone and joint deformities can develop, especially of the feet (Charcot foot).
• Reduced feeling or numbness, most often in the feet.
• Reduced sweating, especially in your feet and legs.
• Greatly reduced or greatly increased sense of pain from a light touch or change in temperature.
• Weakness and loss of balance and coordination.

Symptoms of autonomic neuropathy (affecting internal functions) include:

• Digestive problems, including frequent bloating, belching, constipation, nausea and vomiting, diarrhea, and abdominal pain. These symptoms may indicate that you have gastroparesis, a condition that causes your stomach to empty too slowly.
• Temperature control problems, including profuse sweating on your chest, face, or neck at night or while eating certain foods, such as cheese and spicy foods.
• Difficulty sensing when your bladder is full or difficulty emptying your bladder completely.
• Sexual problems, such as erection problems in men and vaginal dryness in women.
• Dizziness, weakness, or fainting when you stand or sit up from a reclining position (orthostatic hypotension).
• Difficulty knowing when your blood sugar is low (hypoglycemia unawareness).

Symptoms of focal neuropathy (affecting a single nerve) usually develop suddenly and may include:

• Pain, weakness, and movement difficulty in a single area of your body, such as a wrist, thigh, or foot.
• Pain in and around one of your eyes (if neuropathy affects the nerves that control eye muscles), difficulty moving your eyes, and double vision.

For more information, see the topic Diabetic Neuropathy.

If complications from type 1 diabetes are found early, treatment can slow and sometimes reverse the damage. Complications that progress may cause serious disability or death.

• Diabetic retinopathy can lead to vision loss and blindness. You are also at risk for other eye conditions that can cause vision loss, such as cataracts or glaucoma. For more information, see the topic Diabetic Retinopathy.
• Diabetic nephropathy can lead to kidney failure. For more information, see the topic Diabetic Nephropathy.
• Large blood vessel damage (macrovascular disease) can lead to heart attack, stroke, or circulation problems in your legs. For more information, see the topics Heart Attack and Unstable Angina, Peripheral Arterial Disease of the Legs, or Stroke.
• Diabetic neuropathy can lead to a variety of problems. Peripheral neuropathy (affecting sensation) along with blood vessel disease in the legs can cause foot problems, including Charcot foot. If you develop a severe foot infection, it can lead to amputation. Autonomic neuropathy (affecting internal functioning) can cause many problems, such as gastroparesis, hypoglycemia unawareness, and impotence. For more information, see the topic Diabetic Neuropathy.

What can be done?

If your complication is found early, you may need to make only minor lifestyle changes to stop its progression. For example, if you have early diabetic nephropathy, medicine can help prevent further damage to your kidneys. Early treatment for a complication and keeping your blood sugar at a near-normal level can help prevent new complications. The American Diabetes Association recommends a hemoglobin A1c (HbA1c) level of less than 7%. Some people may be able to achieve a normal level of less than 6%.² The lower the A1c, the lower the rate of complications. The A1c level is a measure of your blood sugar over the past 2 or 3 months.

Other ways to prevent new complications and/or to keep the complications you have from getting worse include:

• Seeing your health professional regularly to have your treatment evaluated and to have screening exams and tests.
• Treating high blood pressure and high cholesterol.
• Stopping smoking.
• Checking your feet for cuts or calluses, which can lead to infection. Good foot care also includes having a health professional check your feet regularly. Wear socks and shoes at all times to protect your feet.
• Limiting alcohol to 1 drink a day for women and 2 drinks a day for men.

These factors can contribute to your developing complications from type 1 diabetes.

