Diabetes Self-Management Education

Complications are health problems that result when your blood sugar stays high for a long time. Some people may have diabetes for several years before it is diagnosed. During this time, your blood sugar may have been high and started to cause long-term complications.

Chronic Kidney Disease • Endstage Renal Disease

Kidneys are made up of many blood vessels that act as filters. They take the waste products out of the blood. Diabetes can hurt your kidneys by making them work too hard. Then the kidneys cannot filter the waste from the blood and the waste products stay in the blood. When the kidneys stop working it is called end stage renal disease. When this happens the person needs a kidney transplant or dialysis (when a machine takes the waste products from the blood). If kidney damage is found early there are treatments that may keep it from getting worse.

Your provider may order a blood pressure medicine called an ACE inhibitor or an ARB to protect your kidneys and heart.

*Controlling blood sugar can reduce kidney damage by up to 84%.*

Prevent Kidney Damage

Keep your blood sugar levels under control. Control high blood pressure. See your provider regularly so you can have tests for protein in the urine and check your blood pressure. Take an ACE Inhibitor or ARB if prescribed by your provider.

Things That Can Increase the Risk of Problems

• High blood sugar
• Tobacco use/Smoking
• High blood cholesterol
• High blood pressure
• Being overweight
• Lack of physical activity
• Family history of heart disease

Heart and Blood Vessel Problems

People with diabetes have a higher risk for heart and blood vessel problems. High blood sugar can cause damage due to inflammation to the blood vessels. Over time, high cholesterol and fat levels in the blood vessels can slowly reduce or block blood flow to the heart and other organs.

Signs of Heart Problems

Stroke Warning Signs or Symptoms

• Feeling dizzy or sudden severe headache with no known cause
• Sudden trouble walking
• Loss of balance or coordination
• Sudden loss of sight or trouble seeing with one or both eyes
• Slurring of speech, confusion, or trouble speaking or understanding
• Numbness or weakness in face, arm or leg especially one side of the body

Heart Attack Warning Signs or Symptoms

• Chest pain or pressure
• Trouble breathing
• Discomfort or pain in one or both arms, the back, the neck, the jaw, and the stomach (indigestion with no known cause)
• A cold sweat, stomach sickness, or feeling lightheaded

GO TO THE EMERGENCY ROOM FOR ANY OF THE ABOVE SYMPTOMS.

• At the emergency room doctors might be able to give you medicine to reduce the effects of a heart attack or stroke.
• Tell your provider if you have pain in the buttocks, thighs, or calf of the leg with exercise.
• See your provider regularly so he/she can watch for problems and treat them early.

* Controlling blood sugar can reduce the risk of heart attack and stroke by 16%.*

Diabetes is the leading cause of new causes of blindness among adults aged 18-64 years.

Behaviors to Prevent Eye Problems

• Keep your blood sugar levels under control
• Control high blood pressure
• Quit smoking
• See an eye doctor once a year for a dilated eye exam

Call your provider if:

• Your eyes hurt
• You feel pressure in your eye
• You see spots or floaters
• If you can’t see to the side or If you have double vision or blurry vision

* Good blood sugar control may reduce the risk of eye problems by 21%.*

NEVER GET NEW GLASSES WHILE YOUR BLOOD SUGAR IS HIGH.

Signs and Symptoms of Gum Disease

• Plaque on teeth, loose, or sensitive teeth
• Gums that bleed when you floss and brush your teeth
• Red, swollen, or tender gums, pus around your teeth, bad breath
• Gums that are pulled away from the teeth

Behaviors to Prevent Gum Disease

Important Things to Know

• If your mouth is sore after a dental visit use the list of foods in the “Sick Days” section until you can eat your regular foods.
• If you smoke talk to your provider about quitting.
• High levels of sugar in the saliva can cause tooth decay.
• Infections in the mouth are hard to treat.

Dry Mouth

Dry mouth may be a problem for people with diabetes. This may be caused by the medicine you take. You may also notice a dry mouth when your blood sugar is high. Less saliva can cause cavities because the saliva washes away germs and acid.

If dry mouth is a problem try drinking more fluids, chewing sugar-free gum, or sugar free hard candy. These help to increase the saliva in the mouth.

See the Dentist if You Have

• Swelling or pus around your gums, teeth, or anywhere in your mouth. Swelling can be as small as the size of a pimple.
• Pain in your mouth and face that does not go away.
• White or red patches on your gums, tongue, cheeks, or the roof of your mouth. This may be a fungus infection called thrush.
• Teeth that hurt when you eat something hot, cold, or sweet. 
• Pain when chewing.
• Dark spots or holes in your teeth.

Take your medicine and eat before going to the dentist.

