Diabetes the Basics–Reducing Risks

Diabetes Self-Management- REDUCING RISKS– based on the ADCES7 Self-Care Behaviors

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Updated 2021 by Kim Ladd, RN, BS, CPHQ, CDCES

When diabetes is not properly managed, other health complications occur. It is important to help reduce your risk of complications by quitting smoking, performing foot checks, monitoring your blood pressure, monitoring your blood glucose levels, and getting regular eye, foot, and dental examinations.

People who have diabetes can live long and healthy lives. There are indeed many long-term health problems or complications that can happen because of diabetes. However, it is also true that diabetes complications can be prevented. By knowing how to reduce risks, you have a good chance of avoiding complications and staying healthy throughout your life.

Why Do Complications Happen?

Diabetes complications happen when blood sugar levels are high for a long period of time. The high levels of sugar damage the body, especially the blood vessels and the nerves. Many people with diabetes also have high blood pressure and high cholesterol in their blood. Each of these conditions can damage the body themselves. When they are combined with high blood sugar levels, the damage can happen sooner and can be more serious.

What are the Most Common Diabetes Complications?

Eye Problems: Diabetes can cause damage to the tiny blood vessels in the eyes. This damage is called diabetic retinopathy. These blood vessels can become weak and bleed. The person may have no warning signs until vision is already blurred. If not treated, diabetic retinopathy can lead to permanent loss of vision. Diabetes can also cause other eye diseases such as cataracts and glaucoma.

Heart Attack, Stroke and Blood Vessel Problems: Cardiac problems are the number 1 complication of diabetes. Diabetes can damage the large blood vessels of the body, causing blockages. This can lead to heart attack and stroke, as well as poor circulation in the legs and feet.

Kidney Problems: Diabetes can damage the small blood vessels running through the kidneys. This damage is called nephropathy. In the early stages, damaged kidneys do not filter everything out of the urine very well, so the urine contains protein. In the late stages, the kidneys are so damaged, the person needs to have dialysis or a kidney transplant to live.

Problems with the Nerves: The nerves all over the body can be damaged by diabetes. This damage is called neuropathy. When the nerves to the feet or hands are damaged, the person experiences tingling, numbness, or pain in the feet or hands. Nerves can also be damaged in the stomach and intestines, heart, lungs, bladder, or sex organs, causing problems with the function of these parts of the body.

Foot Problems: Damage to the vessels and nerves can lead to major problems of the feet. A small cut or blister may not heal well because of poor circulation and then can become infected. If the feet are numb, the person may not know anything is wrong until the infection is deep and hard to heal. If untreated, this can lead to amputation.

Gum Disease: High blood sugar levels can also lead to gum disease leading to infections in the mouth and loss of teeth.

How Can These Complications be Prevented?

To help reduce the risks for diabetes complications, you should:

Keep your blood sugar, blood pressure, and cholesterol levels as close to normal as possible.
Do not smoke. Smoking can damage circulation by itself, and it makes the damage from high blood sugar even worse.
See your diabetes doctor for a checkup every 3 to 6 months. Your blood pressure and A1c should be checked at every diabetes visit. Every year your diabetes doctor should check your cholesterol level and check your urine for protein.
At least once a year, get your eyes checked by an eye doctor called an ophthalmologist. You need to have a dilated eye exam so the eye doctor can see the blood vessels in the eyes.
Check your own feet daily and see a foot doctor if there are any problems. At least every year, have a complete foot exam done by a podiatrist or your diabetes doctor. Avoid salon pedicures and consider getting regular pedicures by a podiatrist, which can be covered by insurance.
See your dentist to have your teeth and gums checked at least every six months.

If any of these checkups show diabetes complications are beginning to develop, talk with the doctor who found the problem about what you can do. Diabetes complications usually develop gradually. If you have early signs of complications, you will probably be able to do something to keep the problem from getting worse.

Tests that Show Diabetes Control

Why Do I have to Have So Many Tests?

Diabetes is a complicated disease. Over time, it can cause changes in your heart, kidneys, blood vessels and nerves. The more you and your healthcare team know about your body, the easier it is to treat your diabetes. Some of these tests show whether your blood glucose and cholesterol are in control. Some show whether you have early signs of diabetes complications. You and your healthcare team can use these tests to decide if you need to change your medicines, insulin, or diet.