• Having one complication. If you have one complication from diabetes, you have a higher chance of getting other complications.
• Ongoing high blood sugar over time. If your blood sugar levels are high most of the time, you have a higher chance of getting complications.
• Length of time you have the disease. The longer you have diabetes, even if you control your blood sugar, the more likely you are to develop complications.
  • Diabetic retinopathy. About 60% of people with type 1 diabetes get diabetic retinopathy after 10 years. Almost all have it to some degree after 20 years.³ About 25% get the advanced stage (proliferative retinopathy) after 15 years.³
  • Diabetic nephropathy. Diabetic nephropathy eventually occurs in 20% to 30% of all people with type 1 and type 2 diabetes.⁴ Without treatment to slow kidney disease, most people with type 1 diabetes will move from the early stage to the advanced stage of nephropathy in 10 to 15 years.⁴ Children who get nephropathy usually show the first signs of the condition after puberty.
  • Heart and large blood vessel disease. About 73% of adults with diabetes have high blood pressure. People with diabetes are 2 to 4 times more likely to die from heart disease or to have a stroke.⁵
  • Diabetic neuropathy. Most people with diabetes develop some diabetic neuropathy over the years. But only about 13% to 15% of people with diabetes have symptoms of neuropathy.⁶
• Other risk factors. Other factors that can raise your chance of getting complications include:
  • Smoking.
  • High blood pressure.
  • High cholesterol.
  • Family history of heart disease.
  • Peripheral arterial disease.
  • Psychiatric disorders (such as depression).
  • Family history of diabetic complications.
  • Not having health insurance for supplies and other medical expenses related to diabetes.

Call 911 or other emergency services immediately if you have:

• New or sudden vision loss. Partial or complete vision loss is a symptom of many disorders that can occur in or near the eye, including retinal detachment or bleeding within the eye. Sudden vision loss is always a medical emergency.
• Chest discomfort or pain that is crushing, squeezing, or feels like a heavy weight on the chest. The pain of a heart attack usually lasts longer than 10 minutes and often occurs with other symptoms, including:
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain that spreads from the chest to the neck, jaw, or one or both shoulders or arms.
  • Dizziness or lightheadedness.
  • Fast or irregular heartbeat.
• Any signs of a stroke. Signs include:
  • Numbness, weakness, or inability to move (paralysis of) the face, arm, or leg, especially on one side of the body.
  • Trouble seeing with one or both eyes, such as dimness, blurring, double vision, or loss of vision.
  • Confusion, trouble speaking or understanding.
  • Trouble walking, dizziness, loss of balance or coordination.
  • Severe headache with no known cause.

Call your health professional if you have one or more symptoms of a new diabetic complication or symptoms of a complication getting worse, such as:

• Blurred or distorted vision.
• Seeing floaters or flashes of light, or large, floating red or black spots, or large areas that look like floating hair, cotton fibers, or spider webs
• Pain in the eyes.
• Wounds that won't heal, including foot ulcers.
• Burning pain, numbness, or swelling in your feet or hands.
• Frequent bloating, belching, constipation, nausea and vomiting, diarrhea, and abdominal pain. These symptoms may indicate gastroparesis.
• Profuse sweating or reduced sweating.
• Feeling dizzy or weak when you sit or stand up suddenly.
• Difficulty sensing when your bladder is full or difficulty emptying the bladder completely.
• Erection problems or vaginal dryness.
• Difficulty knowing when your blood sugar is low (hypoglycemia unawareness).

Call a health professional if you are having frequent or persistent high blood sugar levels.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. Watchful waiting for type 1 diabetes is not appropriate if you have any of the following symptoms.

• Persistent or frequent high or low blood sugar levels. Keeping your blood sugar levels as close to normal as possible can help slow the progression of your complication and prevent the development of others. You can keep track of your blood sugar levels with home tests and hemoglobin A1c tests at your doctor's office. The A1c test gives you an average of your blood sugar levels over the past 2 or 3 months.
• Symptoms of a new complication from diabetes. Early detection and treatment may reverse, stop, or at least slow the progression of the complication.
• Symptoms indicating that your complication from diabetes is getting worse. Prompt treatment may help prevent serious disability or death.

See your health professional if you have any of these symptoms.

Who To See

The specialist that you need to see depends on which complication you have. The following health professionals treat complications from type 1 diabetes:

• An ophthalmologist or optometrist can diagnose eye disease from diabetes. An ophthalmologist is the preferred specialist for retinal complications.
• A nephrologist treats kidney disease.
• A cardiologist or a vascular surgeon treats heart and/or circulation problems.
• A neurologist diagnoses and treats nerve damage.
• A podiatrist, pedorthist (a certified technician who can make special shoes or shoe inserts), or an orthopedic surgeon treats foot and ankle problems.
• A gastroenterologist treats stomach and intestinal problems.
• A urologist treats sexual and urinary tract problems.

