This topic provides
information for people who have complications from diabetes, such as eye,
heart, blood vessel, nerve, or kidney disease. If this topic does not answer
your questions, see:
Type 2 Diabetes, if you want to learn about type 2
diabetes but do not have the disease.
Type 2 Diabetes: Living With the Disease, if you have type 2 diabetes. If you have not read the
topic Type 2 Diabetes: Recently Diagnosed, you may want to read it
first.
Type 2 diabetes is a
lifelong disease that affects the way your body uses food for energy. The
disease develops when the cells of the body become resistant to insulin or when
the pancreas cannot make enough insulin. Insulin is a
hormone that helps your body's cells get the energy they need from sugar. When
insulin is not able to do its job, too much sugar builds up in your blood. Over
time, this extra sugar in your blood can lead to problems with your
eyes, heart, blood vessels, nerves, and kidneys. It also makes you more likely
to get severe illnesses or infections. When diabetes causes other problems,
they are called complications.
What is it like to live with the complications?
Diabetes and its complications can change your life. Living with health
problems caused by diabetes can be an ongoing struggle. It is a lot of work to
monitor your health, keep up with your doctor appointments, and control your
blood sugar. You may not always do everything exactly right, and it is normal
to feel frustrated and sad at times. But don't give up. People with health
problems from diabetes can still live full lives. If you are having trouble
coping, talk to your doctor. Counseling or a diabetes support group may also
help.
Diabetic neuropathy. This is a nerve disease that can affect your internal organs
as well as your ability to feel touch and pain, especially in your feet.
What are the symptoms?
Your symptoms will vary
depending on which complications you have.
Eye disease can cause vision problems,
blindness, or (rarely) pain in your eyes.
Heart disease can cause
chest pain (also called
angina) or shortness of breath when you exercise. You
may have other symptoms, such as dizziness or lightheadedness, shoulder or
stomach pain, or a racing heartbeat. Some people don't have any symptoms until
they have a heart attack or a stroke.
Circulation problems in your
legs and feet (peripheral arterial disease) can cause changes in skin color,
less feeling in your legs and feet, and leg cramps during
exercise.
Nerve disease causes different symptoms depending on
which nerves are affected.
If the nerves related to feeling and
touch are affected, it can cause tingling, numbness, tightness, burning, or
shooting or stabbing pain in your feet, hands, or other parts of your body,
especially at night. It is possible that you may not notice an injury,
especially on your foot, until a severe infection develops. A bad foot
infection can spread up your leg and into your bones. If this happens, the
affected limb may need to be removed (amputated).
If the nerves
that control internal organs are damaged, you may have digestion, bladder, or
sexual problems. You may also sweat a lot or too little, feel dizzy or weak, or
faint when you stand up. It may become hard to tell when your blood sugar is
low.
Kidney disease may not cause any symptoms at first. As time
goes on, you may have swelling in your feet and legs and, later, throughout
your body. It can also cause high blood pressure over time.
How are they treated?
The treatment for
complications focuses on stopping or at least slowing down the damage.
Depending on the problem, treatment may include medicine, surgery, or other
therapies. Early treatment for a complication can help slow the damage and may
prevent other problems.
Here are eight steps that people with
diabetes can take to help keep health problems from getting worse.
Keep your blood sugar as close to normal as
possible. Part of your daily routine includes checking your blood sugar levels
regularly as advised by your doctor.
Eat a balanced diet and, if
you are overweight, reduce your calorie intake so that you can lose some
weight. Losing as little as 10 to 20 pounds can improve your blood sugar
levels. There are many ways to manage how much and when you eat. Your doctor, a
diabetes educator, or a dietitian can help you find a plan that works for you.
Making these lifestyle changes may make you feel better and help control your
blood sugar.
Exercise regularly. Aim for at least 2½ hours a week of
moderate activity. Exercise helps control your blood
sugar by using glucose for energy during and after activity. It also helps you
to stay at a healthy weight, lower your total
cholesterol, raise your
HDL (good) cholesterol, and lower
high blood pressure.
If you are age 40 or older, talk to your doctor about taking a
low-dose aspirin each day. This may help prevent heart attack, stroke, or other
large blood vessel disease.
Don't smoke. Smoking increases your risk for heart attack,
stroke, and many other serious problems.
Control your cholesterol
and keep your blood pressure lower than 130/80 by exercising regularly, eating
a balanced diet, and taking medicine if necessary.
Take care of your feet. Wash and dry them carefully every day,
and look for any sores or injuries that you may not feel because of nerve
damage.
Have regular checkups every 3 to 6 months (or more often if
needed), and watch for signs of other problems. During these visits, your
doctor will review your treatment and look for other problems. Also be sure to
see your eye doctor and dentist regularly.
