Diabetes Series: Control Your Diabetes for Life

Circulars 569A-569J

Authors: Karen Halderson, MPH, RD, CDE Extension Diabetes Coordinator; and Martha Archuleta, PhD, RD Extension Food and Nutrition Specialist.

Circular 569A: What is Diabetes?
Circular 569B: Who Gets Diabetes?
Circular 569C: Healthy Living with Diabetes
Circular 569D: Navigating the Health Care System
Circular 569E: Know Your Numbers
Circular 569F: Diabetes Medications
Circular 569G: Coping with Diabetes
Circular 569H: Exercise for People with Diabetes
Circular 569I: Preventing Complications
Circular 569J: Healthy Feet

Circular 569A: What is Diabetes?

• Diabetes occurs when the body is not able to properly use energy from food.

• There are three main types of diabetes: type 1, type 2, and gestational diabetes.

• Most people who have diabetes have type 2 diabetes.

• Women who have had gestational diabetes are at risk for type 2 diabetes.

• Diabetes can be controlled, but it cannot be cured.

• Diabetes complications are caused by high blood glucose levels.

• Diabetes complications can be prevented.

Diabetes is a disease that occurs when the body is not able to properly use energy from food. The body needs glucose for growth and energy. Glucose is a kind of sugar we get from many of the foods we eat and is absorbed into the blood through the digestive system. Once in the blood, glucose needs to move into cells where it can be used for energy. A hormone called insulin acts like a key to open doors to cells, allowing glucose to enter. Diabetes occurs when either the pancreas doesn't make enough insulin, or the body isn't using insulin effectively. As a result, glucose stays in the blood. Over time, too much glucose in the blood can cause damage to tissues and result in diabetes complications, such as amputations, blindness, kidney disease, heart disease, and nerve and blood vessel damage.

Types of Diabetes

Type 1 diabetes occurs when the pancreas can no longer make insulin. Type 1 usually comes on abruptly and generally occurs in children and adults who are under age 30. Since the body is not capable of making insulin, people with type 1 diabetes need to take daily injections of insulin to stay alive. The causes of type 1 diabetes are not known. Scientists think that type 1 may have many causes: hereditary causes (when someone has parents or other family members with the disease) and causes both inside and outside the body, including viruses.

Type 2 diabetes, the most common form, affects about 90 to 95 percent of the people who have diabetes and seems to be related to being overweight and an inactive lifestyle. Type 2 diabetes seems to have a strong hereditary link. Unlike people with type 1 diabetes, people with type 2 make some insulin, sometimes even too much, but their body doesn't use the insulin properly. Others may not make enough insulin or their cells don't recognize the insulin.

Some people are able to control their blood glucose levels simply by making lifestyle changes: eating a balanced, healthy diet and increasing their physical activity. Other people with type 2 diabetes may also need to take medicines. These medicines can be pills which lower blood glucose levels or improve insulin action, insulin injections, or a combination of the two. Type 2 diabetes usually develops over a long period of time and can develop at any age. In the past, type 2 mainly affected older people. However, today we are seeing type 2 much more often in younger age groups, including in children.

Gestational diabetes begins during pregnancy and disappears after delivery. Women who are overweight, have a family history of diabetes, have given birth to a very large baby, or who are older than 25 are at increased risk of developing gestational diabetes. The American Diabetes Association recommends screening for gestational diabetes in all pregnant women. This screening is usually performed at the end of the second trimester or beginning of the third trimester.

Diabetes Complications

Health problems caused by uncontrolled diabetes—blindness, kidney disease, amputations, and heart disease—can be prevented. The key to preventing complications is to keep blood glucose levels as close to "normal" as possible. Eating a healthy diet, getting daily physical activity, taking medicines as prescribed, and seeing your health care provider regularly can keep diabetes under control.

Diabetes can be controlled—diabetes complications can be prevented!

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Circular 569B: Who Gets Diabetes?

