This topic is about
complications from diabetes, such as eye, kidney, heart, nerve, or blood vessel
disease. If you need other diabetes information, see:
Type 1 Diabetes, if you want to learn about type 1 diabetes.
Type 1 Diabetes: Living With the Disease, if you or
your teen 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.
Type 1 diabetes is a
lifelong disease that develops when the pancreas stops making insulin. Your
body needs insulin to let sugar (glucose) move from the blood into the body's
cells, where it can be used for energy or stored for later use.
If sugar cannot move from the blood into the cells, your blood sugar gets too
high and your cells cannot work right. High blood sugar can harm your blood
vessels and nerves and lead to problems with your eyes, heart, feet, kidneys,
and other areas of the body. These problems are called complications.
Diabetic neuropathy. This is a nerve disease that can
affect your internal organs as well as your ability to sense touch and pain,
especially in your feet.
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 a constant struggle. It is a lot of work to
monitor your health (such as foot care), 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. Getting counseling or joining a diabetes
support group may also help.
What are the symptoms of diabetes complications?
Different complications have different symptoms.
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
belly pain, or a racing heartbeat. Some people don't have any symptoms until
they have a heart attack or 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.
Eye disease can cause vision problems,
blindness, or (rarely) pain in your eyes.
Kidney disease may not cause any
symptoms at first. As time goes on, you may have swelling in your feet and legs
and, later, all through your body. It can also cause high blood pressure over
time.
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. You may
not notice an injury, especially on your foot, until you have a severe
infection. 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 sexual problems or problems with digestion or your bladder. You may
also sweat a lot or too little, feel dizzy or weak, or faint when you stand up.
It may be hard to tell when your blood sugar is low.
How are they treated?
Depending on the problem,
treatment for a diabetes complication may include medicine, surgery, or other
therapies. Early treatment for a complication can help slow the damage and may
prevent other problems.
But there is a lot that you can do
yourself. Here are seven steps you 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.
Lose weight if you need to, get plenty of exercise, and try to
eat about the same amount of
carbohydrate at each meal. Making these lifestyle
changes may make you feel better and help control your blood sugar.
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 raises your risk for heart attack, stroke,
and many other serious problems.
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
you need to), and watch for signs of other problems. Also be sure to see your
eye doctor and dentist regularly.
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.
Symptoms
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.
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.
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).
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 doctor 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.
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.
Leaking urine or having 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).
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 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 level of less than 7%. The A1c level is
a measure of your blood sugar over the past 2 or 3 months. Talk to your doctor
about what A1c level is best for you.
Other ways to prevent new
complications and/or to keep the complications you have from getting worse
include:
Seeing your doctor regularly to have your treatment evaluated
and to have screening exams and tests.
Checking your feet for cuts or calluses, which can lead to
infection. Good foot care also includes having a doctor 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.2 About 25% get
the advanced stage (proliferative retinopathy) after 15
years.2
Diabetic nephropathy. Diabetic nephropathy eventually
occurs in 20% to 30% of all people with type 1 and
type 2 diabetes.3 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.3 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.4
Diabetic neuropathy. Most people with diabetes develop
some diabetic neuropathy over the years.
Other risk factors. Other factors that can
raise your chance of getting complications include:
Drowsy, confused, 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.
Having new or sudden vision loss. You may have a
retinal detachment or bleeding within the eye.
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 one adult-strength aspirin
(325 mg) or 4 low-dose aspirin (80 mg each) before emergency medical personnel
such as paramedics arrive. This will help prevent a blood clot. Be sure to tell
emergency personnel that aspirin has been taken.
Any loss of function. You could be having a
stroke. Signs of a stroke include:
Numbness, weakness, or inability to move (paralysis) of 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, trouble speaking or understanding.
Trouble walking, dizziness, loss of balance or
coordination.
Severe headache with no known cause.
Call your doctor immediately if you
have any of the following symptoms of a new complication or one that is getting
worse:
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.
Burning pain, numbness, or swelling in your feet or
hands.
Frequent bloating, belching, constipation, nausea and vomiting,
diarrhea, and abdominal pain, which may indicate
gastroparesis.
Profuse sweating or reduced sweating.
Feeling dizzy or weak when you sit or stand up suddenly.
Leaking urine or having difficulty emptying the bladder
completely.
Watchful waiting is a period of time during
which you and your doctor 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 doctor 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.
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.
Schedule of exams and tests for diabetic complications
A
urine test for protein levels such as
microalbuminuria, macroalbuminuria, or the albumin to creatinine ratio. These
tests check for damage to your kidneys.
Creatinine, a urine or blood test that
checks kidney function.
