Diabetes and Your Heart and Blood Vessels

The biggest problem for people with diabetes is heart and blood vessel disease. Heart and blood vessel disease can lead to heart attacks and strokes. It also causes poor blood flow, also called circulation, in the legs and feet.

To check for heart and blood vessel disease, your health care team will do some tests. At least once a year, have a blood test to see how much cholesterol is in your blood. Your health care provider should take your blood pressure at every visit. Your provider may also check the circulation in your legs, feet, and neck.

The best way to prevent heart and blood vessel disease is to take good care of yourself and your diabetes.

• Eat foods that are low in sodium. Check the amount of sodium by looking at the Nutrition Facts on food packages. Limit the amount of salt you use when you cook and at the table. Choose foods naturally low in sodium, such as vegetables, fruits, dry beans and peas, and unprocessed meats, poultry, and fish.

• Limit how much you have of these kinds of fat:

  • saturated fat, such as bacon, butter, cream, lard, and high-fat dairy products such as whole milk
  • trans fat, found in processed foods with partially hydrogenated or hydrogenated oil
  • cholesterol, found in high-fat dairy products, high-fat meats and poultry, egg yolks, and liver
  
  

• Keep your blood glucose on track. Know your A1C. The target for most people is below 7.

• Keep your blood pressure on track. The target for most people is below 130/80. If needed, take medicine to control your blood pressure.

• Keep your cholesterol level on track. The target for LDL cholesterol for most people is below 100. If needed, take medicine to control your blood fat levels.

• If you smoke, quit.

• Be physically active.

• Lose weight if you need to.

• Ask your health care team whether you should take an aspirin every day.

What's a desirable blood pressure level?

Blood pressure levels tell how hard your blood is pushing against the walls of your blood vessels. Your pressure is given as two numbers: The first is the pressure as your heart pushes blood out into your blood vessels and the second is the pressure as your heart rests. If your blood pressure is higher than your target, talk with your health care team about changing your meal plan, exercising, or taking medicine.

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What are desirable blood fat levels?

Cholesterol, a fat found in the body, appears in several forms. If your LDL cholesterol, also called "bad" cholesterol, is 100 or above, you are at increased risk of heart disease and may need treatment. A high level of total cholesterol also means a greater risk of heart disease. But HDL cholesterol, also called "good" cholesterol, protects you from heart disease, so the higher it is, the better. You should keep your triglyceride-another type of fat-levels below 150. All of these target numbers are important for preventing heart disease. But the most important target to reach first is for your LDL cholesterol.

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Rose is 55 years old and teaches at a high school on an American Indian reservation in New Mexico. Rose has had type 2 diabetes for almost 10 years. When she first found out she had diabetes, she weighed too much and didn't get much exercise. After talking it over with her doctor, Rose began an exercise program. She lost weight, and her blood glucose began to come down. She felt better too. Now Rose teaches an exercise class in her spare time.

Diabetes and Your Eyes

Have your eyes checked once a year. You could have eye problems that you haven't noticed yet. Yearly exams may catch eye problems early so problems can be treated. Treating eye problems early can help prevent blindness.

High blood glucose can make the blood vessels in the eyes bleed. This bleeding can lead to blindness. You can help prevent eye damage by keeping your blood glucose and blood pressure as close to normal as possible. If you already have eye problems, your eye doctor may be able to suggest treatments that can help.

The best way to prevent eye disease is to have a yearly eye exam. In this exam, the eye doctor puts drops in your eyes to dilate your pupils. When the pupils are dilated, or big, the doctor can see into the back of the eye. This type of exam is called a dilated eye exam and it doesn't hurt. If you've never had this kind of eye exam before, you should have one now, even if you haven't had any trouble with your eyes. Be sure to tell your eye doctor that you have diabetes.

Follow these tips to take care of your eyes:

• For adults and adolescents-10 years old and older-with type 1 diabetes: Have your eyes examined within 5 years of being diagnosed with diabetes. Then have an exam every year.
• For people with type 2 diabetes: Have an eye exam every year.
• Have an eye exam before becoming pregnant or as soon as possible after becoming pregnant.
• If you smoke, quit.
• Keep your blood glucose and blood pressure as close to normal as possible.

See your eye doctor for a dilated eye exam every year. Early treatment of eye problems can help save your sight.

Tell your eye doctor right away if you have any problems like blurry vision or seeing dark spots, flashing lights, or rings around lights.

Diabetes and Your Kidneys

Your kidneys help clean waste products from your blood. They also work to keep the right balance of sodium and fluid in your body.

Too much glucose in your blood is hard on your kidneys. After a number of years, high blood glucose can cause the kidneys to stop working, a condition called kidney failure. If your kidneys stop working, you'll need dialysis-a treatment that does some of the work your kidneys used to do-or a kidney transplant.