• Twenty-one million Americans have diabetes—one out of three do not know it!

• Symptoms of diabetes can go unnoticed.

• People who have diabetes may not feel sick enough to visit a doctor.

• Some people have a higher risk for developing diabetes than others.

• Diabetes is diagnosed by a simple blood test.

• Early detection and control of diabetes can prevent complications and save lives.

Are You "At Risk" for Diabetes?

Twenty-one million Americans have diabetes. But one-third of the people with the disease don't know that they have it! By knowing your risk (chances) of developing diabetes, you can help your health care provider diagnose diabetes early. Type 2 diabetes often is not diagnosed until disease complications develop. People who have diabetes may not feel sick enough to see a doctor until they begin to experience problems with vision, kidneys, legs and feet, or they have unexplained infections or wounds that won't heal. Diagnosing diabetes early and controlling blood glucose levels can prevent or postpone many diabetes complications.

According to the American Diabetes Association (ADA), the following factors may put you at risk for diabetes:

• age 45 years and above

• overweight

• family history of diabetes (parents or siblings)

• Hispanic, Native American, Asian American, African American, or Pacific Islander

• having delivered a baby weighing more than 9 pounds or having been diagnosed with gestational diabetes

• high blood pressure

• high blood cholesterol or triglyceride levels

If you have one or more of these factors, the ADA recommends annual testing for diabetes.

Signs and Symptoms of Diabetes

Type 2 diabetes is called a silent killer, because people can have the disease for a long time without knowing it. High levels of glucose in the blood (hyperglycemia) develop gradually and can go undetected since symptoms may not be obvious. Diabetes is often discovered only after complications from having high blood glucose levels for a long time have developed. When glucose builds up in the blood, the kidneys work hard to flush out the excess, causing thirst and the need to urinate often. People with untreated diabetes often get hungry and tired, because the body is not able to use food the way it should. High blood glucose levels over a long time are responsible for the cell and tissue damage that causes diabetes complications.

If you are at risk for diabetes, know the signs and symptoms:

• frequent urination

• unplanned weight loss

• unusual thirst

• hunger

• blurred vision

• dry, itchy skin

• sores heal slowly

• tingling or numbness in legs

• cuts or bruises heal slowly

• irritability

• tiredness or drowsiness

Diagnosing Diabetes

Diabetes is diagnosed by your health care provider with a simple blood test. If you have any of the symptoms mentioned above, or if you have any of the risk factors for diabetes, make an appointment to see your health care provider now. Diabetes can be controlled—diabetes complications can be prevented!

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Circular 569C: Healthy Living with Diabetes

By taking an active role in controlling your

• feel better

• have more energy

• prevent diabetes complications

• live longer

Taking control of your diabetes involves:

• eating a healthy diet

• regular physical activity

• taking medications as prescribed by your health care provider

• checking your blood glucose

• taking care of your skin and feet

What are the benefits of choosing to live a healthy life with diabetes? Feeling better and having more energy are short-term benefits. Living longer and preventing diabetes complications are long-term benefits. People who have diabetes can live healthy lives when they take on the day-to-day responsibilities of their own diabetes self-care.

Essentials of Diabetes Self-Care

Diabetes self-care is what people with diabetes do day to day to control blood glucose and prevent diabetes complications. The five basic elements of diabetes self-care are diet, exercise, medications, monitoring, and skin/foot care. As with any habit, such as brushing your teeth after every meal, these diabetes self-care habits will help you maintain good health when done regularly.

Diet: Choosing a balanced diet that is low in fat and high in fiber helps control blood glucose and provides all the nutrients your body needs to stay healthy. People with diabetes must pay special attention to the amount of fats and carbohydrates (the body's primary sources of energy) in their diet. See your dietitian for a meal pattern that fits your lifestyle and eating habits.

Exercise: Daily physical activity helps control weight and blood glucose, and reduces your risks for other chronic diseases like heart disease. The effects of physical activity add up. Several short periods of physical activity done at various times throughout the day can be just as beneficial as one longer period of activity.

