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Diabetes Chapter 2

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Diabetes and Your Eyes

Have your eyes checked once a year. You could have eye problems that you haven't noticed yet. It is important to catch eye problems early when they 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 as close to normal as possible. If your eyes are already damaged, an eye doctor may be able to save your sight with laser treatments or surgery. 

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 make your pupils get bigger (dilate). 

When the pupils are big, the doctor can see into the back of the eye. This 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. 

Here are some tips for taking care of your eyes:

  • For people with type 1 diabetes: Have your eyes examined when you have had diabetes for 5 years and every year after that first exam.
  • (Children should have an eye exam in their early teens.)
  • For people with type 2 diabetes: Have an eye exam every year.
  • For women planning to have a baby: Have an eye exam before becoming pregnant.
  • If you smoke, quit.
  • Keep your blood glucose and blood pressure as close to normal as possible.

Tell your eye doctor right away if you have any problems like blurry vision or seeing dark spots, flashing lights, or rings around lights. See your eye doctor for an eye exam with dilated pupils every year. Early treatment of eye problems can help save your sight.

Diabetes and Your Kidneys


Your kidneys help clean waste products from your blood. They also work to keep the right balance of salt and fluid in your body. Too much glucose in your blood is very hard on your kidneys. 

After a number of years, high blood glucose can cause the kidneys to stop working. This condition is called kidney failure. If your kidneys stop working, you'll need dialysis (using a machine or special fluids to clean your blood) or a kidney transplant. Have a urine test once a year for signs of kidney damage. 

The test measures how much protein is in your urine. A blood pressure medicine (called an ACE inhibitor) can help prevent kidney damage. Ask your doctor whether this medicine could help you. 

Other ways to help prevent kidney problems are to:

  • Take your medicine if you have high blood pressure.
  • Ask your doctor or your dietitian whether you should eat less meat, cheese, milk, and fish or fewer eggs. 
  • 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.
  • Keep your blood glucose and blood pressure as close to normal as possible.
  • If you smoke, quit.

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.

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. It can also cause pain in your legs, arms, or hands or cause problems with eating, 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 your nerves at least once a year. Part of this exam should include tests to check your sense of feeling and the pulse in your feet.


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


Nerve damage to the feet can lead to amputations. 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. 

Ask your doctor whether you already have nerve damage in your feet. If you do, it is especially important to take good care of your feet. To help prevent complications from nerve damage, check your feet every day (see Foot care tips below).


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 to him about the importance of good foot care and keeping his blood glucose in a good range.
Here are some ways to take care of your nerves:


  • Keep your blood glucose and blood pressure as close to normal as possible.

  • Limit the amount of alcohol you drink.

  • Check your feet every day.

  • If you smoke, quit.

Foot Care Tips

  • You can do a lot to prevent problems with your feet. Keeping your blood glucose in your target range and taking care of your feet can 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 the next 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 stockings or stockings 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. This will 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. 

  • To help prevent damage to your gums and teeth:
  • See your dentist twice a year. Tell your dentist that you have diabetes.
  • Brush and floss your teeth at least twice a day.
  • If you smoke, quit.
  • Keep your blood glucose as close to normal as possible.


Keeping your blood glucose in your target range, brushing and flossing your teeth every day, and having regular dental checkups are the best ways to prevent gum and teeth problems when you have diabetes. 

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 hypoglycemia while at the dentist. He also carries glucose tablets and wears an identification bracelet that has the name and the telephone number of his doctor on it.

Taking Care of Your Diabetes at Special Times

When You're Sick

Take good care of yourself when you have a cold, the flu, an infection, or other
illness. Being sick can raise your blood glucose. 

When you're sick:

  • Check your blood glucose every 4 hours. Write down the results.
  • Keep taking your insulin and your diabetes pills. Even if you can't keep
    food down, you still need your diabetes medicine.
  •  .Ask your doctor or diabetes educator whether to change the amount of insulin or pills you take.
  • Drink at least a cup (8 ounces) of water or other calorie-free, caffeine -free liquid every hour while you're awake.
  • If you can't eat your usual food, try drinking juice or eating crackers, Popsicles, or soup.
  • If you can't eat at all, drink clear liquids such as ginger ale. Eat or drink something with sugar in it if you have trouble keeping food down.

Test your urine for ketones if:


o your blood glucose is over 240
o you can't keep food or liquids down
o Call your health care provider right away if
o your blood glucose has been over 240 for longer than a day
o you have moderate to large amounts of ketones in your urine
o you feel sleepier than usual
o you have trouble breathing
o you can't think clearly
o you throw up more than once
o you've had diarrhea for more than 6 hours

ACTION STEPS

If you use insulin

  • Take your insulin, even if you've been throwing up. Ask your doctor about how to adjust your insulin dose, based on your blood glucose test results.

ACTION STEPS

If you DON'T use insulin

  • Take your diabetes pills, even if you've been throwing up.

When You're at School or Work

  • Take care of your diabetes when you're at school or at work:
  • Follow your meal plan.
  • Take your medicine and check your blood glucose as usual.
  • Tell your teachers, friends, or close co-workers about the signs of hypoglycemia. You may need their help if your blood glucose drops too low.
  • Keep snacks nearby and carry some with you at all times to treat
    hypoglycemia.
  • Tell your company nurse or school nurse that you have diabetes. Sally, a 12-year-old with type 1 diabetes, loves her gymnastics class. She practices every day for an hour. Before Sally exercises, she checks her blood glucose to make sure it's okay to start her workout. 
  • If her blood glucose is too low, she eats a snack before beginning to practice. Sally has told her coach that she has diabetes. She knows that if she has a problem with hypoglycemia, her coach will be there to help her.