To prepare for your appointment, see the topic Making the Most of Your Appointment

Because you have a complication from type 1 diabetes, you need to have regular exams and tests to monitor its progression and screen for new complications.

Because persistent high blood sugar levels are directly related to getting diabetic complications, you need hemoglobin A1c and blood glucose tests every 3 to 4 months to monitor your blood sugar control.

Treatment for your complication from type 1 diabetes depends on the stage of the disease.

For eye disease (diabetic retinopathy)

Keep all appointments with your eye specialist, and call if you notice any changes in your vision. Vision changes may mean your diabetic retinopathy is getting worse. Early detection and treatment of any changes can help prevent vision loss.

• If you have diabetic retinopathy in an early stage (nonproliferative stage), you need no treatment unless it is affecting the macula, the part of the retina that provides central vision. If the macula is damaged by swelling (macular edema), you may have laser treatment to seal leaking blood vessels, surgical removal (vitrectomy) of the fluid within the eye (vitreous gel), or steroid injections into the fluid of the eye.
• If the eye disease is advanced (proliferative stage), you may have either laser treatment or vitrectomy.

If you have severe vision loss, vision aids can help. Your local or state organization for the visually impaired can help you find these aids.

For more information, see the topic Diabetic Retinopathy.

For kidney disease (diabetic nephropathy)

Keep all appointments with your health professional, because the blood and urine tests done during these visits will monitor any kidney damage. Also, follow your doctor's instructions on taking your medicines (if you take any), because this can help slow damage.

If you have small amounts of protein in your urine (microalbuminuria), which is an early sign of kidney damage, you may be given an angiotensin-converting enzyme (ACE) inhibitor. Angiotensin II receptor blockers (ARBs) also treat kidney disease. These medicines are usually the first choice for people with type 1 diabetes who have microalbuminuria. Treatment for high blood pressure and high cholesterol may also help your kidneys work better.⁴ If you develop kidney failure, you may need dialysis, a kidney transplant, or possibly a pancreas-kidney transplant.⁹

You can also:

• Limit protein in your diet to no more than 10% of your daily calories.⁴
• Limit salt in your diet because it makes your body retain fluid and can increase your blood pressure.

For more information, see the topics Diabetic Nephropathy and Chronic Kidney Disease.

For heart and large blood vessel disease (macrovascular disease)

You can treat heart and large blood vessel disease by:

• Controlling high blood pressure. You may try some lifestyle or behavioral therapy for 3 months before starting medicine if your systolic blood pressure is between 130 mm Hg and 139 mm Hg or your diastolic blood pressure is between 80 mm Hg and 89 mm Hg.² Angiotensin-converting enzyme (ACE) inhibitors or other medicines can keep your blood pressure consistently below 130/80 mm Hg. Angiotensin II receptor blockers (ARBs) also help treat high blood pressure and kidney disease in people with diabetes. ARBs are used alone or along with an ACE inhibitor. For more information, see the topic High Blood Pressure (Hypertension).
• Controlling high cholesterol. Cholesterol-reducing medicines can keep your LDL cholesterol level less than 100 mg/dL (2.60 mmol/L), your triglyceride level less than 150 mg/dL (1.7 mmol/L), and if possible, your HDL cholesterol level more than 40 mg/dL (1.15 mmol/L) in men. Women may want to keep their HDL higher than 50 mg/dL. For more information, see the topic High Cholesterol.
• Taking aspirin. Consider taking aspirin if you've had a heart attack or stroke or are age 40 or older and at risk for heart attack or stroke.¹⁰ For more information, see the topics Coronary Artery Disease, Heart Attack and Unstable Angina, Peripheral Arterial Disease of the Legs, and Stroke.
• Not smoking. Smoking increases your risk for heart attack and stroke and makes many health problems worse. Quitting can lower your risk.¹¹
• Exercising. Try to get at least 30 minutes of exercise on most, preferably all, days of the week. Take steps to exercise safely.

For nerve disease (diabetic neuropathy)

Keeping your blood sugar levels as close to normal as possible (hemoglobin A1c of 6% or less) is the only treatment that can stop or slow the progression of neuropathy.