Make sure you have the following tests at least once a year to make sure your kidneys are working well:

• a urine test for protein, called the microalbumin test
• a blood test for creatinine, a waste product made by your body

Some types of blood pressure medicines can help prevent kidney damage. Ask your doctor whether these medicines could help you. You can also help prevent kidney problems by

• taking your medicine if you have high blood pressure
• asking your doctor or your dietitian whether you should eat less high-protein foods, such as meat, poultry, cheese, milk, fish, and eggs
• keeping your blood glucose and blood pressure as close to normal as possible
• quitting smoking

Mike is a migrant farm worker with type 2 diabetes and high blood pressure. Mike, 47, is married, and he and his wife have three children. The family is often on the move, depending on where the work is. Mike has his blood pressure and kidneys checked at clinics in migrant worker camps. Some of the clinics also offer diabetes classes. Whenever they can, Mike and his wife attend these classes. They especially like the cooking classes because they learn how to prepare low-cost, healthy meals for the whole family.

You should see your doctor right away if you get a bladder or kidney infection. Signs of bladder or kidney infections are cloudy or bloody urine, pain or burning when you urinate, and having to urinate often or in a hurry. Back pain, chills, and fever are also signs of kidney infection.

Diabetes and Your Nerves

Over time, high blood glucose can harm the nerves in your body. Nerve damage can cause you to lose the feeling in your feet or to have painful, burning feet. You may not feel pain from injuries or sore spots on your feet. If you have poor circulation because of blood vessel problems in your legs, the sores on your feet can't heal and might become infected. If the infection isn't treated, it could lead to amputation.

Nerve damage can also cause pain in your legs, arms, or hands or cause problems with digesting food, going to the bathroom, or having sex.

Nerve damage can happen slowly. You may not even realize you have nerve problems. Your doctor should check the nerves in your feet at least once a year. Your doctor should check your sense of feeling and the pulses in your feet.

Tell the doctor about any problems with your feet, legs, hands, or arms. Also, tell the doctor if you have trouble digesting food, going to the bathroom, or having sex, or if you sometimes feel dizzy.

Ask your doctor whether you already have nerve damage in your feet. If you do, you should take good care of your feet. To help prevent complications from nerve damage, check your feet every day. See Foot Care Tips.

Joe is a 65-year-old retired letter carrier with type 2 diabetes. Every time he visits his doctor, he takes his shoes and socks off so the doctor can check his feet for sores, ulcers, and wounds. The doctor also checks the sense of feeling in Joe's feet. Joe and his doctor talk about ways to prevent foot and nerve problems. Since Joe has lost some feeling in his toes, the doctor also talks with him about the importance of good foot care and keeping his blood glucose in a good range.

You can prevent nerve problems by

• keeping your blood glucose and blood pressure as close to normal as possible
• limiting the amount of alcohol you drink
• checking your feet every day
• quitting smoking

Foot Care Tips

You can do a lot to prevent problems with your feet. Keep your blood glucose in your target range and follow these tips to take care of your feet and help protect them.

• Check your bare feet every day. Look for cuts, sores, bumps, or red spots. Use a mirror or ask a family member for help if you have trouble seeing the bottoms of your feet.

• Wash your feet in warm-not hot-water every day, but don't soak them. Use mild soap. Dry your feet with a soft towel, and dry carefully between your toes.

• After washing your feet, cover them with lotion before putting your shoes and socks on. Don't put lotion or cream between your toes.

• File your toenails straight across with an emery board. Don't leave sharp edges that could cut into your toe.

• Don't try to cut calluses or corns off with a razor blade or knife, and don't use wart removers on your feet. If you have warts or painful corns or calluses, see a podiatrist, a doctor who treats foot problems.

• Wear thick, soft socks. Don't wear mended socks or socks with holes or seams that might rub against your feet.

• Check your shoes before you put them on to be sure they have no sharp edges or objects in them.

• Wear shoes that fit well and let your toes move. Break new shoes in slowly. Don't wear flip-flops, shoes with pointed toes, or plastic shoes. Never go barefoot.

• Wear socks if your feet get cold at night. Don't use heating pads or hot water bottles on your feet.

• Have your doctor check your feet at every visit. Take your shoes and socks off when you go into the examining room to remind the doctor to check your feet.

• See a podiatrist for help if you can't take care of your feet yourself.

Diabetes and Your Gums and Teeth

Diabetes can lead to infections in your gums and the bones that hold your teeth in place. Like all infections, gum infections can cause blood glucose to rise. Without treatment, teeth may become loose and fall out.

Help prevent damage to your gums and teeth by

• seeing your dentist twice a year
• brushing and flossing your teeth at least twice a day
• quitting smoking
• keeping your blood glucose as close to normal as possible
• having regular checkups with your dentist

James runs a bookstore in California. He's 35 years old and has had type 1 diabetes for 15 years. James takes good care of his teeth and sees his dentist twice a year. He makes his appointments in the morning, after breakfast, so he won't get low blood glucose while at the dentist. He also carries glucose tablets for treatment of low blood glucose and wears a medical identification bracelet.

Be sure to tell your dentist that you have diabetes.