Common Tests

Blood Glucose: Everyone with diabetes should test their own blood glucose levels at home. This tells you what your blood glucose is at that moment in time. Knowing your blood glucose level can help you make decisions about food and exercise every day. If you don’t know how often to test your own blood glucose, ask your doctor or diabetes educator. Guidelines for good control of blood glucose according to the American Diabetes Association (ADA) are as follows:

Fasting/pre-meal: between 80 and 130 mg/dL
One to two hours after meal: below 180 mg/dL

Hemoglobin A1c (HbA1c or simply A1c): This test shows what your blood glucose level has been over the last 3 months. It gives the healthcare team information so you can plan for the next step in your diabetes care. This test should be done about every 3-6 months.

Micro-albumin: This is a urine test to check how your kidneys are working. It checks for small amounts of protein in urine, which is an early sign of kidney damage. It should be done once a year. If a kidney problem is found early, it can be treated.

Lipid Profile: This blood test checks the amount and types of fat in your blood. It checks total cholesterol, HDL (healthy cholesterol), LDL (bad cholesterol), and triglycerides. Keeping these fats at healthy levels can help you reduce your risks for diabetes complications. You should have a lipid profile once a year. Of all the fats measured in the lipid profile, the most important one is LDL cholesterol that should be less than 100 mg/dl. It is also good if these levels are met:

HDL cholesterol – over 50 mg/dl
Triglycerides – less than 150 mg/dl

Eye Exam: People with diabetes need to see an eye doctor or ophthalmologist every year for a dilated eye exam. The doctor will use drops to dilate or open the pupil and a special machine to look in the back of the eye. Diabetes can cause damage to the blood vessels in the back of the eye. This damage is called retinopathy. If the doctor finds retinopathy early, it can be treated so the damage will stop. If retinopathy is left untreated, it can cause blindness. If you don’t have an eye doctor, you can ask your doctor or diabetes educator to help you find one.

Foot Care: Over time, diabetes can damage many parts of the body. When your blood sugar levels are higher than normal on a regular basis, you have a greater chance of damage to the nerves and blood vessels in your legs and feet and this can lead to many different problems. Neuropathy is the name of nerve damage to the legs and feet caused by high blood sugars levels. It might cause pain, burning or tingling in your feet. These symptoms may be worse at night while resting. If your feet are numb, you may not be able to feel pain, heat or cold. If you do not have much feeling in your feet, you may not know when you have a cut, blister, or burn on your foot. Such wounds can quickly get worse and become infected. Talk to your doctor if you have pain, tingling, or numbness in your feet. There are special pain medicines that may help.

For the most part, people with diabetes and visual impairments reduce risks in the same ways fully sighted people do; the only difference is a reliance on vision loss adaptations such as large print record logs and talking monitoring equipment. The one area in which special adaptive skills are necessary is foot care.

Best Foot Forward

Avoiding infection is paramount when dealing with diabetes, and feet are especially vulnerable because of the daily punishment we inflict on them. They must be protected with well-fitted shoes, kept clean and dried thoroughly after baths and showers, and, for many people, the skin must be softened with lotions to avoid cracking. This care is the same for people with vision loss as it is for fully sighted people.

Cutting Toenails

Small cuts on the foot can become easily infected, so people with diabetes need to cut toenails very carefully. With visual impairment, it may be easier to accidentally cut the toes, especially if the nerves to the feet are damaged and the feet are numb. Therefore, foot care specialists strongly recommend that people with visual impairment have their toenails cut by a podiatrist, which has the added advantage of giving the person frequent expert foot inspection. Medicare and most health insurance policies cover cutting of toenails for people with diabetes and visual impairment.

Daily Foot Inspection

All people with diabetes should inspect their feet daily, looking for blisters, cuts, scratches, corns, calluses, and any change from the previous day. For fully sighted people, this is usually done by looking at the top, sides, and bottom of the feet, and between the toes. People with reliable low vision can use a lighted magnifying mirror to inspect their feet.

If you cannot rely on your vision to see problems on your feet, you can make use of your other senses, such as your sense of smell. When you remove your shoes and socks, notice the smell of your feet. An exceptionally bad smell on the feet is often associated with an infection. Sometimes the smell of the feet changes before any other sign of an infection is present.

You can also rely on your sense of touch. Follow these steps to do a tactile foot inspection:

Sit and lift a bare foot to your lap, or stand and place your foot on a chair.
Using the balls of your fingers and thumbs, search your feet for irregularities of texture and differences in the shape of your toes and feet from the way they felt the previous day.
Beginning with the large toe, feel the sides, top, and bottom of the toe, then the space between the large toe and the next toe.
Continue feeling the remaining toes.
Move your hand to the outside edge of the foot, the heel, and the inside edge of the foot.
Feel the entire surface of the top of the foot and the sole of the foot.
Finally, turn your hand over. The back of the hand is more highly sensitive to temperature changes. You can use it to find any spots that are unusually warm, which may indicate an inflammation.
Feel the entire top and bottom surfaces of your foot and toes, and the sides of your foot with the back of your hand.
Repeat this entire process with your other foot.