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Health Tools help you make wise health decisions or take action to improve your health.
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Complications from
type 2 diabetes may be caused by one or all of the
following:
Damage to the lining of the blood vessels
throughout your body, contributing to development of
plaque
Damage to the nerves that reduces
or blocks their ability to send messages to your organs, legs and arms, and
other parts of your body. Nerve damage can also affect information getting back
to the brain.
Changes to your
immune system that decrease your body's ability to
fight infection
Damage to the filtering cells in the kidneys,
causing a buildup of toxins
The damage results from hormonal and cellular changes
caused by excess sugar (glucose) in your body.
Symptoms
Your symptoms depend on which complication
of
type 2 diabetes you have.
Eye disease
Diabetic retinopathy in its early stages does not
noticeably affect your vision. But if it's not treated early, diabetic
retinopathy can cause symptoms such as:
Blurred or distorted vision or difficulty
reading. This may be caused by
macular edema or other changes in the retina. High
blood sugar levels may cause temporary blurred vision, which will clear up
after the level returns to a
normal or near-normal range. It may take several hours
after blood sugar has been corrected for your vision to return to normal.
Contact your health professional if vision changes last 12 to 24
hours.
Partial or total loss of
vision, or a shadow or veil across your field of vision. These symptoms also
are caused by retinal detachment or bleeding in the vitreous gel.
Symptoms of
transient ischemic attack (TIA)-a temporary
interruption of blood flow to part of the brain and a warning sign of an
impending stroke-include:
Weakness on one side of the body, or
inability to move a part or all of one side of the body, such as the face, arm,
and leg.
Numbness, tingling, or a feeling of
heaviness.
Difficulty speaking or understanding
words.
Loss of vision or changes such as blurring or double
vision.
Symptoms of peripheral arterial disease include:
Intermittent claudication, a tightness or squeezing pain in the calf, thigh, or
buttock during exertion, such as walking.
Decreased leg strength
and poor balance when standing.
Symptoms of
peripheral neuropathy (affecting the nerves that
control sensation, touch, and movement) include:
Tingling, numbness, tightness, burning, or
shooting or stabbing pain that starts in the feet and may spread to the legs,
hands, and arms. Usually, symptoms develop in the toes first and are worse in
the evening. Ulcers and infection may develop in the feet. Bone and joint
deformities also can develop, especially in the feet (Charcot foot).
Greatly reduced or greatly increased sensitivity to
temperature changes and a sense of pain with light touch.
Weakness
and loss of balance and coordination.
Symptoms of
autonomic neuropathy (affecting the nerves that
control internal functions) include:
Digestive problems, such as frequent
bloating, belching, constipation, nausea and vomiting, diarrhea, and abdominal
pain. These symptoms may indicate that you have
gastroparesis.
Temperature regulation
problems, including profuse sweating on your chest, face, or neck at night or
while eating certain foods, such as spicy foods and cheese. Or you may have
reduced sweating, especially in your feet and legs.
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.
The only sign of
diabetic nephropathy in its early stage is very small
amounts of protein leaking into the urine (microalbuminuria). This can be
detected only by a urine test for microalbumin. Treatment at this stage can
delay progression and prevent symptoms from developing. But if your kidney
disease progresses, you may have:
Increasing tiredness or
fatigue.
Swelling (edema) in your feet and legs and later
throughout your body.
Increasing blood pressure.
Large
amounts of protein leaking into your urine (macroalbuminuria). Frothy or foamy
urine can be a sign of excess protein in your urine.
Kidney disease increases your risk of forming blood
clots. As nephropathy gets worse, kidney failure develops. Your kidneys become
severely damaged, and they may not eliminate insulin from your body as quickly.
Insulin can then build up in your blood and cause low blood sugar. Your insulin
dose will have to be adjusted. You also may need to lower the dose of, or stop
taking, other medicines. For instance, the oral diabetes medicine metformin can
be deadly in people who have kidney failure.
You may have developed one or more
complications from
type 2 diabetes before you were diagnosed. This can
happen if you had diabetes for several years before being diagnosed. If your
complication progresses, it may cause serious disability or may shorten your
life.
Diabetic neuropathy can lead to a variety of problems. Peripheral neuropathy
(affecting sensations and touch) along with blood vessel disease in the legs
can lead to foot problems, including a deformity called
Charcot foot, or osteomyelitis, a severe bone
infection that may require
amputation. Autonomic neuropathy (affecting internal
functioning) can lead to many different problems, such as
gastroparesis,
hypoglycemia unawareness, and erection problems. For
more information, see the topic
Diabetic Neuropathy.
Factors that increase your
risk for complications from
type 2 diabetes include:
Having persistently high blood sugar over time. The higher your blood sugar and the longer it remains
too high, the greater your risk of developing complications.