Monitoring: Monitoring blood glucose is an essential tool for controlling diabetes. Just as a car speedometer tells how fast or slow you are traveling, your blood glucose levels tell where you are with your diabetes control. Day-to-day blood glucose control is monitored by the use of a glucose meter. Monitoring helps you make decisions about food choices, exercise, medications, and stress. Long-term blood glucose control is measured by your health care provider with a test called hemoglobin A1c.

Medications: Many people with diabetes need to take medications to control blood glucose. Medications should be taken daily as prescribed by your health care provider. Changes in diet, physical activity level, or blood glucose control may require changes in your medications. Visit your health care provider often, especially if you have any changes in your lifestyle or blood glucose control.

Skin/foot care: Diabetes causes changes in nerves and blood circulation, particularly in the lower legs. Amputations, a major diabetes complication, can be prevented. Daily foot care should include looking for sores or cuts, wearing comfortable shoes and socks, and taking care of your skin to prevent blisters, calluses, and cracks.

Other things you can do to stay healthy:

• Don't smoke.

• Learn how to manage stress.

• Learn more about diabetes and diabetes self-care.

• Learn about diabetes resources in your community.

• Get support from friends, family or support groups.

• See your dentist twice a year. Tell your dentist you have diabetes.

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Circular 569D: Navigating the Health Care System

• Diabetes standards of care were first developed 15 years ago to define state-of-the-art diabetes treatment.

• Some people with diabetes do not receive the level of care defined by the diabetes standards of care.

• People who do receive all of the diabetes standards of care are healthier and less likely to develop diabetes complications.

• Many health care providers are not aware of the diabetes standards of care.

• Diabetes education and equipment are covered by most insurance policies.

Diabetes Standards of Care

While diabetes has been known as a disease for at least 2,000 years, it has only been within the last 15 years that research has shown a link between controlling diabetes and preventing or postponing diabetes complications. The American Diabetes Association has developed the Standards of Medical Care for Patients with Diabetes. These standards guide health care providers and patients through the complex process of managing diabetes. The standards define specific tests, treatments, and education that are the basis of state-of-the-art diabetes management.

Diabetes is an ongoing disease that you and your health care provider will manage together for the rest of your life. Some people with diabetes do not receive the level of care defined by the standards of care for diabetes. People who do receive the standards of care control their diabetes better, are less likely to develop diabetes complications, and will live a healthier life. To insure you get the best care possible, visit your provider every three to four months, even if you feel fine.

At each visit, have your provider do the following:

• Check your weight: Changes in weight may require changes in diet, medications, or other care plans.

• Check your blood glucose: Know your "goals" for blood glucose control. Any changes in blood glucose may mean that you need to look at your diet, medications, or other diabetes self-care habits.

• Check your blood pressure: High blood pressure increases your risk for heart attack, stroke, and circulation problems and can worsen eye and kidney damage from diabetes.

• Check your feet: Numbness or burning, infections, sores, calluses, or other problems may require treatment by a podiatrist (foot doctor).

• Review your goals for blood glucose, blood pressure, and blood lipids (cholesterol and triglycerides): Talk about your progress in meeting these goals.

• Visit with a diabetes educator: Ask about your diabetes self-care skills, diet, medications, monitoring, exercise, sick days, or any other concerns.

Two to four times a year:

• Hemoglobin A1c (HbA1c)

Twice a year:

• Dental check-up

Once a year you should also have the following:

• Dilated eye exam to look for diabetic eye disease

• Urine test to check your kidneys

• Blood lipids (cholesterol and triglycerides) and EKG to check your heart health

• Flu vaccination

You also should ask your doctor about a pneumonia shot and a TB test, if you have never had them.

