Diabetes


What Is Diabetes?

Most of the food we eat is turned into glucose (sugar) for our bodies to use for energy. The pancreas, an organ near the stomach, makes a hormone called insulin to help glucose get into our body cells. When you have diabetes, your body either doesn’t make enough insulin or can’t use its own insulin very well. This problem causes glucose to build up in your blood.

Signs and Symptoms of Diabetes

You may recall having some of these signs before you found out you had diabetes:

  • Being very thirsty.
  • Urinating a lot, often at night.
  • Having blurry vision from time to time.
  • Feeling very tired much of the time.
  • Losing weight without trying.
  • Having very dry skin.
  • Having sores that are slow to heal.
  • Getting more infections than usual.
  • Losing feeling or getting a tingling feeling in the feet.
  • Vomiting.

Types of Diabetes

There are two main types of diabetes:

  • Type 1.
  • Type 2.

Another type of diabetes appears during pregnancy in some women. It’s called gestational diabetes.

One out of 10 people with diabetes has type 1 diabetes. These people usually find out they have diabetes when they are children or young adults. People with type 1 diabetes must inject insulin every day to live. The pancreas of a person with type 1 makes little or no insulin. Scientists are learning more about what causes the body to attack its own beta cells of the pancreas (an autoimmune process) to stop making insulin in people with certain sets of genes.

Most people with diabetes (9 out of 10) have type 2 diabetes. The pancreas of people with type 2 diabetes keeps making insulin for some time, but the body can’t use it very well. Most people with type 2 find out about their diabetes after age 30 or 40.

Certain risk factors make people more likely to get type 2 diabetes. Some of these are

  • A family history of diabetes.
  • Lack of exercise.
  • Weighing too much.
  • Being of African American, American Indian, Alaska Native, Hispanic/Latino, or Asian/Pacific Islander heritage.

You can help manage your diabetes by controlling your weight, making healthy food choices, and getting regular physical activity. Ask for help from your health care team. Some people with type 2 diabetes may also need to take diabetes pills or insulin shots to help control their diabetes.

Some people with diabetes are concerned about their family members getting diabetes. There is a new study that shows that some people may be able to prevent or delay the onset of type 2 diabetes. To find out more, talk to your health care provider, visit the CDC Diabetes Website, or call 1-877-CDC-DIAB (232-3422).

Keeping Track of Your Blood Glucose

Diabetes - Keeping track of your blood glucose

It’s important to your health to control your blood glucose (also called blood sugar). Keeping your glucose level close to normal helps prevent or delay some diabetes problems, such as eye disease, kidney disease, and nerve damage. One thing that can help you control your glucose level is to keep track of it. You can do this by

  • Testing your own glucose a number of times each day (self-monitoring blood glucose). Many people with diabetes test their glucose 2 to 4 times a day.
  • Getting an A1C test from your health care provider about every 3 months if you take insulin and at least every 6 months if you don’t take insulin.

These tests can help you and the rest of your diabetes health care team (doctor, diabetes educator, and others) work together to help you control your blood glucose.

Testing Your Blood Glucose Each Day

You can do a test to find out what your blood glucose is at any moment. Your health care team can show you how to do the test yourself. Using a finger prick, you place a drop of blood on a special coated strip, which “reads” your blood glucose. Many people use an electronic meter to get this reading.

Blood glucose testing can help you understand how food, physical activity, and diabetes medicine affect your glucose levels. Testing can help you make day-to-day choices about how to balance these things. It can also tell you when your glucose is too low or too high so that you can treat these problems.

Ask your health care team to help you set a goal for your glucose range and show you how to record your glucose readings in a logbook or record sheet. If you need a daily logbook, ask your health care provider for one.

Be sure to write down each glucose reading and the date and time you took it. When you review your records, you can see a pattern of your recent glucose control. Keeping track of your glucose on a day-to-day basis is one of the best ways you can take charge of your diabetes.

Getting a Summary Lab Test (A1C)

An A1C test uses blood drawn from a vein in your arm to sum up your diabetes control for the past few months. An A1C test measures how much glucose has been sticking to your red blood cells. Since each red blood cell is replaced by a new one every 4 months, this test tells you how high the glucose levels have been during the life of the cells.