Having the disease for a long time. The longer you have
diabetes, the more likely you are to develop complications, even if blood sugar
levels are controlled.
Diabetic retinopathy
develops in more than 60% of the people with type 2 diabetes by 20 years after
diagnosis.3
Most people with diabetes
develop some
diabetic neuropathy over the years, but only about 13%
to 15% have noticeable symptoms.4
Having one complication.
You are at a higher risk for developing more complications from diabetes if you
already have a complication. For example, your risk of having diabetic
nephropathy is much higher if you already have diabetic
retinopathy.
Other risk factors. Smoking,
psychiatric disorders (such as
depression),
high blood pressure,
high cholesterol, or a family history of complications
from diabetes may increase your risk for developing a complication. Not having
health insurance coverage for supplies and other medical expenses related to
diabetes care can contribute to poorer control of the disease and the
development of complications.
When to Call a Doctor
Call 911 or other emergency services immediately if you:
Lose consciousness or become very sleepy
unexpectedly. You may have low blood sugar, called
hypoglycemia. While you wait for emergency help,
follow:
Are drowsy, confused, and breathing fast, and
your breath smells fruity. You may have high blood sugar, called hyperglycemia.
A life-threatening condition called diabetic ketoacidosis could be
present.
Have new or sudden vision loss. You may have a
retinal detachment or bleeding within the eye.
Have chest discomfort or pain that is
crushing, squeezing, or feels like a heavy weight on the chest. You could be
having a
heart attack. Other symptoms of
a heart attack include:
Sweating.
Shortness of
breath.
Nausea or vomiting.
Pain that spreads from the
chest to the back, neck, jaw, upper belly, or one or both shoulders or arms.
The left shoulder and arm are more commonly affected. See a picture of areas
that may be affected by
chest pain.
Dizziness,
lightheadedness, or feeling like you are going to
faint.
A fast, slow, or irregular heartbeat.
Note: If you
have these symptoms, you should immediately chew 1 adult-strength aspirin (325
mg) or 4 low-dose aspirin (80 mg each) before emergency medical personnel such
as paramedics arrive. This can help to prevent a blood clot. Be sure to tell
emergency personnel that you took aspirin.
Have any loss of function. You could be having a
stroke. Signs of a stroke include:
Numbness, weakness, or inability to move
(paralysis) the face, arm, or leg, especially on one side of the
body.
Trouble seeing in one or both eyes, such as dimness,
blurring, double vision, or loss of vision.
Confusion or trouble
speaking or understanding.
Trouble walking, dizziness, or loss of
balance or coordination.
A severe headache with no known
cause.
Call your doctor immediately if you
have any of the following symptoms of a new or worsening complication:
Blurred or distorted vision; seeing
floaters or
flashes of light, large floating red or black spots,
or large areas that look like floating hair, cotton fibers, or spiderwebs; or
pain in the eyes
A wound that won't heal or that looks
infected
Call your doctor if you:
Are having high blood sugar levels persistently
or frequently. Your treatment may need to be changed.
Have burning
pain, numbness, or swelling in your feet or hands.
Have frequent bloating, belching, constipation, nausea and
vomiting, diarrhea, and belly pain, which may indicate
gastroparesis.
Have profuse sweating or
reduced sweating.
Feel dizzy or weak when you sit or stand up
suddenly.
Have trouble sensing when your bladder is full or trouble
emptying your bladder completely.
You need to have regular exams and
tests to monitor the progress of your complication from
type 2 diabetes and to screen for other complications
that may develop.
Schedule of exams and tests for diabetes complications
A spot urine or 24-hour urine test, to
check the total amount of protein leaking from your kidneys over 24 hours. A
result of 300 mg or greater of protein in 24 hours indicates that the kidneys
are leaking large amounts of protein (macroalbuminuria).5
Blood
electrolyte tests, to evaluate whether your kidneys
are maintaining normal electrolyte balance.
If you develop kidney failure, you may need other
tests. For more information, see the topic
Chronic Kidney Disease.
Your blood pressure checked to see
whether it is rising. Your blood pressure should be less than 130/80 mm
Hg.6
Every 1 to 2 years or more often, if indicated, have
a:5
Cholesterol and triglyceride level test, to evaluate
cholesterol levels in your bloodstream. Your LDL cholesterol level needs to be
less than 100 mg/dL or aim for keeping it at 70 mg/dL, your triglyceride level
needs to be less than 150 mg/dL, and if possible, your HDL cholesterol level
needs to be more than 40 mg/dL for men, and more than 50 mg/dL for women.
Physical examination to check for your
response to light touch, pressure, temperature, and vibration, particularly in
your feet and legs. Simple tests can be used to screen for loss of sensation.
These tests should be done on both feet.