Becoming Your Own Health Care Advocate

When it comes to your health—you take center stage! Take an active role as a consumer in the health care system. Keep records of when you have tests done, what the results were, and what tests need to be done. Many health care providers are not aware of the diabetes standards of care. Use your records to remind your provider about the standards of care to ensure you get the best care possible. Never neglect diabetes self-care or medical treatment due to financial difficulties. Talk to your health care provider about low- or no-cost prescriptions or treatment options. Diabetes education and equipment are now covered by most insurance policies. If you are denied coverage, call your American Diabetes Association at 1-800-DIABETES for help.

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Circular 569E: Know Your Numbers

• Blood glucose levels kept close to "normal" prevent diabetes complications.

• Monitoring is the only way to know how well you are controlling your diabetes.

• You cannot tell what your blood glucose levels are by how you "feel."

• Day-to-day blood glucose control is measured by a glucose meter.

• Long-term blood glucose control is measured by a test called "hemoglobin A1c."

The Diabetes Control and Complications Trial (DCCT) and other studies have shown that the risk of complications can be less when blood glucose levels are kept close to "normal." For people with diabetes, normal blood glucose levels before eating are 90–130 mg/dl and usually go no higher than 140 mg/dl after a meal. High blood glucose levels (above 180) for long periods of time can cause damage to the body, resulting in blindness, kidney disease, nerve damage, circulation problems, and amputations.

Monitoring blood glucose is an important way to control diabetes. Just as a car speedometer tells how fast or slow you are traveling, blood glucose monitoring tells where you are with your diabetes control. Monitoring helps you detect high and low blood glucose levels, and allows you to make decisions about food choices, exercise, medications, and stress management. You cannot tell how well you are controlling your diabetes by how you feel. Monitoring is the only way to know how you are doing.

There are two types of blood glucose tests: finger-stick tests and the hemoglobin A1c or glycated hemoglobin test, which is done by your health care provider.

Blood Glucose Monitoring

Day-to-day blood glucose levels are measured by finger-stick tests with a blood glucose meter. This type of test, which you can do yourself, tells the actual glucose level in your blood at the time you stick your finger. Ideal results are 90–130 mg/dl before meals, and less than 180 mg/dl one to two hours after meals. Women who are pregnant should check with their doctor to set monitoring goals.

Long-Term Blood Glucose Monitoring

Long-term blood glucose control is measured by hemoglobin A1c tests. These tests measure your average blood glucose control over the past three months and should be done at least twice a year, more often if your diabetes is not in good control. Your risk for diabetes complications can be lessened with hemoglobin A1c results of 7 percent or lower.

Finger-stick test tips:

• Your health care provider can teach you how to use a glucose meter. Together you will develop a monitoring plan that includes deciding when and how often to test your blood glucose and setting your blood glucose goals. Check your technique with your provider to make sure you are getting accurate results.

• Testing at different times of the day gives different information about diabetes control, and how your medication, food, exercise and stress level affect blood glucose. The best times to test are when fasting; before meals; one to two hours after meals; at bedtime; before, during and after exercise; and if you are not feeling well.

• Record your test results in a logbook. Make sure you include the date and time of the test and your results. Bring your logbook to all health care visits and review it with your health care provider. Talk with your provider about improving your diabetes control if your blood glucose numbers are too high or too low.

Hemoglobin A1c (HbA1c) test tips:

• Visit your health care provider at least twice a year and ask for a hemoglobin A1c test.

• Ask your provider to explain the test results and help set a goal.

• Keep a record of your test results.

• If your hemoglobin A1c test is too high, talk to your health care provider about ways to improve your diabetes control.

Continuous Glucose Monitoring System:

A sensor is inserted under the skin through a probe. The sensor measures glucose in the interestitial fluid (fluid around the cells). Alarms alert you to high or low blood glucose levels. This system can help people who want to have tight control of their blood glucose or have trouble with low blood glucose.

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Circular 569F: Diabetes Medications

• People with type 1 diabetes are not able to make their own insulin.

• People with type 2 diabetes may need to take diabetes pills or insulin.