If you have peripheral neuropathy, your health professional may suggest medicines (such as nonprescription pain relievers, creams, or prescription oral or injected medicines). Physical therapy or acupuncture may relieve pain and stiffness, as well as improve your mood and mental well-being.

To help prevent injuries:

• Turn your water heater down, and use a bath thermometer or have someone test your bath water to make sure that it is not too hot. Don't use an electric blanket.
• Arrange your furniture so that the walkways through your house are free of clutter, preventing falls.

If you have focal neuropathy (affecting one nerve), your health professional may suggest a joint splint.

If you have autonomic neuropathy (affecting internal functioning), your health professional may suggest the following:

• For digestive problems: Eat smaller, more frequent meals that contain less fat and fiber. You can also take medicine for gastroparesis, such as metoclopramide (Reglan), domperidone (available in Europe and Canada), and erythromycin. If gastroparesis becomes severe, you may need surgery to place a feeding tube in the small intestine.
• For urinary problems: Drink more fluids each day to prevent urinary tract infections.
• For profuse sweating: Drink more fluids when you are outside in hot weather to prevent dehydration.
• For sexual problems: Try a device for erection problems or a lubricating cream for vaginal dryness. Medicines for erection problems include sildenafil citrate (Viagra), tadalafil (Cialis), and vardenafil (Levitra). But all of these medicines can make heart problems worse. Do not take them if you take nitrate medicines (such as nitroglycerin). Talk to your health professional about which medicine would work best for you.
• For hypoglycemia unawareness: Check your blood sugar level more often to prevent very low blood sugar levels.

Your health professional may refer you to a specialist for treatment of specific complications.

For more information, see the topic Diabetic Neuropathy.

For foot problems

Have your health professional examine your feet during each visit and do a thorough foot exam yearly. If you develop serious infections or bone and joint deformities, you may need surgery (possibly amputation). You can prevent many foot problems by inspecting your feet daily and protecting them from injury.

Foot care for people with diabetes

What To Think About

The most important thing you can do is to keep your blood sugar level as close to normal as possible. This slows the progression of your complication from diabetes and lowers your risk for developing others. Continue eating a diet that spreads carbohydrate throughout the day, get regular exercise, and take your prescribed insulin. You can take insulin by injection, an insulin pump, or an inhaler. For more information, see the Home Treatment section of the topic Type 1 Diabetes: Living With the Disease.

You can slow the progression of your complication from type 1 diabetes and prevent or delay other complications by keeping your blood sugar levels as close to normal as possible.

• Keeping your blood sugar at normal or near-normal levels (tight control) may prevent the development and progression of small blood vessel disease and nerve disease (neuropathy).
• Tight control of blood sugar may reduce your risk of heart and large blood vessel disease from diabetes.¹²

You can:

• Have regular eye exams by an ophthalmologist or optometrist, even if you do not have symptoms. Immediately report any symptoms, such as blurred vision, floaters, or flashes of light. Early treatment can prevent vision loss.
• Detect kidney disease early by having your urine tested for small amounts of protein (microalbuminuria). At the first sign of microalbuminuria, talk with your health professional about whether you can take a high blood pressure medicine. Angiotensin-converting enzyme (ACE) inhibitors are the preferred medicines for people with type 1 diabetes who have microalbuminuria, even if their blood pressure is normal. If you cannot take an ACE inhibitor, your doctor may prescribe an angiotensin II receptor blocker (ARB) to prevent further kidney damage.
• Prevent heart and blood vessel problems by getting effective treatment for high blood pressure and high cholesterol.¹² You can take aspirin if you've had a heart attack or stroke, have peripheral arterial disease, or are 40 years of age or older and are at risk for these diseases, unless there is a medical reason you shouldn't.¹⁰
• Detect nerve problems through yearly exams that check sensations in your feet and legs. As soon as you notice them, report any symptoms of digestive, sexual, or urinary problems or signs of hypoglycemia unawareness.
• Prevent foot problems by inspecting your feet daily, wearing shoes that fit well, not going barefoot, not using home remedies, and having yearly foot examinations. Talk with your health professional about treatment for even minor problems, such as corns or calluses. Catching problems early prevents minor injuries from turning into major problems.
  • Foot care for people with diabetes

Other preventive measures

• Quit smoking. If you quit smoking, you decrease your risk for developing early damage to the blood vessels caused by diabetes.¹¹ For more information, see the topic Quitting Tobacco Use.
• Keep your immunizations up to date. Diabetes affects your immune system, increasing your risk for having a serious case of the flu or pneumonia. Ask your health professional if you should have a flu vaccination. For more information, see the topic Immunizations.