When You're Away From Home

  • Taking care of your diabetes, even on vacation, is very important. Here are some tips:
  • Follow your meal plan as much as possible when you eat out. Always carry a snack with you in case you have to wait to be served.
  • Limit your drinking of beer, wine, or other alcoholic beverages.  Ask your diabetes educator how much alcohol you can safely drink. Eat something when you drink.
  • If you're taking a long trip by car, check your blood glucose before driving. Stop and check your blood glucose every 2 hours. Always carry snacks like fruit, crackers, juice, or soda in the car in case your blood glucose drops too low.
  • Ask ahead of time for a diabetes meal if you're traveling by plane. Most airlines serve special meals for people with health needs. Carry food (like crackers or fruit) with you in case meals are late.
  • Carry your medicines (insulin, insulin needles, and diabetes pills) and your blood testing supplies with you. Never put them in the suitcase you don't carry with you on the plane or train.
  • Ask your health care team how to adjust your medicines, especially your insulin, if you're traveling across time zones.
  • Take comfortable, well-fitting shoes on vacation. You'll probably be walking more than usual, so you should take extra care of your feet.
  • If you're going to be away for a long time, ask your doctor for a written prescription for your diabetes medicine and the name of a doctor in the place you're going to visit.
  • Don't count on buying extra supplies when you're traveling, especially if you're going to another country. Different countries use different kinds of insulin, needles, and pills. When traveling by plane, find out if and when a meal will be served. Then decide when to take your insulin shot or diabetes pills. You may need to bring healthy snacks for the trip.

ACTION STEPS

If you use insulin When you travel:

  • Buy special insulated bags to carry your insulin and to keep it from freezing or getting too hot.
  • Take extra needles, insulin, and blood glucose test strips in case of loss or breakage.
  • If you're going to another country, ask your doctor for a letter saying that you have diabetes and need insulin shots. If asked, show the letter to the customs people.

When You're Planning a Pregnancy


Planning ahead is very important if you want to have a baby. High blood glucose can be harmful to both a mother and her unborn baby. Even before you become pregnant, your blood glucose should be close to the normal range. 

Keeping blood glucose near normal before and during pregnancy helps protect both mother and baby. Your insulin needs may change when you're pregnant. Your doctor may want you to take more insulin and check your blood glucose more often. If you take diabetes pills, your doctor will switch you to insulin when you're pregnant.

If you plan to have a baby:

  • Work with your health care team to get your blood glucose as close to the
    normal range as possible.
  • See a doctor who has experience in taking care of pregnant women with
    diabetes.
  • Have your eyes and kidneys checked. Pregnancy can make eye and
    kidney problems worse.
  • Don't smoke, drink alcohol, or use harmful drugs.
  • Follow the meal plan you get from your dietitian or diabetes educator to
    make sure you and your unborn baby have a healthy diet.


If you're already pregnant, see your doctor right away. It's not too late to bring your blood glucose close to normal so that you'll stay healthy during the rest of your pregnancy. 

Maria, a 25-year-old woman with type 1 diabetes, wanted children. Her doctor told Maria and her husband that before she got pregnant, her blood glucose should be close to normal and her kidneys, eyes, and blood pressure should be checked. 

Maria began to watch her diabetes very carefully. She checked her blood glucose four times a day, ate healthy meals, began to walk a lot, and checked her blood and urine often to make sure that her body was healthy enough to carry a baby. Once Maria became pregnant, she spent a lot of time taking care of her diabetes. 

Her hard work paid off. After 9 months, she gave birth to a healthy baby boy.

Where to Get More Help With Your Diabetes

People Who Can Help You


Your doctor.
 

He or she may be your doctor at the clinic where you go for health care, your family doctor, or someone who has special training in caring for people with diabetes. A doctor with that kind of special training is called an endocrinologist or diabetologist.


You'll talk with your doctor about what kind of medicine you need and how much you should take. You'll also agree on a target blood glucose range and blood pressure and cholesterol targets. Your doctor will do tests to be sure that your blood glucose, blood pressure, and cholesterol are staying on track and that you're staying healthy. Ask your doctor if you should take aspirin every day to help prevent heart disease.

Your diabetes educator.  

A diabetes educator may be a nurse, a dietitian, or another kind of health care worker. Diabetes educators teach you about meal planning, diabetes medicines, exercise, how to check your blood glucose, and how to fit diabetes care into your everyday life.


Don't be shy about asking your doctor or diabetes educator about the information in this guide.  

Ask questions if you don't understand something. After all, it's your health!

Your family and friends. 

Keeping your blood glucose at your target level is a daily job. You may need help or support from your family or friends. You may want to bring a family member or close friend with you when you visit your doctor or diabetes educator. Taking good care of your diabetes can sometimes be a family affair!

A counselor or mental health worker.

You might feel sad about having diabetes or get tired of taking care of yourself. Or you might be having problems because of work, school, or family. If diabetes makes you feel sad or angry or if you have other problems that make you feel bad, you can talk to a counselor or mental health worker. Your doctor or diabetes educator can help you find a counselor if you need one.

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Source National Diabetes Information Clearinghouse (NDIC)

 

© Anthony George 2005