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What Diabetes Is: Chapter Four Why It's Important to Take Care of Your Diabetes In this chapter: Diabetes and Your Heart and Blood Vessels Diabetes and Your Eyes Diabetes and Your Kidneys Diabetes and Your Nerves Diabetes and Your Gums and Teeth Taking care of your diabetes every day will help keep your blood glucose in your target range and help prevent other health problems that diabetes can cause over the years. This part of the guide describes those problems. We tell you about them not to scare you, but to help you understand what you can do to keep them from happening. Do what you can every day to keep your blood glucose in the range that's best for you. 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 (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 fat and salt. Keep your blood glucose on track. Know your A1C. The target for most people is under 7. 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. Keep your blood pressure on track. The target for most people is under 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 under 100. If needed, take medicine to control your blood fat levels. 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 beats and the second is the pressure as your heart relaxes. If your blood pressure is higher than your target, talk with your health care team about changing your meal plan, exercising, or taking medicine. Blood Pressure Results Target for most people with diabetes: under 130/80 What are desirable blood fat levels? Cholesterol, a fat found in the body, appears in different forms. If your LDL cholesterol ("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 ("good" cholesterol) protects you from heart disease, so the higher it is, the better. It's best to keep triglyceride (another type of fat) levels under 150. All of these target numbers are important for preventing heart disease. Target Blood Fat Levels for People With Diabetes Total cholesterol: under 200 LDL cholesterol: under 100 HDL cholesterol: above 40 (men)/above 50 (women) Triglycerides: under 150 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. 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, called a microalbumin test, once a year to check for signs of kidney damage. The test measures how much protein is in your urine. 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 doing the following: Take your medicine if you have high blood pressure. Ask your doctor or your dietitian whether you should eat less protein (meat, poultry, cheese, milk, fish, and 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. 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 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 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). 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 water. 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. Help prevent damage to your gums and teeth by doing the following: 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.