If most of your recent blood glucose readings have been near normal (70 to 140 milligrams per deciliter or mg/dL, with the higher reading mainly after meals), the A1C test will be near normal (usually about 6%-7%). If you’ve had many readings above normal, the extra glucose sticking to your red blood cells will make your A1C test read higher.

You should get an A1C test at least 2 times a year. People who take insulin need to get this test about 4 times a year. If your A1C test results are high, work with your team to adjust your balance of food, physical activity, and diabetes medicine. When your A1C test result is near your goal, you’ll know you’ve balanced things well.

Having Problems with Low Blood Glucose

In general, a blood glucose reading lower than 70 mg/dL is too low. If you take insulin or diabetes pills, you can have low blood glucose (also called hypoglycemia). Low blood glucose is usually caused by eating less or later than usual, being more active than usual, or taking too much diabetes medicine. Drinking beer, wine, or liquor may also cause low blood glucose or make it worse.

Low blood glucose happens more often when you’re trying to keep your glucose level near normal. This is no reason to stop trying to control your diabetes. It just means you have to watch more carefully for low levels. Talk this over with your health care team.

Signs of Low Blood Glucose

Some possible signs of low blood glucose are feeling nervous, shaky, or sweaty. Sometimes people just feel tired.

The signs may be mild at first. But a low glucose level can quickly drop much lower if you don’t treat it. When your glucose level is very low, you may get confused, pass out, or have seizures. If you have any signs that your glucose may be low, test it right away. If it’s less than 60 to 70 mg/dL, you need to treat it right away.

Treating Low Blood Glucose

If you feel like your blood glucose is getting too low but you can’t test it right then, play it safe-go ahead and treat it. Eat 10 to 15 grams of carbohydrate right away. Examples of foods and liquids with this amount of carbohydrate are listed below:

Foods and Liquids for Low Blood Glucose

(Each item equals about 10 to 15 grams of carbohydrate)

FOOD ITEM AMOUNT
Sugar packets 2 to 3
Fruit juice 1/2 cup (4 ounces)
Soda pop (not diet) 1/2 cup (4 ounces)
Hard candy 3 to 5 pieces
Sugar or honey 3 teaspoons
Glucose tablets 2 to 3

Check your blood glucose again in 15 minutes. Eat another 10 to 15 grams of carbohydrate every 15 minutes until your blood glucose is above 70 mg/dL.

Eating or drinking an item from the list on this page will keep your glucose up for only about 30 minutes. So if your next planned meal or snack is more than 30 minutes away, you should go ahead and eat something like crackers and a tablespoon of peanut butter or a slice of cheese.

In your glucose logbook or record sheet, write down the numbers and the times when low levels happen. Think about what may be causing them. If you think you know the reason, write it beside the numbers you recorded. You may need to call your health care provider to talk about changing your diet, activity, or diabetes medicine.

Tell family members, close friends, teachers, and people at work that you have diabetes. Tell them how to know when your blood glucose is low. Show them what to do if you can’t treat yourself. Someone will need to give you fruit juice, soda pop (not diet), or sugar.

If you can’t swallow, someone will need to give you a shot of glucagon and call for help. Glucagon is a prescription medicine that raises the blood glucose and is injected like insulin. If you take insulin, you should have a glucagon kit handy. Teach family members, roommates, and friends when and how to use it.

Waiting to treat low blood glucose is not safe. You may be in danger of passing out. If you get confused, pass out, or have a seizure, you need emergency help. Don’t try to drive yourself to get help. Be prepared for an emergency.

Preventing Low Blood Glucose

Keep a balance

Try to stay close to your usual schedule of eating, activity, and medicine. If you’re late getting a meal or if you’re more active than usual, you may need an extra snack.

Test your blood glucose

Keeping track of your blood glucose is a good way to know when it tends to run low. Show your logbook or record sheet to your health care providers. Be sure to let them know if you’re having a number of low glucose readings a week.

To be safe, always check your glucose before doing any of these things:

  • Driving a vehicle.
  • Using heavy equipment.
  • Being very physically active.
  • Being active for a long time.

Ask your health care team whether you should test your glucose before (or during) any other activities.

