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Short-Term

Low blood sugar (hypoglycemia) is caused when there is an imbalance in the amount of food compared to the amount of exercise or insulin and/or some of the oral medications for diabetes. The symptoms may be felt suddenly and should be treated immediately. Some of the signs of low blood sugar are shaking, fast heartbeat, sweating, anxiety, dizziness, hunger, impaired vision, weakness/fatigue, headache or irritability. Sudden severe low blood sugar may make you seem drunk to others. To bring your blood-sugar level up quickly you can drink a half glass of orange juice, milk or eat fast dissolving candy. If possible, test your blood-sugar level in 10 minutes. If it is more than 30 minutes to your next meal, you should eat a light snack and test your blood sugar again. Many people who take insulin like to have a sugar emergency kit ready for use. In addition, it?s also a good idea to carry a card or wear identification that says you have diabetes and what you might need in an emergency. For a small fee, some groups offer a registration service that keeps information about your treatment on file for emergency medical use. Several organizations, including Central Ohio Diabetes Association, sell identification items, such as bracelets, necklaces and key rings, inscribed with your medical condition and other important information.

High blood sugar (hyperglycemia) is caused by too much food, too little insulin or diabetes medicine, illness or stress. It begins slowly and, if left untreated, may progress to diabetic coma. Symptoms are extreme thirst, frequent urination, dry skin, hunger, blurred vision, headache, drowsiness or being very tired, and being sick to your stomach. Test your blood sugar and record levels. If more than 250 mg/dl for several tests, call your physician.

When you have diabetes, special care needs to be taken when you are sick with a cold or the flu. Check your blood sugar often and, if you have Type 1 diabetes, test for ketones in your urine (see Monitoring). Your physician will need to know this information when you call. Drink plenty of caffeine-free, calorie-free liquids. Try to eat something such as broth or plain toast, or drink some juice, even if your stomach is upset. Never stop taking your diabetes medication. If changes are needed, your doctor will tell you. It's always a good idea to get the name of a back-up doctor or nurse to call in case you're unable to reach a team member when you're ill. If you live alone it's also a good idea to have someone (a relative, friend or neighbor) regularly check in on you to see how you are doing.

For people with diabetes, the flu can be more than aches and pains. It can mean longer illnesses, hospitalization and even death because diabetes can make the immune system more vulnerable to severe cases of the flu. People with diabetes are almost three times more likely to die with influenza or pneumonia. Flu vaccines are available at little or no cost-in fact, they're covered by Medicare, Part B -at doctor's offices, clinics, pharmacies and grocery stores before the flu season starts in the fall. Consult your doctor before getting vaccinated. While at your doctor's office ask about getting vaccinated against pneumonia. It's safe to have along with a flu shot, provides long lasting protection and is also covered by Medicare.

Long-Term

If you have diabetes, your entire body will in some way be affected by the complex nature of diabetes. People with diabetes need to keep blood pressure, cholesterol and sugar levels under control. High blood pressure (hypertension), high blood fats (hyperlipidemia) and high blood sugar (hyperglycemia) can cause severe problems if left untreated.

High blood pressure
An estimated 60 to 65 percent of people with diabetes have high blood pressure. Acceptable levels vary, but if your blood pressure is 140/85 or higher, consult your physician. A major study that ran from 1977-1997, the United Kingdom Prospective Diabetes Study (UKPDS), showed that tight control of blood sugar and blood pressure, and the use of prescribed medication instead of diet alone did help people with Type 2 diabetes avoid complications.

Patient education is critical. People with diabetes can reduce their risk for complications if they are educated about their disease and practice the skills necessary to better control their blood sugar, pressure, cholesterol and sugar levels.

What to do:

  • Have your blood pressure checked regularly
  • Take blood pressure medication as prescribed
  • Follow a healthy meal plan
  • Avoid salt
  • Exercise regularly
  • Reduce stress

Nerve damage (neuropathy)
About 60 to 70 percent of people with diabetes has mild to severe forms of nerve damage (neuropathy). This includes loss of feeling or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, sexual dysfunction (impotence) and other nerve problems. Nerve damage happens over a long period of time, usually after several years of uncontrolled high blood sugar, so the brain can't recognize pain in that area. Watch for problems with numbness, tingling/ burning feelings in hands or feet, sexual function, and diarrhea.