Touching the end of your toe with a
thin plastic fiber (monofilament test) can assess your sense of light touch or
pressure.
A cold metal tuning fork may be held to your leg to
evaluate your sensation of temperature.
A vibrating tuning fork may
be touched to your foot to assess your sensation of vibration.
Test of muscle strength and reflexes,
especially those in your ankles and knees.
Careful examination of
your feet for infections, injuries, or bone and joint problems. A complete
examination of your feet should be done at least once a year.7
Blood pressure and pulse check when lying down,
sitting, and standing.
As indicated, have:
Electromyogram (EMG), to measure how well and how
quickly particular nerves and muscles are working.
Nerve conduction
studies, to test how well specific nerves conduct electrical impulses.
Tests for autonomic neuropathy (which affects
internal functioning) are specific to your symptoms, such as:
Ultrasound of the bladder, X-ray of the
entire urinary system (intravenous pyelogram), or a cystometrogram (which
measures bladder storage capacity), if you have a problem with bladder
control.
Gastric emptying study to evaluate the speed at which your
stomach empties. Nerve damage from diabetes (gastroparesis)
can slow this rate.
Since persistent high blood sugar levels are directly
related to the development of complications from diabetes, have a
hemoglobin A1c test every 3 to 6 months to monitor
your blood sugar control.
Treatment of your complications
of
type 2 diabetes depends on the stage of the
disease.
In general, keeping your blood sugar levels in a
normal or near-normal range can prevent or slow the
worsening of your complication and reduce the risk of developing new ones.
Keeping blood sugar under control can help protect your vision and kidney
function even before you develop any symptoms of eye or kidney
complications.
You should see your health professional regularly
to review your treatment and to have screening exams and tests for
complications.
If you are age 40 or older, talk to your health
professional about taking a low-dose aspirin daily to help prevent
heart attack,
stroke, or other large blood vessel disease (macrovascular disease). People with diabetes are 2 to
4 times more likely than people who don't have diabetes to die from heart and
blood vessel diseases.8
Effective
treatment of
high blood pressure and
high cholesterol can help decrease your risk for
worsening of complications.
Stopping smoking and limiting alcohol to one drink a
day for women and two drinks a day for men also can help.
Keep all appointments with your eye
specialist, and call if you notice any changes in your vision. Early detection
and treatment of any changes can help prevent vision loss.
Early (nonproliferative) diabetic retinopathy
should be closely watched but may not need treatment right away. Laser
treatment or surgical removal of the
vitreous gel (vitrectomy) may be needed if the
macula has been damaged by swelling (macular
edema).
Late-stage (proliferative) diabetic retinopathy may require
laser treatment or vitrectomy.
If you have severe vision loss, use
vision aids to help you do as much of your diabetes
care and remain as active as possible. Your local or state organization for the
visually impaired can help you find appropriate vision aids.
Don't
smoke. Smoking increases your risk for heart attack.
Control your
blood pressure. Keep it at 130/80
millimeters of mercury (mm Hg) or lower. Often, more
than one blood pressure medicine will be necessary in addition to lifestyle
changes. Blood pressure medicines that can be useful include:
Diuretics, angiotensin-converting enzyme
(ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers, or
calcium channel blockers. 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, you may try some lifestyle or behavioral therapy for 3 months before
starting medicine.5 For more information, see the
topic
High Blood Pressure (Hypertension).
Statins to reduce
high cholesterol. Strive for a goal of less than 100
milligrams per deciliter (mg/dL) or aim for keeping it at 70 mg/dL for
low-density lipoprotein (LDL), or "bad," cholesterol.
High-density lipoprotein (HDL)-the "good"
cholesterol-should be more than 40 mg/dL for men, and more than 50 mg/dL for
women.
Triglycerides should be less than 150 mg/dL. A low-fat
diet, exercise, and weight loss can lower your cholesterol, but you may need to
take lipid-lowering medicines, such as statins, to reach your goals. Statins
reduce LDL levels and the risk of heart disease in people with
diabetes.9 They also have been shown to reduce the
risk of heart attack and stroke by one-third in people with diabetes, even
those who do not have high LDL levels or existing heart disease.10
For more information, see the topic
High Cholesterol.
Keeping your blood sugar levels within a
normal or near-normal range is the only way to stop or
slow the progression of neuropathy.
If you have
peripheral neuropathy, you may take medicines (such as
nonprescription pain relievers, creams, or prescription oral or injection
medicines) to relieve pain. You also may try
physical therapy or
acupuncture to relieve pain and improve your physical
functioning, mood, and mental well-being.