The most important measures you can take at home if you have one or more complications from type 1 diabetes are:

• Keep your blood sugar as close to normal as possible. Keep track of your blood sugar levels with home tests and hemoglobin A1c (A1c) tests at your doctor's office. The A1c test gives you an average of your blood sugar levels over the past 2 or 3 months. The American Diabetes Association recommends a hemoglobin A1c level of less than 7%. Some people may be able to achieve a normal level of less than 6%.² The lower the A1c, the lower the chance of complications.
• Eat a diet that spreads carbohydrate throughout the day.
• Get regular exercise.
• Take your prescribed insulin either by injection, through an insulin pump, or with an inhaler.
• Do not smoke.

For more information, see the Home Treatment section of the topic Type 1 Diabetes: Living With the Disease.

Other measures to care for and protect yourself depend on which complication you have.

Eye disease (diabetic retinopathy)

Call your eye specialist if you notice any changes in your vision. Vision changes may mean that diabetic retinopathy is getting worse. Early detection and treatment can help prevent vision loss.

If you have severe vision loss from diabetic retinopathy, vision aids can help. Your local or state organization for the visually impaired can help you find these aids.

For more information, see the topic Diabetic Retinopathy.

Kidney disease (diabetic nephropathy)

• Take your blood pressure medicines, if prescribed. Your blood pressure should be less than 130/80 mm Hg. Ask your health professional if you need to monitor your blood pressure at home.
• Get no more than 10% of your daily calories from protein foods if you have small amounts of protein in your urine (microalbuminuria).²
• Limit salt in your diet because it makes your body retain fluid and can increase your blood pressure.

For more information, see the topic Diabetic Nephropathy.

Heart and large blood vessel disease

Even if you don't have heart and blood vessel problems, you are at risk for them.

• Don't smoke. Smoking increases your risk of a heart attack or stroke, and makes many health problems worse.
• Take your blood pressure medicine, if prescribed.
• Take your cholesterol-lowering medicine, if prescribed.
• Eat a heart-healthy diet.
• Take aspirin daily, if advised by your health professional.
• Limit alcohol. Drink no more than 1 drink a day for women and no more than 2 drinks a day for men. Discuss with your health professional whether you should drink alcohol.

Nerve damage (diabetic neuropathy)

If it affects your ability to feel (peripheral neuropathy):

• Turn your water heater down, and use a bath thermometer or have someone test your bath water to make sure it is not too hot.
• Don't go barefoot. Always wear shoes, even in the house.
• Don't use an electric blanket.
• Arrange your furniture so that the walkways through your house are free of clutter.

If it affects your body's internal functioning (autonomic neuropathy):

• Eat smaller, more frequent meals that contain less fat and fiber, if you have gastroparesis or other digestive problems.
• Drink more fluids each day, if you have urinary problems or profuse sweating. This will prevent urinary tract infections and dehydration.
• Try a device for erection problems or a lubricating cream for vaginal dryness, if you have sexual problems. Talk to your health professional about medicine for erection problems (Cialis, Levitra, Viagra). For more information, see the topic Erection Problems.
• Check your blood sugar level frequently during the day and during the night occasionally, if you have hypoglycemia unawareness.

For more information, see the topic Diabetic Neuropathy.

Foot problems

Daily care of your feet is very important. Because diabetic neuropathy and diabetic damage to the blood vessels in your legs can lead to severe infections and deformities of your feet, seek treatment for any foot problem, no matter how minor it seems. Even a small foot injury can lead to serious complications.