• Diabetes pills are not a form of insulin.

• Insulin cannot be taken by mouth.

• All diabetes medicines work better if you eat a healthy diet and exercise daily.

• Low blood glucose is caused by too much medicine, not enough food, or greater than normal exercise without adjusting medications.

Many people can successfully control their diabetes without using medications. If you need diabetes medications, know how and when they work to improve blood glucose control. There are many new medicines available for people with diabetes today. They fall into three main categories: insulin, other injectable medications and oral medications (pills).

Insulin is a hormone made by the pancreas. It acts like a key to open the door for glucose to enter cells, where it is used for energy. If glucose cannot get into the cells, it stays in the blood and causes blood glucose to rise. When glucose moves into the cells, it leaves the blood, lowering blood glucose.

Other injectable medications are now available. One is for people with type 2 diabetes who take oral medications. Another is for people with type 1 diabetes or people with type 2 diabetes who take insulin.

Oral diabetes medications are pills. They are not insulin. Insulin is a protein that is digested if taken by mouth. Oral medications work to lower blood glucose in different ways. They coax the body to make more insulin, help the body use insulin better, stop the liver from making glucose, or slow down how quickly glucose from food gets into the blood. Ask your provider or pharmacist to explain how your diabetes medication works.

People who have type 1 diabetes are not able to make insulin and require injections to stay alive. People who have type 2 diabetes can control their diabetes in many different ways. If detected early enough and if the body still makes insulin, type 2 diabetes can be controlled well by diet and exercise alone. Lifestyle changes, such as eating a healthy diet, taking part in daily physical activity, and watching your weight, often help the body use its own insulin. Over time, the body may lose the ability to make insulin. Your health care provider may prescribe oral medication to control your blood glucose. Oral medication alone may work well for some people, but others may require insulin injections as well.

There are several different types of insulin, each with different characteristics (actions). Types of insulin may differ by when they start to work, when they are most active, and how long they are active.

Ask your provider or pharmacist to explain the action of your insulin. You need this information to plan meals (what and how much to eat) and to time your injections.

Taking Diabetes Medications

Make sure you understand how much medicine to take (dose), and when and how often you should take it. Bring all of your medications to clinic visits, so your provider can make sure there are no problems with the combination of drugs you take. Try to fill all of your prescriptions at the same pharmacy. This way your pharmacist can alert you to any problems. For best results:

• Take your medications as prescribed.

• Take medications at the same time each day as part of your routine, such as when you brush your teeth.

• Keep medications where you can see them to remind you.

• Give yourself cues to remind you to take medicines–leave a note on your bathroom mirror, or in your lunch box.

• Eat a healthy diet.

• Eat meals at the same time each day with the same amounts of food.

• Spread your meals out—three smaller meals are better than one big meal.

• Get some kind of physical activity every day—one to two hours after meals is best.

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Circular 569G: Coping with Diabetes

How well you cope with diabetes depends on how well you:

• Understand diabetes and how it affects your body

• Understand how to control your blood glucose levels

• Communicate with your health care provider

• Understand the diabetes care plan developed with your health care provider

• Understand the emotional ups and downs that come with having diabetes

• Cope with stressful life events

• Use family and social support systems

Meet the Challenge

Once you learn you have diabetes, many things in your life may change. Financial and emotional costs of diabetes self-care, medical treatment, physical disabilities, changes in lifestyle, or hospitalizations can be overwhelming at times. Being prepared for these changes can help you better meet the challenges of having diabetes. Learn all that you can about controlling diabetes, participate in your health care, keep a positive attitude, and you will meet the challenge!

Learn All You Can

Take advantage of chances to learn all you can about diabetes, how it affects your body, and what you need to do each day to control your blood glucose levels. Knowledge is power! Changes in your lifestyle—eating habits, exercise, blood glucose monitoring, medications, and more—need not be difficult or drastic. Contact hospitals and clinics in your area for information about group diabetes classes, workshops, or health fairs. NMSU's Cooperative Extension Service is a good source of information about nutrition, meal planning, and healthy food preparation.