You also can make
changes in your home to reduce the risk of hurting yourself because of
diminished sensation. These include lowering the water temperature in your
home, using pot holders to avoid burns, and removing clutter that can cause
falls. For more information on making life easier when you have neuropathy, see
the Home Treatment section of this topic. Also, see the topic
Diabetic Neuropathy for more on this
complication.
Early detection and treatment of kidney
disease can help prevent worsening of your kidney function. Treatment involves
taking medicines that can lower blood pressure (and can protect your kidneys
even if you do not have high blood pressure), keeping your blood sugar under
control, and possibly limiting the amount of protein in your diet.
Foot care is important for
people with diabetes. You need to inspect your feet every day and protect them
from injury. If you have poor eyesight, have someone else check your feet. If
you develop serious infections or bone and joint deformities, you may need
surgery (even
amputation) to treat those problems.
To
protect your feet:
Avoid exercise that could injure your feet.
Walking is fine, but jogging may be too rough.
Make sure bathwater
is not too hot.
Wash and moisturize your feet every
day.
Do not walk barefoot.
Wear cotton socks, and wear
shoes that fit you well.
Check your shoes for any loose objects or
rough edges before you put them on.
Get early treatment for any
foot problem, even a minor one. Call your doctor at the first sign of a problem
with your feet. Blisters, small cuts, or other problems that may seem minor can
quickly become more serious.
For more information on protecting your feet, see:
Make every effort to keep your
blood sugar levels within a normal or near-normal range to slow the progression
of your complication and reduce your risk for developing others. Eat a balanced
diet with the calories you need to help you stay at a healthy weight. Or if you
are overweight, eat a balanced diet and reduce your calories to help you lose
some weight. Get regular physical exercise, and take your prescribed oral
diabetes medicine or insulin. For more information, see the Home Treatment
section of the topic
Type 2 Diabetes: Living With the Disease.
You can prevent or delay the development
of complications from
type 2 diabetes by keeping your blood sugar levels
within a
normal or near-normal range (tight control).
Scientific evidence shows that tightly controlling blood sugar levels:
Prevents the development and progression of
small blood vessel (microvascular) disease and nerve disease
(neuropathy).
Slightly reduces your risk for heart and large blood
vessel (macrovascular) disease from diabetes.
If you are age 40 or older, talk to your health
professional about taking a low-dose aspirin daily to help prevent
heart attack,
stroke, or other large blood vessel disease (macrovascular disease). People with diabetes are 2 to
4 times more likely than people who don't have diabetes to die from heart and
blood vessel diseases.8
Prevention and early detection
To prevent and
detect complications early:
Don't
smoke. If you quit smoking, you will reduce your risk
for developing early damage to the blood vessels caused by diabetes.11 For information on how to quit smoking, see the topic
Quitting Smoking.
Inspect your feet daily,
wear properly fitted shoes, do not go barefoot or use home remedies, and have
yearly foot examinations. If you have poor vision, have someone else examine
your feet daily and help you with foot and toenail care. Keep pathways in your
home clear of objects that could cause a fall.
Report blurred
vision,
floaters, or flashes of light to your doctor
immediately, and have yearly eye exams by an
ophthalmologist or
optometrist.
Have yearly urine tests for
protein. At the first sign of small amounts of protein (microalbuminuria), talk
with your doctor about whether you can take a
high blood pressure medicine, such as an
angiotensin-converting enzyme (ACE) inhibitor or an angiotension II receptor
blocker (ARB).
Get effective treatment for high blood pressure and
high cholesterol. You may take a
diuretic, ACE inhibitor, ARB, or other medicines to
keep your blood pressure consistently below 130/80 millimeters of mercury (mm
Hg). You also may need to take cholesterol-lowering medicines such as statins
(for example, Lipitor, Zocor, or Pravachol) to reach your goals.9
Have
yearly exams to test for touch and feeling sensations in your feet and legs and
report any symptoms of digestive, sexual, or urinary problems or signs of
hypoglycemia unawareness as soon as you notice
them.
Other preventive measures
Keep your immunizations up to date. Diabetes
affects your
immune system, increasing your risk for having a
serious case of the flu,
pneumonia, or other infections. For the recommended
immunization schedule, see the topic
Immunizations.
Early treatment of complications can help save your vision, slow the rate
of kidney failure, and reduce the risk of amputation. Keep all appointments
with your doctor, specialists, and other health professionals. The examinations
and tests done during these visits can detect early signs of complications and
monitor the progression of existing complications.
Take the
following measures at home to help control complications.
Call your
ophthalmologist or
optometrist if you notice any changes in your vision.
Early detection and treatment of any changes can help prevent vision
loss.
Call your
ophthalmologist if you have retinopathy and become pregnant. Retinopathy can
become worse rapidly during pregnancy.