As needed to check on your
condition, have:
A 24-hour urine test to check the total amount of protein
leaking from your kidneys. A result of 300 mg or greater of protein in 24 hours
shows that the kidneys are leaking large amounts of protein
(macroalbuminuria).5
Blood urea nitrogen (BUN) and
creatinine levels, to help estimate how well your
kidneys are removing wastes from the bloodstream.
Blood electrolyte tests, to check whether your kidneys are
keeping normal levels of
electrolytes (salts) in your blood.
If you develop kidney failure, you may need other
tests. For more information, see the topic
Chronic Kidney Disease.
Heart and blood vessel disease (macrovascular
disease)
During every medical appointment,
have:
Your blood pressure checked. Your blood pressure should be
less than 130/80 mm Hg.6
At least every year, 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. Women may consider an HDL goal of more than 50 mg/dL.
Physical examination to check your response to light touch,
pressure, temperature, and vibration, particularly in your feet and legs.
Simple tests can screen for loss of sensation. Have these tests done on both
feet.
Touching the end of your toe with a cotton wisp or a
thin plastic fiber (called a monofilament test) assesses your sense of light
touch or pressure.
A cold metal tuning fork held to your leg evaluates
your sensation of temperature.
A vibrating tuning fork touched to your foot assesses
your sensation of vibration.
Checkup on your muscle strength and reflexes, especially
those in your ankles and knees.
Careful exam of your feet for corns, calluses, infections,
injuries, or bone and joint problems. Have a complete exam of your feet at
least once a year.7
Measurement of your blood pressure and pulse when lying
down, sitting, and standing.
As indicated, have:
Electromyogram (EMG), to measure how well and how
quickly particular nerves and muscles are working.
Tests for
autonomic neuropathy (internal functioning) are
specific to your symptoms, such as:
Gastric emptying study, to evaluate how quickly your
stomach empties. Nerve damage from diabetes can slow this rate.
Other tests
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.
You may need a
thyroid-stimulating hormone (TSH) test when type 1
diabetes is diagnosed and then every 1 to 2 years. This test checks for thyroid
problems, which are common among people with diabetes.
Treatment Overview
Treatment for your complication from
type 1 diabetes depends on the stage of the
disease.
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.
Keep all appointments with your doctor,
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.3
If you develop kidney failure, you may need
dialysis, a kidney transplant, or possibly a
pancreas-kidney transplant.8
You can
also:
Limit your intake of protein. This may help you preserve kidney
function. Talk to your doctor or
dietitian about how much protein is best for
you.
Limit salt in your diet because it makes your body retain fluid
and can increase your blood pressure.
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.5 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. Or you can
aim for keeping your LDL at 70 mg/dL, your
triglyceride level less than 150 mg/dL, and if
possible, your
HDL cholesterol level more than 40 mg/dL in men. Women
may want to keep their HDL higher than 50 mg/dL. For more information, see the
topic
High Cholesterol.
Not smoking. Smoking increases your risk for heart attack and stroke and
makes many health problems worse. Quitting can lower your risk.9
Exercising. Try to do at least 2½ hours a week of
moderate activity. One way to do this is to be active
30 minutes a day, at least 5 days a 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 7% or less) is the only treatment that can stop or slow the
progression of neuropathy.
If you have
peripheral neuropathy, your doctor may suggest
medicines (such as nonprescription pain relievers, creams, or prescription oral
or injected medicines).
Physical therapy or
acupuncture may relieve pain and stiffness and/or
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 doctor may suggest a joint splint.
If
you have autonomic neuropathy (affecting internal
functioning), your doctor 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) 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 doctor 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 doctor may refer you to a specialist for treatment
of specific complications.
Have your doctor 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.
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 or through
an
insulin pump. For more information, see the Home
Treatment section of the topic
Type 1 Diabetes: Living With the Disease.
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.10
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 doctor 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.10 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.5
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 doctor about treatment for even minor
problems, such as corns or calluses. Catching problems early prevents minor
injuries from turning into major problems.
Quit smoking. If you quit smoking, you decrease your risk for
developing early damage to the blood vessels caused by diabetes.9
For more information, see the topic
Quitting Smoking.
Keep your immunizations up to date. Diabetes affects your
immune system, increasing your risk for having a
serious case of the
fluor
pneumonia. Ask your doctor if you should have a flu
vaccination. For more information, see the topic
Immunizations.
Home Treatment
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%. Talk to your doctor about what A1c level is best for
you.
Eat a diet that spreads
carbohydrate throughout the day.
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.
Take your
blood pressure medicines, if prescribed. Your blood
pressure should be less than 130/80 mm Hg. Ask your doctor if you need to
monitor your blood pressure at home.