Be a Part of the Team

You are not alone! Talk to your health care provider, dietitian, diabetes educator, and pharmacist whenever you have questions or concerns about diabetes, your medications, or your treatment plan. This team of health professionals is dedicated to helping you manage your diabetes. Be honest, ask questions, and participate in planning a diabetes treatment and self-care plan. Talking to your providers openly and taking an active role in making decisions about your health will help you be successful in managing your diabetes.

Build Coping Skills

Life can be challenging enough without the burden of a chronic disease like diabetes. How you handle the emotional ups and downs of living with diabetes and how you cope with stressful life events will be very personal. Learn strategies and skills to cope with daily challenges. Some people use prayer, exercise, meditation, or other forms of stress management. Take control of your daily life. Much of the stress in our lives comes from feeling overwhelmed by too many demands. Look for ways to reduce the demands on your time and make sure to take time each day for yourself. For help with learning how to deal with stress and diabetes, ask your health care provider about finding a mental health specialist who has experience working with people who have diabetes.

Family Support

People who have a strong support system in place tend to be healthier and recover quicker from illnesses. Without help and understanding from family and friends, you may feel alone and isolated when dealing with the daily demands of having diabetes. Keep family members involved in your diabetes management. Remember that many things you need to do to stay healthy are the same things your family should be doing now to prevent diabetes in the future. Lifestyle changes are easier when the entire family joins in. Diabetes support groups and group classes provide a chance to discuss problems with other people who have diabetes. Since diabetes affects the whole family, invite your spouse and/or children to join you at classes and meetings. Health care providers or diabetes educators are available to answer specific questions you or your family may have.

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Circular 569H: Exercise for People with Diabetes

• Regular physical activity is an important part of controlling your diabetes.

• A little physical activity every day can improve blood glucose control.

• For some people, diabetes medicines can be decreased or eliminated with weight loss and daily physical activity.

• Foot care is important when exercising.

• Walking, cycling, and swimming are good exercise choices.

• You can prevent low blood glucose during exercise by balancing insulin, food, and activity.

Benefits of Exercise

Exercise is an important part of controlling your diabetes. When you have diabetes, being overweight or inactive can contribute to blood glucose problems. Increasing your daily activity, even by small amounts, can help improve blood glucose control, reduce the need for diabetes medications, reduce your chances for heart disease, help control your weight. Exercise can also improve your quality of life and emotional well-being. Walking as little as 15 minutes a day can make a difference!

Getting Started

For many people, the most difficult part of becoming more active is getting started. Just like brushing your teeth, daily exercise is a habit you need to fit into your lifestyle. To get started, make a plan or goal for yourself. Start with small, easy-to-achieve goals—like walking each evening for 10 minutes. Make an appointment or set aside a regular time. Find a walking buddy to keep it fun, or include a family member. Remember, exercise is good for the whole family! Keep a calendar or logbook of your progress and reward yourself for achieving your goals—weekly, monthly, and yearly. Soon your daily walk will be a habit you can't live without!

Safe Exercise

Exercise is safe for most people; however, certain precautions should be taken. After being inactive for many years, some people may be in poor physical condition. If you are over the age of 35 and have not been exercising regularly, see your doctor before beginning or trying new forms of exercise. If you have eye problems from diabetes, make sure you check with your doctor before doing some exercises, such as lifting weights.

Pay attention to your feet if you plan to exercise. If you have problems with circulation or feeling in the legs and feet, choose activities that avoid trauma to your feet. Always wear comfortable shoes that protect your feet. Walking, biking, and swimming are good exercise choices for people who have diabetes.

Guidelines for People with Diabetes

• Carry an identification card and wear a bracelet, necklace, or tag that identifies you as a person with diabetes.

• Check your blood glucose level before and after exercise.