If your foot inspection turns up anything unusual, call your podiatrist or doctor right away! Small problems unattended can turn into big problems, so be sure to take care of small cuts, blisters, corns, and calluses while they are still small and easy to heal.

Peripheral Vascular Disease (PVD)- is the name for damage to the small blood vessels to the legs and feet. This causes poor blood flow which makes it harder for infection to heal. If you have PVD, you may have some of these symptoms in your feet and legs: coldness, swelling, or changes in skin color that make them look pale white, red, blue or purple, pain while walking or even at night while resting. Smoking can also cause PVD and make it worse. Talk to your doctor if you notice these changes. Supervised exercise, medicine and sometimes surgery may help PVD. Do these things to keep your feet healthy:

Stop smoking
Keep blood sugar levels in your target range as much as you can.
Wash your feet everyday with warm water and mild soap. Then gently pat your feet dry. Always dry between your toes. Rub a lotion on your feet every day, but never put the lotion between your toes or over breaks in the skin. Look at and feel the tops, bottoms, and sides of your feet every day. If you see or feel red areas, blisters, cuts, scratches, bruises, or changes in the shape of your feet that stay for more than two days, call your doctor. Do not wait.
Wear socks or stockings without bulky seams at the toes. Make sure the elastic at the top of the sock is not too tight.
Always wear shoes and socks. Shoes made of leather or canvas are best. Wear shoes or slippers inside your house. Be sure they have a sole that will protect your feet so nothing can poke through.
When you visit the doctor, take your shoes and socks off and ask the doctor to look at your feet.
Visit a podiatrist every year. This is a doctor that takes special care of the feet.

Illness and Sick Days

Being ill can cause your blood glucose levels to be higher or lower than normal. It is important to be prepared since high levels can lead to life threatening conditions, such as dehydration or coma.

During an illness, you may need to call your doctor if you:

Are sick and have had a fever for more than 2 days and you are not getting better.
Have blood glucose levels higher than 240 mg/dl.
Have moderate or large amounts of ketones in your urine.
Have had vomiting or diarrhea for 6 hours.
Have abdominal pain or trouble breathing, chest discomfort, dry lips or tongue or a fruity smell to your breath.

Keep a card with your doctor’s phone number with your diabetes medicines so you can find it quickly if you need it.

Sick Day Plan

Talk to your diabetes team before you become ill to develop a “sick day plan.” Having this plan in place will help you manage your diabetes when you are ill.

Glucose Testing: If you have type 1 diabetes, you should test your blood glucose every 4 hours when you are sick. If you have type 2 diabetes, testing your blood glucose 4 times/per day may be enough.

Ketone Testing: If you are not able to use glucose for energy, then your body will burn fat for energy. Burning fat can cause a buildup of acids called ketones in the blood, which can be dangerous. If you have type 1 diabetes, you should check your urine for ketones every 4 hours while ill. People with type 2 diabetes should check their urine for ketones if they have a blood glucose level over 300mg/dl. You can buy ketone test strips at the pharmacy without a prescription. Follow the directions for the correct method of testing. Be sure to check the expiration date. It is important that the strips are not outdated.

Fluids or Liquids: When your blood glucose levels are high, you will urinate more. If you do not take in enough fluids, you can become dehydrated. Take frequent sips of calorie-free and caffeine-free liquids such as water, diet soda, sugar-free gelatin, or broth. Drink at least 6-8 ounces or about 1 cup every hour.

Food: If possible, follow your regular meal plan. If you cannot eat solid food, try to have about 50 grams of carbohydrates every 3-4 hours. The following foods and beverages contain approximately 15gms of carbohydrate and are good for sick day use. Eat three of these for about 50 gm.

½ cup regular gelatin
1 cup broth soup with noodles or rice
6 saltine crackers
½ cup ice cream
¼ cup sherbet
1 twin popsicle
½ cup cooked cereal
½ cup apple juice
½ cup regular soda

Medications: Illness can cause your blood glucose levels to be higher so it is important that you take all your diabetes medications when sick, even if you cannot eat. If you take insulin, talk with your physician to see if you need to take extra during your illness. People who take oral medications for their type 2 diabetes may need insulin for a short time, if their blood glucose levels are too high. Be cautious about taking over-the-counter medicines like cough syrup or cold medication when you are sick. Talk to your pharmacist before you take any of these since some of them can affect your blood glucose levels.