If you have severe vision
loss from diabetic retinopathy,
vision aids can help you do as much of your diabetes
care as possible. These include home glucose monitors with large-print displays
and talking glucose monitors. Your local or state organization for the visually
impaired can help you find appropriate vision aids.
If
it affects your ability to feel (peripheral neuropathy):
Turn down the temperature of your hot-water
heater and use a bath thermometer or have someone test your bathwater to see
whether it is too hot.
Do not go barefoot, even in the
house.
Do not use an electric blanket.
To prevent
falls, arrange your furniture so that walkways are free of clutter.
To avoid burning your hands, use pot holders when you
cook.
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 or medicines
such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) for
erection problems or a lubricating cream for vaginal dryness if you have sexual
problems. Check with your doctor to find out whether you can take these
medicines.
Check your blood sugar level more often if you have
hypoglycemia unawareness, especially before
driving.
If it affects one nerve (focal neuropathy):
Wear a joint splint, if your health
professional advises this.
Take breaks when you are doing
activities that require repetitive movements.
Make sure your work
environment provides appropriate support.
Take your blood pressure medicines, if
prescribed. Your blood pressure should be 130/80 millimeters of mercury (mm Hg)
or lower.
Get no more than 10% of your daily calories from
protein.
Limit salt in your diet, because it makes your body
retain fluid and can increase your blood pressure.
Avoid
nonsteroidal anti-inflammatory drugs (NSAIDs), except
aspirin (a single low-dose aspirin daily is fine). NSAIDs to avoid include
ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve). These
medicines can harm your kidneys.
Foot care is important for people
with diabetes. You need to inspect your feet every day and protect them from
injury. If you have poor eyesight, have someone else check your feet.
To protect your feet:
Avoid exercise that could injure your feet.
Walking is fine, but jogging may be too rough.
Make sure that
bathwater is not too hot.
Check your shoes for any loose objects or
rough edges before you put them on.
Get early treatment for any
foot problem, even a minor one. Call your doctor at the first sign of a problem
with your feet. Blisters, small cuts, or other problems that may seem minor can
quickly become more serious.
For more information on protecting your feet, see:
You may be taking more than one oral
medicine to treat your
type 2 diabetes. You may be taking insulin by
injection or through an
insulin pump alone or along with oral diabetes
medicine. Taking these medicines as prescribed can help keep your blood sugar
levels within your
target range. For information on these medicines, see
the Medications section of the topic
Type 2 Diabetes: Living With the Disease.
You may need to take:
Aspirin. If you are age 40 or older, talk to your health
professional about taking a low-dose aspirin daily to prevent
heart attack,
stroke, or other large blood vessel disease (macrovascular disease).12
A
diuretic, an angiotensin-converting enzyme (ACE)
inhibitor, angiotensin II receptor blocker, or other medicine if you have
high blood pressure or have protein in your urine.
These medicines can slow or prevent further damage to your
kidneys.
Medicines for digestive problems. The type of medicine
will depend on the problem you are 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.
Medicines such as
sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) if you have
erection problems. These medicines can make heart problems worse in some
people, especially those who take nitrate medicines (such as nitroglycerin).
Check with your doctor before taking any of these medicines.
Medication Choices
Medicines for some
complications include:
Aspirin after a
heart attack or stroke or to prevent these.
Statins such as atorvastatin (Lipitor), simvastatin
(Zocor), or pravastatin (Pravachol), to help prevent heart attack or
stroke.
Fibrates such as gemfibrozil (Lopid) or fenofibrate
(Tricor) to help lower triglycerides and increase HDL levels.
What to Think About
Keep your blood sugar levels
tightly within a normal or near-normal range by taking your oral diabetes
medicine (and, in some cases, insulin) as prescribed.
If you have high blood
pressure, take medicines to keep your blood pressure consistently below 130/80
mm Hg. 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, you may try some lifestyle or behavioral therapy for 3 months before
starting medicine.6 For more information, see the
topic
High Blood Pressure (Hypertension).
Avoid products that promise a cure
for
type 2 diabetes complications or are advertised by
testimonials of satisfied customers. These products or remedies may be harmful
and costly. If you have questions about a product for diabetes, check with your
local American Diabetes Association office, your doctor, or a diabetes
educator.
Other types of meal plans
Talk with a
registered dietitian before following other types of
meal plans or using low
glycemic index foods to prevent high blood sugar
levels after meals.
Complementary therapies
Other types of treatment
for diabetes complications are provided by therapists or others who do not
operate within mainstream medical practice. Their unconventional approaches may
be attractive, particularly if you have complications from diabetes. None of
these complementary therapies has been proven to be effective in treating
diabetes or its complications. But you may benefit from safe nontraditional
therapies that complement conventional medical treatment for your
disease.
Do not use complementary therapies alone to treat your
diabetes or its complications.