For more information, see

Foot care for people with diabetes

Insulin prescribed for type 1 diabetes by an injection, an insulin pump, or an inhaler helps keep your blood sugar level tightly controlled and as close to normal as possible. You may also take:

• An angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker, or other medicine, if you have high blood pressure or small amounts of protein in your urine (microalbuminuria). These medicines can slow or prevent further damage to your kidneys if you have microalbuminuria, even if you don't have high blood pressure.
• Aspirin, if you've already had a heart attack or stroke or are age 30 or older and at risk for these conditions, unless there's a medical reason you shouldn't.¹⁰ Ask your health professional if taking aspirin might help you.
• Sildenafil citrate (Viagra), tadalafil (Cialis), or vardenafil (Levitra), if you have erection problems and don't have medical reasons why you can't take them. These medicines can make heart problems worse in some people, so you should not take them if you are taking nitrate medicines, such as nitroglycerin. Check with your health professional before taking these medicines. Also, you can try a device for improving erections before you try medicine.
• Medicines for digestive problems. The type of medicine will depend on the problem you're having. For example, if you have gastroparesis, you may take metoclopramide (Reglan), domperidone (available in Europe and Canada), or erythromycin.
• Nonprescription pain relievers, creams, or prescription oral or injection medicines if you have pain from peripheral neuropathy.
• Statins (such as lovastatin and simvastatin) to help decrease "bad" cholesterol (LDL).

Medication Choices

For your diabetes:

Insulin

For some complications:

Angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) for diabetic nephropathy or cardiovascular disease

Aspirin after a heart attack or stroke or for prevention

Medicines for erection problems (such as Viagra, Cialis, or Levitra). These medicines can make heart problems worse in some people, especially those who are taking nitrate medicines (such as nitroglycerin). Check with your health professional before taking these medicines.

What To Think About

Take cholesterol-reducing medicines, if you have high cholesterol, to keep your LDL cholesterol level less than 100 mg/dL (2.60 mmol/L), your triglyceride level less than 150 mg/dL (1.7 mmol/L), and if possible, your HDL cholesterol level more than 40 mg/dL (1.15 mmol/L) in men. Women may want to consider an HDL of more than 50 mg/dL (1.40 mmol/L). For more information, see the topic High Cholesterol.

Keep your blood sugar levels within your target range. Your target range may be close to normal blood sugar levels. If you frequently have low blood sugar levels, call your doctor. You and your doctor may decide to make your target range higher than the normal range to avoid low blood sugar emergencies.

Some complications from type 1 diabetes may need surgical treatment. For example, surgery to remove the vitreous gel (vitrectomy) may improve eye disease, diabetic retinopathy.

For more information, see the topics:

• Diabetic Retinopathy.
• Diabetic Nephropathy.
• Diabetic Neuropathy.

For more information on heart and blood vessel disease, see the topics:

• Coronary Artery Disease.
• Heart Attack and Unstable Angina.
• Peripheral Arterial Disease of the Legs.

If you have kidney damage from diabetes and are considering a kidney transplant, you may be eligible for surgery to replace your pancreas (pancreas transplant) at the same time. In either case, you need to meet specific criteria to be considered for the surgery.

The only other surgery for type 1 diabetes is the insertion of working pancreas cells (islet cell transplant) into your body. Islet cell transplant surgery is experimental at this time, and you also need to meet specific criteria.

Surgery

Pancreas transplant surgery

Pancreatic islet cell transplantation

What To Think About

Pancreas and islet cell transplants are very expensive. After having one of these surgeries, you must take immunosuppressive medicines to keep your body from rejecting the new tissue.

The success rate for pancreas transplants is improving because of new surgical techniques and new medicines. However, islet cell transplants may replace pancreas transplants in the future.¹³ People with complications from diabetes aren't always eligible for islet cell transplants.

You may hear about products that promise a “cure” for type 1 diabetes complications. No such cure exists. Also, avoid products for diabetes that are advertised by "satisfied customers." These products or remedies may be harmful and costly. They also might cause you to delay or avoid getting treatments that do work. If you have questions about a product for treating diabetes, check with your local American Diabetes Association office, your doctor, or a diabetes educator.

Other types of meal plans

You may hear of people with diabetes following other types of meal plans or using low glycemic-index foods to control their blood sugar levels. Talk with a registered dietitian before trying one of these plans.