• If you use insulin, avoid exercise during peak insulin action and take shots in locations other than your legs and arms.

• If you use insulin, decrease the dosage when you exercise. Consult with a health care provider or diabetes educator to learn how.

• Be aware of signs of hypoglycemia (low blood glucose) during and after exercise. Signs include feeling weak or shaky, a rapid heartbeat, and vision changes. Keep sources of carbohydrate (glucose tabs, hard candy, juice, etc.) handy to treat low blood glucose.

• Drink plenty of water before, after, and during exercise to prevent dehydration.

• Wear good-fitting, comfortable shoes that protect your feet from injury.

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Circular 569I: Preventing Complications

• Health problems associated with diabetes can be prevented.

• Too much glucose in the blood can damage blood vessels and nerves.

• Eyes, kidneys, heart, and feet are most commonly affected by diabetes.

• Regular visits to your health care provider can reveal damage from diabetes before you notice problems.

• Diabetes complications develop earlier if you smoke or drink alcoholic beverages.

• High blood pressure makes damage from diabetes to eyes and kidneys worse.

People who have diabetes often experience other health problems. The most common problems (or complications) people with diabetes experience are vision loss, kidney disease, heart disease, and amputations. High glucose levels in the blood over time can damage nerves and blood vessels. Complications occur as blood vessels become blocked, or break and bleed, and nerves lose the ability to transmit impulses through parts of the body.

The most important actions you can take to prevent or postpone diabetes complications include:

• controlling your blood glucose levels

• eating a healthy diet

• getting regular physical activity

• visiting your health care provider regularly to check for problems with your eyes, kidneys, heart, and feet.

Eyes

People with diabetes are at risk for developing eye disease. Many people do not notice symptoms—there is no pain, no blurred vision in the early stages of the disease. Vision problems often are not noticed until the disease is well advanced and vision cannot be restored. Early detection and treatment is important to prevent vision loss. You can reduce your risk of vision loss by having a dilated eye exam annually to detect problems early. If you have high blood pressure, damage to small blood vessels in the eyes from diabetes can worsen. Keep your blood pressure under control and don't smoke to help prevent further damage to fragile blood vessels in the eyes.

Kidneys

High blood glucose levels and a diet with too much protein can damage kidneys over time. The kidneys will lose their ability to filter blood and may fail altogether. When kidneys fail, waste products need to be artificially filtered from the blood (dialysis) to stay alive. Each year, your health care provider should check your kidneys by testing blood and urine. Early stages of kidney problems can be treated with medications and by decreasing protein in the diet. High blood pressure also is linked to kidney disease. Your provider may prescribe blood pressure medicine to help protect your kidneys.

Heart

Heart disease is the most common cause of death for people who have diabetes. If you have diabetes, you are more likely to have too much fat (lipids, cholesterol and triglycerides) in the blood. These fats can clog blood vessels, blocking blood flow throughout the body, including to the heart. The heart muscle can be damaged (heart attack) when there is not enough blood flowing to it. High blood pressure often occurs with heart disease.

You can help prevent heart disease by:

• eating a healthy diet (low in fat and sodium, high in fiber).

• getting daily physical activity.

• maintaining a healthy weight.

• quitting smoking.

• asking your health care provider to check your blood pressure and weight at every visit and your blood cholesterol and triglycerides at least once a year.

Legs and Feet

Damage to nerves and blood vessels from uncontrolled diabetes can affect many different parts of the body. Most often, damage occurs in the legs and feet, causing numbness, tingling, cramping, burning, or pain. Nerve damage in other parts of the body can affect the heart, stomach and digestive tract, veins and arteries, bladder, and sexual function. Smoking and alcohol use can worsen circulation and nerve problems.

Amputations often result from foot injuries that you do not even feel. These injuries can quickly become infected and are difficult to heal. Check your feet daily for swelling, redness, or breaks in the skin. Wear comfortable shoes that fit well to protect your feet from injury. Call your health care provider if you notice any problems with your feet.