Talk with your doctor if you are
using the following or other complementary or alternative therapies:
The American Academy of Ophthalmology (AAO) is an association of
medical eye doctors. It provides general information and brochures on eye
conditions and diseases and low-vision resources and services. The AAO is not
able to answer questions about specific medical problems or conditions.
American Association of Diabetes
Educators
100 West Monroe Street
Suite 400
Chicago, IL 60603
Phone:
1-800-338-3633
Fax:
(312) 424-2427
E-mail:
aade@aadenet.org
Web Address:
www.aadenet.org
The American Association of Diabetes Educators is made up of
doctors, nurses, dietitians, and other health professionals with special
interest and training in diabetes care. The Web site can supply the names of
these types of health professionals in your local area.
American Diabetes Association (ADA)
1701 North Beauregard Street
Alexandria, VA 22311
Phone:
1-800-DIABETES (1-800-342-2383)
E-mail:
AskADA@diabetes.org
Web Address:
www.diabetes.org
The American Diabetes Association (ADA) is a national organization
for health professionals and consumers. Almost every state has a local office.
ADA sets the standards for the care of people with diabetes. Its focus is on
research for the prevention and treatment of all types of diabetes. ADA
provides patient and professional education mainly through its publications,
which include the monthly magazine Diabetes Forecast,
books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also
provides information for parents about caring for a child with diabetes.
National Diabetes Education Program
(NDEP)
1 Diabetes Way
Bethesda, MD 20814-9692
Phone:
1-800-438-5383 to order materials (301) 496-3583
E-mail:
ndep@mail.nih.gov
Web Address:
http://ndep.nih.gov
The National Diabetes Education Program (NDEP) is
sponsored by the U.S. National Institutes of Health (NIH) and the U.S. Centers
for Disease Control and Prevention (CDC). The program's goal is to improve the
treatment of people who have diabetes, to promote early diagnosis, and to
prevent the development of diabetes. Information about the program can be found
on two Web sites: one managed by NIH (http://ndep.nih.gov) and the other by CDC
(www.cdc.gov/team-ndep).
National Diabetes Information Clearinghouse
(NDIC)
1 Information Way
Bethesda, MD 20892-3560
Phone:
1-800-860-8747
Fax:
(703) 738-4929
TDD:
1-866-569-1162 toll-free
E-mail:
ndic@info.niddk.nih.gov
Web Address:
http://diabetes.niddk.nih.gov
This clearinghouse provides information about research
and clinical trials supported by the U.S. National Institutes of Health. This
service is provided by the National Institute of Diabetes and Digestive and
Kidney Disease (NIDDK), a part of the National Institutes of Health (NIH).
National Library Service for the Blind and Physically
Handicapped (NLS), Library of Congress
1291 Taylor Street NW
Washington, DC 20011
Phone:
1-888-NLS-READ (1-888-657-7323) (202) 707-5100
Fax:
(202) 707-0712
TDD:
(202) 707-0744
E-mail:
nls@loc.gov
Web Address:
www.loc.gov/nls/index.html
The National Library Service has established a national network of
cooperating libraries to provide a free library program of braille and audio
materials. Materials, including some magazines, in braille, large print, or
cassette can be borrowed postage-free by people who are eligible for the
service.
Prevent Blindness America
211 West Wacker Drive
Suite 1700
Chicago, IL 60606
Phone:
1-800-331-2020
E-mail:
info@preventblindness.org
Web Address:
www.preventblindness.org
Prevent Blindness America assists the visually impaired and
provides consumer information on vision problems and vision aids. Many states
have local affiliates.
National Institutes of Health (accessed March 2007). Diabetic retinopathy fact sheet. Available online: http://www.nih.gov/about/researchresultsforthepublic/DiabeticRetinopathy.pdf.
American Diabetes Association (2004). Nephropathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79-S83.
American Diabetes Association (2004). Retinopathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84-S87.
Zochodne DW (2001). Peripheral nerve disease. In HC
Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care,
pp. 466-487. Hamilton, ON: BC Decker.
American Diabetes Association (2008). Standards of
medical care in diabetes. Diabetes Care, 31(Suppl 1):
S12-S54.
American Diabetes Association (2004). Hypertension
management in adults with diabetes. Clinical Practice Recommendations 2004.
Diabetes Care, 27(Suppl 1): S65-S67.
American Diabetes Association (2004). Preventive foot
care in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S63-S64.
American Diabetes Association (2004). Aspirin therapy
in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S72-S73.
American Diabetes Association (2004). Dyslipidemia
management in adults with diabetes. Clinical Practice Recommendations 2004.
Diabetes Care, 27(Suppl 1): S68-S71.