Complementary therapies

Complementary therapies are used in addition to traditional treatment. Acupuncture and biofeedback are examples of treatments that may relieve stress and muscle tension. They can help you feel better overall, but they don't treat the underlying disease. Don't use complementary therapies alone to treat your diabetes or its complications. Ask your health professional which therapies might help in your particular situation.

Talk with your health professional before using these or other complementary or alternative therapies:

• Acupuncture
• Biofeedback
• Chiropractic therapy
• Herbal medicines and natural substances, such as antioxidants, vanadium, magnesium, or chromium. Soluble fiber may help keep your blood sugar levels close to a normal range.
• Osteopathy

Online Resource

Organizations

• Diabetic Nephropathy
• Diabetic Neuropathy
• Diabetic Retinopathy
• Type 1 Diabetes
• Type 1 Diabetes: Children Living With the Disease
• Type 1 Diabetes: Living With the Disease
• Type 1 Diabetes: Recently Diagnosed
• Type 2 Diabetes
• Type 2 Diabetes in Children
• Type 2 Diabetes: Living With Complications
• Type 2 Diabetes: Living With the Disease
• Type 2 Diabetes: Recently Diagnosed

Citations

1. Tabibiazar R, Edelman S (2003). Silent ischemia in people with diabetes: A condition that must be heard. Clinical Diabetes, 21(1):5–9.

2. American Diabetes Association (2006). Standards of medical care in diabetes—2006. Clinical Practice Recommendations 2006. Diabetes Care, 29(Suppl 1): S4–S42.

3. American Diabetes Association (2004). Retinopathy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84–S87.

4. American Diabetes Association (2004). Nephropathy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79–S83.

5. American Diabetes Association (2004). All About Diabetes. Available online: http://www.diabetes.org/about-diabetes.jsp.

6. Zochodne DW (2001). Peripheral nerve disease. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 466–487. Hamilton, ON: BC Decker.

7. American Diabetes Association (2004). Hypertension management in adults with diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S65–S67.

8. American Diabetes Association (2004). Preventive foot care in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S63–S64.

9. Nathan DM (2003). Isolated pancreas transplantation for type 1 diabetes. JAMA, 290(21): 2861–2863.

10. American Diabetes Association (2004). Aspirin therapy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S72–S73.

11. American Diabetes Association (2004). Smoking and diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74–S75.

12. Sigal R, et al. (2005). Prevention of cardiovascular events in diabetes, search date May 2006. Online version of Clinical Evidence (14): 1–23.

13. Sutherland DE, et al. (2001). Lessons learned from more than 1,000 pancreas transplants at a single institution. Annals of Surgery, 233(4): 463–501.

Other Works Consulted

• ACE Inhibitors in Diabetic Nephropathy Trialist Group (2001). Should all patients with type 1 diabetes mellitus and microalbuminuria receive angiotensin-converting enzyme inhibitors? Annals of Internal Medicine, 134(5): 370–379.

• Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group (2002). Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA, 287(19): 2563–2569.

• Gerstein HC, et al. (2001). Cardiovascular disease. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 488–514. Hamilton, ON: BC Decker.

• Goguen JM, Leiter LA (2001). Alternative therapy: The role of selected minerals, vitamins, fiber, and herbs in treating hyperglycemia. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 295–322. Hamilton, ON: BC Decker.

• Harvey DT (2001). Classification and risk of musculoskeletal impairment associated with diabetes. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 523–530. Hamilton, ON: BC Decker.

• Heaton JPW, et al. (2001). Erectile dysfunction. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 531–544. Hamilton, ON: BC Decker.

• Ludwig DS (2002). The glycemic index: Physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA, 287(18): 2414–2423.

• Pickup J, Keen H (2002). Continuous subcutaneous insulin infusion at 25 years. Diabetes Care, 25(30): 593–598.

• Steele AW (2001). Kidney disease. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 429–465. Hamilton, ON: BC Decker.

Author:	Robin Parks, MS	Last Updated November 22, 2006
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Matthew I. Kim, MD - Endocrinology & Metabolism
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information. For more information, click here.