What to do:

  • Tell your physician about any problems;
  • Keep blood sugar in an acceptable range.

For nerve damage in the feet watch for pain, numbness, swelling, tenderness, sores which won't heal and high blood pressure. Severe forms of diabetic nerve damage can lead to lower limb amputations. The risk of a leg amputation is 15 to 40 times greater for anyone with diabetes. Unfortunately, more than 56,000 amputations are performed each year among people with diabetes.

What to do:

  • Wear shoes that fit
  • Don't go barefoot
  • Check feet daily for cuts, bruises, redness and swelling
  • Inform physician or podiatrist about any injury
  • Keep feet clean
  • Have a foot exam every three months
  • Keep blood pressure and blood sugar in normal ranges
  • Don't smoke
  • Exercise regularly
  • Avoid drinking alcohol.

Blindness
Diabetes is the leading cause of new cases of blindness in adults. In fact, diabetic retinopathy causes from 12,000 to 24,000 new cases of blindness each year. Watch for any change in eyesight, blurred vision or "floaters."

What to do:

  • Tell your doctor right away about any change
  • Have a dilated eye exam every year
  • Keep blood pressure and blood sugar in acceptable ranges.

Kidney disease (nephropathy)
Diabetes is also the leading cause of kidney disease (nephropathy), accounting for about 40 percent of new cases. Each year approximately 100,000 people with diabetes undergo dialysis or kidney transplantation. Watch for high blood pressure and ask your doctor to check for protein in urine.

What to do:

  • Keep blood pressure and blood sugar in acceptable ranges
  • Limit protein in meal plan if recommended by your physician.

Heart disease
Heart disease is the leading cause of death in people with diabetes. Adults with diabetes are two to four times as likely to die from heart disease than those without diabetes. Watch for chest pain or pressure, shortness of breath and swollen ankles.

What to do:

  • Tell your physician about any problem
  • Ask your physician about low-dose aspirin
  • Keep blood pressure, cholesterol and blood sugar in acceptable ranges
  • Avoid salt
  • Exercise regularly.

Gum disease
Gum disease (specifically periodontal disease) happens more often and is more severe among people with diabetes. Watch for pain or bleeding.

What to do:

  • Clean and floss after eating
  • See dentist twice a year at least
  • Inform dentist you have diabetes
  • Keep blood sugar in an acceptable range.

Stroke
The risk of stroke is two to four times higher in people with diabetes. A stroke is a life-threatening event in which the brain's vital supply of oxygen is disrupted. A stroke can affect the senses, speech, behavior, thought patterns and memory. It also may result in paralysis, coma and death. Symptoms of a stroke require immediate emergency treatment.

Watch for:

  • Sudden weakness or numbness of the face, arm and leg on one side of the body
  • Loss of speech or trouble talking
  • Trouble understanding speech
  • Dimness or loss of vision in one eye
  • Unexplained dizziness, unsteadiness or falls
  • Sudden severe headaches.

What to do:

  • High blood pressure is the major risk factor in stroke, so have it checked regularly and keep it under control
  • Making healthy food choices low in fat
  • Do not smoke
  • Avoid drinking alcohol
  • Ask your physician about taking low-dose aspirin.

Depression
Living with diabetes is not easy. You may feel overwhelmed at times. However, if feelings of sadness, fatigue and hopelessness persist, they may be classified as depression. Because of the similarities between hyperglycemia and depression, the diagnosis is often a tricky one for doctors to make. It has been proven in studies that less than one-third of people with depression and diabetes are recognized and treated. Once diagnosed a combination of antidepressant medication and therapy is found to be effective in relieving depression.

Watch for:

  • Sadness
  • Irritability
  • Loss of interest in activities
  • Trouble concentrating
  • Feelings of guilt and/or hopelessness
  • Weight loss or gain
  • Trouble sleeping--either too much or too little
  • Feeling alone and isolated.

What to do:

  • Talk to your physician about your feelings
  • Consider seeing a mental-health professional
  • Join a diabetes support group.