Be prepared

Always carry some type of carbohydrate with you so you’ll be ready at any time to treat a low glucose level.

Always wear something (like an identification bracelet) that says you have diabetes. Carry a card in your wallet that says you have diabetes and tells if you use medicine to treat it.

Having Problems with High Blood Glucose

For most people, blood glucose levels that stay higher than 140 mg/dL (before meals) are too high. Talk with your health care team about the glucose range that is best for you.

Eating too much food, being less active than usual, or taking too little diabetes medicine are some common reasons for high blood glucose (or hyperglycemia). Your blood glucose can also go up when you’re sick or under stress.

Over time, high blood glucose can damage body organs. For this reason, many people with diabetes try to keep their blood glucose in control as much as they can.

Some people with diabetes are in danger of diabetic ketoacidosis when their glucose level stays high. You can tell if you’re in diabetic ketoacidosis by checking your urine for ketones. If you have ketones in your urine, call your doctor or go to the hospital right away. The most common reason for diabetic ketoacidosis is not taking your insulin. If you have type 1 diabetes, ask your health care team about diabetic ketoacidosis.

Your blood glucose is more likely to go up when you’re sick—for example, when you have the flu or an infection. You’ll need to take special care of yourself during these times.

Signs of High Blood Glucose

Some common signs of high blood glucose are having a dry mouth, being thirsty, and urinating often. Other signs include feeling tired, having blurred vision, and losing weight without trying. If your glucose is very high, you may have stomach pain, feel sick to your stomach, or even throw up.

If you have any signs that your glucose is high, test your blood. In your logbook or on your record sheet, write down your glucose reading and the time you did the test. If your glucose is high, think about what could have caused it to go up. If you think you know of something, write this down beside your glucose reading.

Preventing High Blood Glucose

Keep a balance!

Try to stay with your food and activity plan as much as you can. Drink water. Take your diabetes medicine about the same time each day. Work with your health care team to set goals for weight, glucose level, and activity.

Test your blood glucose

Keep track of your glucose and go over your records often. You’ll learn how certain foods or activities affect your glucose.

Show your records to your health care team. Ask how you can change your food, activity, and medicine to avoid or treat high blood glucose. Ask when you should call for help.

Taking Care of Yourself When You’re Sick

You’ll need to take special care of yourself when you’re sick. The tips that follow can help you do this.

Keep Taking Medicine

Be sure to keep taking your diabetes pills or insulin. Don’t stop taking them even if you can’t eat. Your health care provider may even advise you to take more insulin during sickness.

Keep Eating

Try to eat the same amount of fruits and breads as usual. If you can, eat your regular diet. If you’re having trouble doing this, use food exchanges: eat enough soft foods or drink enough liquids to take the place of the fruits and breads you usually eat. A food exchange is a measured portion of one type of food that can be eaten instead of another type of food. A food exchange will give you similar nutrients. Use the following list to make food exchanges for bread or fruit.

What to Eat or Drink When You’re Sick

(Each item equals one bread or fruit exchange)

FOOD ITEM AMOUNT
Fruit juice 1/3 to 1/2 cup
Fruit-flavored drink 1/2 cup
Soda pop (regular, not diet) 1/2 cup
Jell-O (regular, not sugar-free) 1/2 cup
Popsicle (regular, not sugar-free) 1/2 twin
Sherbet 1/4 cup
Saltine crackers 6 squares
Milk 1 cup
Thin soup (examples: vegetable, chicken noodle) 1 cup
Thick soup (examples: cream of mushroom, tomato) 1/2 cup
Ice cream (vanilla) 1/2 cup
Pudding (sugar-free) 1/2 cup
Pudding (regular) 1/4 cup
Macaroni, noodles, rice, mashed potatoes 1/2 cup (cooked)

Drink liquids

Drink extra liquids. Try to drink at least 1/2 cup (4 ounces) to 3/4 cup (6 ounces) every half-hour to hour, even if you have to do this in small sips. These liquids should not have calories. Water, diet soda pop, or tea without sugar are good choices.