If diabetes has affected your kidneys, limiting your intake of
protein may help you preserve kidney function. Talk to your doctor or
dietitian about how much protein is best for
you.
Limit salt in your diet because it makes your body retain fluid
and can increase your blood pressure.
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 doctor whether you
should drink alcohol.
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 doctor 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 sometimes, if you have
hypoglycemia unawareness.
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.
Insulin prescribed for
type 1 diabetes by an injection or through an
insulin pump helps keep your blood sugar level tightly
controlled and as close to normal as possible. You may also take:
Aspirin, if you've already had a heart attack or stroke or are
age 40 or older and at risk for these conditions, unless there's a medical
reason you shouldn't.5 Ask your doctor 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 doctor 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) 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).
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 doctor 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. Or aim for
keeping your LDL at 70 mg/dL, your
triglyceride level less than 150 mg/dL, and if
possible, your
HDL cholesterol level more than 40 mg/dL in men. Women
may want to consider an HDL of more than 50 mg/dL. 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.
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.
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. But islet cell
transplants may replace pancreas transplants in the future.11 People with complications from diabetes aren't always
eligible for islet cell transplants.
Other Treatment
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 doctor before using these or
other complementary or alternative therapies:
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.
Juvenile Diabetes Research Foundation
International
120 Wall Street
New York, NY 10005-4001
Phone:
1-800-533-CURE (1-800-533-2873)
Fax:
(212) 785-9595
E-mail:
info@jdrf.org
Web Address:
http://www.jdrf.org
The Juvenile Diabetes Research Foundation International is dedicated to finding a cure for type 1 diabetes and its complications. The organization funds research on type 1 diabetes, including research on prevention and treatment. This
organization publishes a wide variety of booklets, magazines, and e-newsletters on complications and
treatments of type 1 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).
Tabibiazar R, Edelman S (2003). Silent ischemia in
people with diabetes: A condition that must be heard. Clinical Diabetes, 21(1):5-9.
American Diabetes Association (2004). Retinopathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84-S87.
American Diabetes Association (2004). Nephropathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79-S83.
American Diabetes Association (2008). All About Diabetes. Available online:
http://www.diabetes.org/about-diabetes.jsp.
American Diabetes Association (2008). Standards of
medical care in diabetes. Clinical Practice Recommendations 2008.
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.
Nathan DM (2003). Isolated pancreas transplantation
for type 1 diabetes. JAMA, 290(21):
2861-2863.
American Diabetes Association (2004). Smoking and
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74-S75.
Sigal R, et al. (2006). Prevention of cardiovascular
events in diabetes, search date November 2004. Online version of
Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
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.
Hunt D (2008). Diabetes: Foot ulcers and amputations,
search date September 2006. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Ludwig DS (2002). The glycemic index: Physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA, 287(18): 2414-2423.
Mendrinos E, et al. (2008). Diabetic nephropathy,
search date March 2007. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Molitch ME, Genuth S (2006). Complications of diabetes
mellitus. In DC Dale, DD Federman, eds., ACP Medicine,
section 9, chap. 3. New York: WebMD.
Patel J (2008). Diabetes: Managing dyslipidaemia,
search date June 2007. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Pickup J, Keen H (2002). Continuous subcutaneous insulin infusion at 25 years. Diabetes Care, 25(30): 593-598.
Shlipak M (2008). Diabetic nephropathy, search date
November 2006. Online version of BMJ Clinical Evidence.
Also available online: http://www.clinicalevidence.com.
Steele AW (2001). Kidney disease. In HC Gerstein, RB
Haynes, eds., Evidence-Based Diabetes Care, pp. 429-465.
Hamilton, ON: BC Decker.
Vijan S, (2008). Diabetes: Treating hypertension,
search date February 2007. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
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.
Tabibiazar R, Edelman S (2003). Silent ischemia in
people with diabetes: A condition that must be heard. Clinical Diabetes, 21(1):5-9.
American Diabetes Association (2004). Retinopathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84-S87.
American Diabetes Association (2004). Nephropathy in
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79-S83.
American Diabetes Association (2008). All About Diabetes. Available online:
http://www.diabetes.org/about-diabetes.jsp.
American Diabetes Association (2008). Standards of
medical care in diabetes. Clinical Practice Recommendations 2008.
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.
Nathan DM (2003). Isolated pancreas transplantation
for type 1 diabetes. JAMA, 290(21):
2861-2863.
American Diabetes Association (2004). Smoking and
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74-S75.
Sigal R, et al. (2006). Prevention of cardiovascular
events in diabetes, search date November 2004. Online version of
Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
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.