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Circular 569J: Healthy Feet

• People with diabetes are prone to foot problems.

• Amputations due to diabetes can be prevented.

• A podiatrist is a doctor who specializes in treating foot problems.

• Neglecting a foot sore or injury can quickly turn into a serious infection.

• Daily foot care is important for people who have diabetes.

• Smoking and alcohol use can cause circulation and nerve damage to feet.

People with diabetes are prone to foot problems that can lead to amputations. An amputation can end a career, limit your freedom and ability to move around, and decrease your quality of life. Controlling diabetes, practicing good daily foot care, and visiting your podiatrist can prevent amputations. A podiatrist is a doctor who specializes in treating foot problems, especially related to diabetes.

Common foot problems are caused by sores or injuries from poor-fitting shoes, irritation from the seam of a sock, a stubbed toe, ingrown toenail, or irritation from a pebble in your shoe that you cannot feel. Any sore or injury to your foot, if neglected, can quickly turn into a serious infection and result in amputation. If you have diabetes, take action to protect and care for your feet.

Wear Comfortable Shoes That Fit Well

Consult an experienced shoe fitter when you buy new shoes. Shoes should fit comfortably when you try them on, and you should have plenty of room to freely move your toes. Don't buy shoes that are tight or pinch, or have high heels or pointed toes that can cause pressure points. The best shoes for daily footwear are cushioned like running or walking shoes. Break in new shoes for short periods to avoid irritation. Sandals or other shoes with open toes or heels can expose your feet to injury. Never go barefoot, even in your own home and especially outdoors.

Wash and Check Your Feet Every Daily

Always test water temperature with your elbow first before stepping into a hot bath. People with diabetes often lose the ability to feel temperature with their feet and may suffer dangerous burns from putting feet into water that is too hot. Dry feet gently before putting on shoes and socks. Check your feet for red areas, cuts, bruises, sores, or other changes. Use a mirror to see the bottoms of your feet. Use a cream or moisturizer on dry, rough areas. Do not put moisturizer between your toes. Socks should be clean, soft, and without seams that can cause irritation. Before putting them on shake out and check the inside of shoes for anything that might rub or injure feet.

Never Try to Remove Calluses, Corns, Warts, or Ingrown Toe nails

Always see your health care provider or podiatrist for help with these problems. You can easily injure yourself by using razors or scissors on feet or toes. Always cut toenails straight across and use an emery board to round sharp corners. Never use scissors to cut corners or dig out ingrown nails. Do not use corn or wart removal preparations that can burn skin.

Stop Smoking and Drinking Alcoholic Beverages

Smoking can cause circulation problems in the feet, making it difficult for healing to take place. Drinking alcoholic beverages can cause damage to nerves in the legs and feet. Damaged nerves result in loss of sensation, making it
difficult to feel pain or injuries.

See your health care provider if you notice:

• changes in the color or temperature of your feet.

• any unusual pain in your feet or legs.

• any open sores or cracks in the skin—especially ones that do not heal.

• ingrown toenails.

• corns or calluses that bleed under the skin.

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Where to Go for More Information

• Your health care provider
• American Diabetes Association: 1-800-DIABETES www.diabetes.org
• National Diabetes Education Program: 1-800-438-5383 or visit the World Wide Web at ndep.nih.gov or www.cdc.gov
• New Mexico Diabetes Prevention and Control Program www.diabetesnm.org
• Your county Extension office

Original author: Raylene McCalman, Extension Diabetes Coordinator

This publication was made possible by grants from New Mexico State University's Cooperative Extension Service and the New Mexico Department of Health Diabetes Prevention and Control Program.

New Mexico State University is an equal opportunity/affirmative action employer and educator. NMSU and the U.S. Department of Agriculture cooperating.

Revised and electronically distributed December 2007, Las Cruces, NM.

This publication is scheduled to be updated and reissued on December 2012.