Check for Changes

  • Test your blood glucose at least once every 4 hours. If your glucose is 240 mg/dL or higher, test your urine for ketones. Ketones are chemicals the liver makes when there’s not enough insulin in the blood. It’s easy to test for ketones. Buy urine ketone strips at the drug store. Urinate on the pad part of the strip. Compare the color that the strip becomes to the color example on the package. If the pad turns a purple color, call your health care provider right away.
  • Weigh yourself every day. Losing weight without trying is a sign of high blood glucose.
  • Check your temperature every morning and evening. A fever may be a sign of infection.
  • Every 4 to 6 hours, check how you’re breathing and decide how alert you feel. Having trouble breathing, feeling more sleepy than usual, or not thinking clearly can be danger signs.

Keep Records

Keep records on sick days. Ask a family member or friend to help if you need it.

Call for Help

Ask your health care provider when you should call. During your sick times, you may need to call every day for advice.

You should call your health care provider or go to an emergency room if any of the following happens:

  • You feel too sick to eat normally and for more than 6 hours can’t keep food or liquids down.
  • You have severe diarrhea (loose bowel movement).
  • You lose 5 pounds or more without trying to.
  • Your temperature is over 101 degrees Farenheit.
  • Your blood glucose level is lower than 60 mg/dL or stays over 300 mg/dL.
  • You have moderate or large amounts of ketones in your urine.
  • You’re having trouble breathing.
  • You feel sleepy or can’t think clearly.

Managing Your Diabetes at Work, School, and During Travel

Staying in charge of your diabetes no matter what your day holds–work, school, travel, or special events—takes planning ahead. Many days will go smoothly, but some days will hold surprises, such as extra activity or delays that throw your schedule off.

Plan ahead for these times by always keeping a treatment for low blood glucose with you. If you have any signs that your glucose may be low, go ahead and treat it right away.

Stay as close to your eating, activity, and medicine schedule as you can. Keep track of your glucose so you can pick up changes early. Always wear or carry identification that says you have diabetes.

Talk with your health care team about your planned schedule and activities. Ask for help in planning ahead for work, school, travel, and special events.

At Work and School

Talk with your health care team about the type of activity you do at work or at school. From time to time, you and your health care team may need to make changes in your activity, medicine, or eating.

Many people take supplies for testing their glucose to work or to school so they can test at regular break times. Some people choose to show their fellow workers, their teachers, or their classmates how to help if they should ever have a problem. They teach them how to tell when their glucose is low and how to treat it. Some people like to have written steps on file at their place of work or with their teacher.

During Travel

When you plan a trip, think about your day-to-day schedule, and try to stay as close to it as you can. For example, if you usually test your blood glucose at noon and then eat lunch, plan to do this on your trip, as well. Trips can hold surprises- in delays and changes. Even the types of food and supplies you can buy on your trip may not be the same as those you get at home.

Before you travel, work with your health care provider to plan your timing for medicine, food, and activity. Talk about what to do if you find changes in your glucose readings.

Plan ahead for trips:

  • Keep snacks with you that could be used to prevent-or treat-low blood glucose.
  • Carry extra food and drink supplies with you, such as cracker packs and small cans of juices or bottled water.
  • Carry glucose testing supplies with you.
  • Take along all the diabetes medicine you’ll need. Keep medicines in the original pharmacy container with the printed label that clearly identifies the medicine.

When you travel, be sure to

  • Test your glucose often and keep track of it. Wear identification that says you have diabetes. Let others know how they can help you. Check new airline travel tips by visiting the Federal Aviation Administration (FAA) website or by calling 800-322-7873.

If you’re traveling in a different time zone, you may need to change your timing of food, medicine, and activity. Ask your health care provider to help you with this. Talk about the food and drink choices that would be healthy for you. If you’ll be in another country, ask your doctor to write a letter explaining that you have diabetes. It’s also a good idea to get your doctor to write a prescription for you to get insulin or supplies if needed.

Eye Problems

Diabetic eye disease (also called diabetic retinopathy) is a serious problem that can lead to loss of sight. There’s a lot you can do to take charge and prevent such problems. A recent study shows that keeping your blood glucose level closer to normal can prevent or delay the onset of diabetic eye disease. Keeping your blood pressure under control is also important. Finding and treating eye problems early can help save sight.