Collins R, et al. (2003). MRC/BHF heart protection
study of cholesterol-lowering with simvastatin in 5,963 people with diabetes: A
randomised placebo-controlled trial. Heart Protection Study Collaborative
Group. Lancet, 361(9374): 2005-2016.
American Diabetes Association (2004). Smoking and
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74-S75.
American Diabetes Association (2008). Standards of
medical care in diabetes. Clinical Practice Recommendations 2008.
Diabetes Care, 31(Suppl 1): S12-S54.
Other Works Consulted
American Diabetes Association (2005). Diabetes
complications and prevention. In American Diabetes Association Complete Guide to Diabetes, 4th ed., pp. 303-335. Alexandria, VA:
American Diabetes Association.
Chalmers KH (2005). Medical nutrition therapy. In
Joslin's Diabetes Mellitus, 14th ed., pp. 611-631.
Philadelphia: Lippincott Williams and Wilkins.
Glaser B, Liebowitz G (2005). Hypoglycemia. In
Joslin's Diabetes Mellitus, 14th ed., pp. 1148-1175.
Philadelphia: Lippincott Williams and Wilkins.
Johnstone MT, Nesto R (2005). Diabetes mellitus and
heart disease. In Joslin's Diabetes Mellitus, 14th ed.,
pp. 975-998. Philadelphia: Lippincott Williams and Wilkins.
Mahimo H, et al. (2005). Effects of diabetes mellitus
on the digestive system. In Joslin's Diabetes Mellitus,
14th ed., pp. 1070-1102. Philadelphia: Lippincott Williams and Wilkins.
McFarlane SI, et al. (2005). Hypertension in diabetes
mellitus. In Joslin's Diabetes Mellitus, 14th ed., pp.
969-974. Philadelphia: Lippincott Williams and Wilkins.
Begg IS, et al. (2001). Eye disease. In HC Gerstein,
RB Haynes, eds., Evidence-Based Diabetes Care, pp.
396-428. Hamilton, ON: BC Decker.
Ganguli SC, Tougas GN (2001). Diabetes and the
gastrointestinal tract. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 545-567. Hamilton, ON:
BC Decker.
Gerstein H, Hunt D (2005). Foot ulcers and amputations
in diabetes, search date September 2004. Online version of Clinical Evidence (13): 1-9.
Grundy SM, et al. (2002). Diabetes and cardiovascular
disease: Lifestyle and medical management of risk factors. AHA Conference
Proceedings. Circulation, 105(18):
E153-E158.
Grundy SM, et al. (2002). Prevention conference IV:
Diabetes and cardiovascular disease. Executive summary. Circulation, 105(18): 2231-2239.
Heaton JPW, et al. (2001). Erectile dysfunction. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 531-544. Hamilton, ON: BC Decker.
Purnell JQ (2005). Obesity. In DC Dale, DD
Federman, eds., ACP Medicine, section 3, chap. 10. New
York: WebMD.
Sigal R, et al. (2004). Prevention of cardiovascular
events in diabetes, search date October 2003. Online version of Clinical Evidence (12): 868-897.
Steele AW (2001). Kidney disease. In HC Gerstein, RB
Haynes, eds., Evidence-Based Diabetes Care, pp. 429-465.
Hamilton, ON: BC Decker.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
National Institutes of Health (accessed March 2007). Diabetic retinopathy fact sheet. Available online: http://www.nih.gov/about/researchresultsforthepublic/DiabeticRetinopathy.pdf.
American Diabetes Association (2004). Nephropathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79-S83.
American Diabetes Association (2004). Retinopathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84-S87.
Zochodne DW (2001). Peripheral nerve disease. In HC
Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care,
pp. 466-487. Hamilton, ON: BC Decker.
American Diabetes Association (2008). Standards of
medical care in diabetes. Diabetes Care, 31(Suppl 1):
S12-S54.
American Diabetes Association (2004). Hypertension
management in adults with diabetes. Clinical Practice Recommendations 2004.
Diabetes Care, 27(Suppl 1): S65-S67.
American Diabetes Association (2004). Preventive foot
care in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S63-S64.
American Diabetes Association (2004). Aspirin therapy
in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S72-S73.
American Diabetes Association (2004). Dyslipidemia
management in adults with diabetes. Clinical Practice Recommendations 2004.
Diabetes Care, 27(Suppl 1): S68-S71.
Collins R, et al. (2003). MRC/BHF heart protection
study of cholesterol-lowering with simvastatin in 5,963 people with diabetes: A
randomised placebo-controlled trial. Heart Protection Study Collaborative
Group. Lancet, 361(9374): 2005-2016.
American Diabetes Association (2004). Smoking and
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74-S75.
American Diabetes Association (2008). Standards of
medical care in diabetes. Clinical Practice Recommendations 2008.
Diabetes Care, 31(Suppl 1): S12-S54.