Signs of Diabetic Eye Disease

Since diabetic eye disease may be developing even when your sight is good, regular eye exams are important for finding problems early. Some people may notice signs of vision changes. If you’re having trouble reading, if your vision is blurred, or if you’re seeing rings around lights, dark spots, or flashing lights, you may have eye problems. Be sure to tell your health care team or eye doctor about any eye problems you may have.

Protecting Your Sight

Keep Your Blood Glucose Under Control

High blood glucose can damage your eyes as time goes by. Work with your health care team to keep your glucose levels as close to normal as you can.

Keep Your Blood Pressure Under Control

High blood pressure can damage your eyes. Have your health care provider check your blood pressure at least 4 times a year. If your blood pressure is higher than 130/80, you may want to buy a blood pressure cuff and check your blood pressure at home. Ask your health care provider where you can buy a cuff.

Get Regular Eye Exams

Even if you’re seeing fine, you need regular, complete eye exams to protect your sight. Ask your health care provider to help you find an eye doctor who cares for people with diabetes. Before the exam, a doctor or nurse will put drops in your eyes to dilate the pupils.

You should have your eyes dilated and examined once a year. Keep track of these exams by using your record sheets. Even if you’ve lost your sight from diabetic eye disease, you still need to have regular eye care. If you haven’t already had a complete eye exam, you should have one now if any of these conditions apply to you:

  • You’ve had type 1 diabetes for 5 or more years.
  • You have type 2 diabetes.
  • You’re going through puberty and you have diabetes.
  • You’re pregnant and you have diabetes.
  • You’re planning to become pregnant and you have diabetes.

If you can’t afford an eye exam, ask about a payment plan or a free exam. If you’re 65 or older, Medicare may pay for diabetic eye exams (but not glasses). Ask your eye doctor to accept the Medicare fee as full payment.

Discuss Your Physical Activity Plan

If you have diabetic eye disease, talk with your health care provider about the kind of physical activity that is best for you.

Treating Diabetic Eye Disease

Treating eye problems early can help save sight. Laser surgery may help people who have advanced diabetic eye disease. An operation called a vitrectomy may help those who have lost their sight from bleeding in the back of the eye.

If your sight is poor, an eye doctor who is an expert in low vision may be able to give you glasses or other devices that can help you use your limited vision more fully. You may want to ask your health care provider about support groups and job training for people with poor vision.

Kidney Problems

Diabetes can cause diabetic kidney disease (also called diabetic nephropathy), which can lead to kidney failure. There’s a lot you can do to take charge and prevent kidney problems. A recent study shows that controlling your blood glucose can prevent or delay the onset of kidney disease. Keeping your blood pressure under control is also important.

The kidneys keep the right amount of water in the body and help filter out harmful wastes. These wastes, called urea, then pass from the body in the urine. Diabetes can cause kidney disease by damaging the parts of the kidneys that filter out wastes. When the kidneys fail, a person has to have his or her blood filtered through a machine (a treatment called dialysis) several times a week or has to get a kidney transplant.

Testing Your Kidneys

Your health care provider can learn how well your kidneys are working by testing for microalbumin (a protein) in the urine. Microalbumin in the urine is an early sign of diabetic kidney disease. You should have your urine checked for microalbumin every year.

Your health care provider can also do a yearly blood test to measure your kidney function. If the tests show microalbumin in the urine or if your kidney function isn’t normal, you’ll need to be checked more often.

Protecting Your Kidneys

Keep Your Blood Glucose Under Control

High blood glucose can damage your kidneys as time goes by. Work with your health care team to keep your glucose levels as close to normal as you can.

Keep Your Blood Pressure Under Control

High blood pressure (or hypertension) can damage your kidneys. You may want to check your blood pressure at home to be sure it stays lower than 130/80. Have your health care provider check your blood pressure at least 4 times a year. Your doctor may have you take a blood pressure pill, called an ACE inhibitor, to help protect your kidneys.

Choose Healthy Foods

You may want to talk to your health care team about cutting back on foods that are high in proteins (such as meat, milk, and cheese). A diet high in proteins can cause more damage to your kidneys over time. Eating less salt is also a good idea.

Preventing and Treating Infections

Bladder and kidney infections can damage your kidneys. Call your health care provider right away if you have any of these signs of bladder infection:

  • Cloudy or bloody urine.
  • Pain or burning when you urinate.
  • An urgent need to urinate often.

Call your health care provider right away if you have any of these signs of kidney infections:

  • Back pain.
  • Chills.
  • Fever.
  • Ketones in the urine.

Your health care provider will test your urine. If you have a bladder or kidney infection, you’ll be given medicine to stop the infection. After you take all the medicine, have your urine checked again to be sure the infection is gone.

Know the Effects of Some Medicines and X-Ray Dyes

If you have kidney disease, ask your health care provider about the possible effects that some medicines and X-ray dyes can have on your kidneys.

Heart and Blood Vessel Problems

Heart and blood vessel problems are the main causes of sickness and death among people with diabetes. These problems can lead to high blood pressure, heart attacks, and strokes. Heart and blood vessel problems can also cause poor circulation (blood flow) in the legs and feet.

You’re more likely to have heart and blood vessel problems if you smoke cigarettes, have high blood pressure, or have too much cholesterol or other fats in your blood. Talk with your health care team about what you can do to lower your risk for heart and blood vessel problems. Ask about taking a daily aspirin to help prevent heart and blood vessel problems.

Signs of Heart and Blood Vessel Problems

If you feel dizzy, have sudden loss of sight, slur your speech, or feel numb or weak in one arm or leg, you may be having serious heart and blood vessel problems. Your blood may not be getting to your brain as well as it should.

Danger signs of circulation problems to the heart include chest pain or pressure, shortness of breath, swollen ankles, or irregular heartbeats. If you have any of these signs, go to an emergency room or call your health care provider right away.

Signs of circulation problems to your legs are pain or cramping in your buttocks, thighs, or calves during physical activity. Even if this pain goes away with rest, report it to your health care provider.

Preventing and Controlling Heart and Blood Vessel Problems

Eat Right and Get Physical Activity

Choose a healthy diet, low in salt. Work with a dietitian to plan healthy meals. If you’re overweight, talk about how to safely lose weight. Ask about a physical activity or exercise program for you.

Don’t Use Tobacco

Smoking cigarettes causes hundreds of thousands of deaths each year. When you have diabetes and also use tobacco, the risk of heart and blood vessel problems is even greater. One of the best choices you can make for your health is to never start smoking—or if you smoke, to quit.

At least once a year, your health care provider will ask you about tobacco use. If you smoke, talk to your provider about ways to help you stop.

Check Your Blood Pressure

Get your blood pressure checked at each visit. Record these numbers on your record sheets. If your blood pressure is higher than 130/80, you may want to buy a blood pressure cuff and check your blood pressure at home. Ask your health care provider where you can buy a cuff.

If your blood pressure is still high after 3 months, you may need medicine to help control it. Many medicines are available to treat high blood pressure. If you have side effects from the medicine, ask your health care provider to change it.

Check Your Cholesterol

Get your cholesterol checked once a year. Your total cholesterol should be lower than 200 mg/dL (milligrams per deciliter). Ask your health care team to explain what your HDL and LDL levels are.

If your cholesterol is higher than 200 mg/dL on two or more checks, you can do several things to lower it. You can work with your health care team to improve your blood glucose control, you can lose weight (if you’re overweight), and you can cut down on foods that are high in fat and cholesterol. Ask your health care team about foods that are low in fats. Also ask about a physical activity program.

If your cholesterol is still high after 6 months, you may need a medicine to help control it. Your health care provider will advise you about what medicine to take.

Ask If You Need an Electrocardiogram (EKG)

If you’re having heart and blood circulation problems, an EKG may help you and your health care provider know if you need to change your treatment.

Nerve Damage

Diabetic nerve damage (also called diabetic neuropathy) is a problem for many people with diabetes. Over time, high blood glucose levels damage the delicate coating of nerves. This damage can cause many problems, such as pain in your feet. There’s a lot you can do to take charge and prevent nerve damage. A recent study shows that controlling your blood glucose can help prevent or delay these problems. Controlling your blood glucose may also help reduce the pain from some types of nerve damage.

Some Signs of Diabetic Nerve Damage

Some signs of diabetic nerve damage are pain, burning, tingling, or loss of feeling in the feet and hands. It can cause you to sweat abnormally, make it hard for you to tell when your blood glucose is low, and make you feel light-headed when you stand up.

Nerve damage can lead to be other problems. Some people develop problems swallowing and keeping food down. Nerve damage can also cause bowel problems, make it hard to urinate, cause dribbling with urination, and lead to bladder and kidney infections. Many people with nerve damage have trouble having sex. For example, men can have trouble keeping their penis erect, a problem called impotence (erectile dysfunction). If you have any of these problems, tell your health care provider. There are ways to help in many cases.

Protecting Your Nerves from Damage

Keep Your Blood Glucose in Control

High blood glucose can damage your nerves as time goes by. Work with your health care team to keep your glucose levels as close to normal as you can.

Have a Physical Activity Plan

Physical activity or exercise may help keep some nerves healthy, such as those in your feet. Ask your health care team about an activity that is healthy for you.

Get Tested for Nerve Damage

Nerve damage can happen slowly. You may not even be aware you’re losing feeling in your feet. Ask your health care provider to check your feet at each visit. At least once a year, your provider should test how well you can sense temperature, pinprick, vibration, and position in your feet. If you have signs of nerve damage, your provider may want to do more tests. Testing can help your provider know what is wrong and how to treat it.

For more information on foot care, call the National Diabetes Information Clearinghouse at 1-800-860-8747 or visit their website.

Check Your Feet for Changes

If you’ve lost feeling in your feet, you’ll need to take special care of them. Check your feet each day. Wear shoes that fit well.

Nerve damage, circulation problems, and infections can cause serious foot problems for people with diabetes. There’s a lot you can do to prevent problems with your feet. Controlling your blood glucose and not smoking or using tobacco can help protect your feet. You can also take some simple safeguards each day to care for and protect your feet. Over half of diabetes-related amputations can be prevented with regular exams and patient education.

It’s helpful to understand why foot problems happen. Nerve damage can cause you to lose feeling in your feet. Sometimes nerve damage can deform or misshape your feet, causing pressure points that can turn into blisters, sores, or ulcers. Poor circulation can make these injuries slow to heal.

Signs of Foot Problems

Your feet may tingle, burn, or hurt. You may not be able to feel touch, heat, or cold very well. The shape of your feet can change over time. There may even be changes in the color and temperature of your feet. Some people lose hair on their toes, feet, and lower legs. The skin on your feet may be dry and cracked. Toenails may turn thick and yellow. Fungus infections can grow between your toes. Blisters, sores, ulcers, infected corns, and ingrown toenails need to be seen by your health care provider or foot doctor (podiatrist) right away.

Protecting Your Feet

Ask your health care provider to look at your feet at least 4 times a year. As a reminder, take off your shoes and socks when you’re in the exam room. Have your sense of feeling and your pulses checked at least once a year. If you have nerve damage, deformed or misshaped feet, or a circulation problem, your feet need special care. Ask your health care provider to show you how to care for your feet. Also ask if special shoes would help you.

Check Your Feet Each Day

You may have serious foot problems yet feel no pain. Look at your feet every day to see if you have scratches, cracks, cuts, or blisters. Always check between your toes and on the bottoms of your feet. If you can’t bend over to see the bottoms of your feet, use a mirror that won’t break. If you can’t see well, ask a family member or friend to help you. Call your health care provider at once if you have a sore on your foot. Sores can get worse quickly.

Wash Your Feet Daily

Wash your feet everyday. Dry them with care, especially between the toes. Don’t soak your feet-it can dry out your skin, and dry skin can lead to infections. Rub lotion or cream on the tops and bottoms of your feet-but not between your toes. Moisture between the toes will let germs grow that could cause an infection. Ask your health care provider for the name of a good lotion or cream.

Trim Your Toenails Carefully

Trim your toenails after you’ve washed and dried your feet—the nails will be softer and safer to cut. Trim the nails to follow the natural curve of your toes. Don’t cut into the corners. Use an emery board to smooth the edges.

If you can’t see well, or if your nails are thick or yellowed, get them trimmed by a foot doctor or another health care provider. Ask your health care provider for the name of a foot doctor. If you see redness around the nails, see your health care provider at once.

Treat Corns and Calluses Gently

Don’t cut corns and calluses. Ask your health care provider how to gently use a pumice stone to rub them. Don’t use razor blades, corn plasters, or liquid corn or callus removers—they can damage your skin.

Protect Your Feet from Heat and Cold

Hot water or hot surfaces are a danger to your feet. Before bathing, test the water with a bath thermometer (90 to 95 degrees F is safe) or with your elbow. Wear shoes and socks when you walk on hot surfaces, such as beaches or the pavement around swimming pools. In summer, be sure to use sunscreen on the tops of your feet.

You also need to protect your feet from the cold. In winter, wear socks and footwear such as fleece-lined boots to protect your feet. If your feet are cold at night, wear socks. Don’t use hot water bottles, heating pads, or electric blankets–they can burn your feet. Don’t use strong antiseptic solutions or adhesive tape on your feet.

Always Wear Shoes and Socks

Wear shoes and socks at all times. Don’t walk barefoot—not even indoors.

Wear shoes that fit well and protect your feet. Don’t wear shoes that have plastic uppers, and don’t wear sandals with thongs between the toes. Ask your health care provider what types of shoes are good choices for you.

New shoes should be comfortable at the time you buy them-don’t expect them to stretch out. Slowly break in new shoes by wearing them only 1 or 2 hours a day.

Always wear socks or stockings with your shoes. Choose socks made of cotton or wool-they help keep your feet dry. Before you put on your shoes each time, look and feel inside them. Check for any loose objects, nail points, torn linings, and rough areas—these can cause injuries. If your shoes aren’t smooth inside, wear other shoes.

Be Physically Active

Physical activity can help increase the circulation in your feet. There are many ways you can exercise your feet, even during times you’re not able to walk. Ask your health care team about things you can do to exercise your feet and legs.

For more information on foot care, call the National Diabetes Information Clearinghouse at 1-800-860-8747 or visit their website.

Dental Disease

Because of high blood glucose, people with diabetes are more likely to have problems with their teeth and gums. There’s a lot you can do to take charge and prevent these problems. Caring for your teeth and gums every day can help keep them healthy. Keeping your blood glucose under control is also important. Regular, complete dental care helps prevent dental disease.

Signs of Dental Disease

Sore, swollen, and red gums that bleed when you brush your teeth are a sign of a dental problem called gingivitis. Another problem, called periodontitis, happens when your gums shrink or pull away from your teeth. Like all infections, dental infections can make your blood glucose go up.

Preventing Dental Problems

Keep Your Blood Glucose Under Control

High blood glucose can cause problems with your teeth and gums. Work with your health care team to keep your glucose levels as close to normal as you can.

Brush Your Teeth Often

Brush your teeth at least twice a day to prevent gum disease and tooth loss. Be sure to brush before you go to sleep. Use a soft toothbrush and toothpaste with fluoride. To help keep bacteria from growing on your toothbrush, rinse it after each brushing and store it upright with the bristles at the top. Get a new toothbrush at least every 3 months.

Floss Your Teeth Daily

Besides brushing, you need to floss between your teeth each day to help remove plaque, a film that forms on teeth and can cause tooth problems. Flossing also helps keep your gums healthy. Your dentist or dental hygienist will help you choose a good method to remove plaque, such as dental floss, bridge cleaners, or water spray. If you’re not sure of the right way to brush or floss, ask your dentist or dental hygienist for help.

Get Regular Dental Care

Get your teeth cleaned and checked at your dentist’s office at least once every 6 months. If you don’t have a dentist, find one or ask your health care provider for the name of a dentist in your community.

See your dentist right away if you have trouble chewing or any signs of dental disease, including bad breath, a bad taste in your mouth, bleeding or sore gums, red or swollen gums, or sore or loose teeth.

Give your dentist the name and telephone number of your diabetes health care provider. Each time you visit, remind your dentist that you have diabetes.

Plan dental visits so they don’t change the times you take your insulin and meals. Don’t skip a meal or diabetes medicine before your visit. Right after breakfast may be a good time for your visit.