People with diabetes are at risk of getting dry, itchy skin and infection, and of poor healing.

Skin should be:

• Warm and soft
• Free of red areas, scrapes, lumps, and cracks
• Moist but not too oily
• Free of irritation and disease
• Able to feel a pinprick, cold, hot, and touch

Behaviors to Care for Your Skin

Prevention

• Keep your skin clean.
• Use lanolin-based lotion to keep your skin moist. Over drying may cause cracks. This is a good place for infection to start.
• Drink plenty of water to prevent dehydration.
• Mucus membranes of mouth or nose should be pink, moist, and warm.

Treatment of Skin Problems

• Wash cuts or scrapes with warm water and non-irritating soap.
• Apply an antibacterial ointment to the wound and cover it loosely.
• Change bandages when they get moist, dirty or as instructed by your provider.
• Do not use any sharp objects to take care of the wound.
• Do not use harsh chemicals like alcohol, vinegar, gasoline, onion, garlic, or iodine on wounds.
• Call your provider if after two days there is more pain, swelling, redness, pus, or heat. Call anytime the cut is severe.
• Report any unusual drainage or odor from a wound.

High Blood Sugar Makes Infections Hard to Heal

Why Are Infections a Complication of Diabetes?

Poorly controlled diabetes can cause the white blood cells to have less ability to fight infections.

What can you do if you think you have an infection?

• See a provider for any discharge from the vagina or penis.
• Tell your provider about burning when you pass your urine, or a change in the color or odor of your urine.
• See your provider if you have a cut or sore that is not healing or if a cut or sore becomes swollen, red, painful, or has pus.

Some Types of Infections Include:

• Mouth infections, thrush, and gum disease
• Fungal infections, like athlete’s foot
• Bladder and kidney infections
• Yeast Infections
• Wound infections
• Ulcers of the feet
• Boils

Behaviors That Can Lead to Infections:

• Poor nutrition
• Not taking medications as ordered
• Lack of exercise
• Poor hygiene
• Bad foot care (shoes that don’t fit or protect, not checking feet daily)

Blood Vessel Problems and Feet

Poor circulation caused by diabetes can make sores and cuts slow to heal.

Foot Ulcers and Infections

When you have diabetes it is harder for your body to fight infections. Damage to the blood vessels can cause poor circulation in your feet. Any sore or cut on your feet can become serious. A small cut can quickly become a big problem.

Life Cycle of  Foot Problem

Pressure on the foot may cause a blister

Poor blood flow to the area can lead to infection at the blister site

High levels of sugar in the blood feed the infection and makes it worse

Early Symptoms of Infection:

• Swelling
• Redness
• Pain (if you have nerve damage you may not feel pain)

Treatment

The provider may order antibiotics or medicines to treat the infection. Be sure to take all your medicine, even if the sore looks better. These medicines help remove the dead tissue and help new, healthy tissue grow. You may need to go to a wound care center if the sore does not heal. The dead tissue may need to be surgically removed. If you have gangrene you may have all or part of your foot amputated. Keep all your visits to your provider. Preventing foot infections is one of the most important things you can do.

Check Your Feet Every Day

Diabetics are 20 times more likely to have gangrene of the foot than people without diabetes.

Take Good Care of Your Feet

• Always wear socks or stockings to help avoid blisters and sores
• Make sure the top of the sock is not tight around your leg. If the top of the socks or stockings leaves a dent in the skin, they are too tight.
• Avoid wrinkles in your socks
• Wear thick, white, cotton socks
• Wear socks to bed to keep your feet warm
• Wear clean socks every day
• Wear socks without seams

Shoe Don'ts

• Pointed toes and high heels put pressure on your toes
• Check the inside of your shoes for rough spots or objects before you put your shoes on
• Do not wear vinyl or plastic shoes, they do not let your feet breathe
• Do not wear sandals with a thong between the toes

Shoe Dos

• Wear shoes that fit well
• Canvas or soft leather shoes are best because they let your feet breathe and they give support
• Choose low shoes with wide toes
• If you wear sandals make sure they have protection for your toes

Be Careful with Your Feet - Never Go Bare Footed

• Always wear shoes and socks even at the beach and in your house
• Put sunscreen on the tops of your feet
• Keep your feet warm and dry
• Keep your feet away from open fires and radiators
• Do not use hot water bottles, heating pads, or electric blankets

Good Foot Care

• Check your feet at the end of every day for redness, swelling, corns, calluses, ingrown toenails, blisters, or breaks in the skin
• Always check the bottoms of the feet and between the toes
• Use a mirror if necessary
• If you have trouble seeing, have a family member check your feet

Keep Your Feet Clean and Dry

• Wash your feet every day with warm (not hot) water and soap
• Always check the water temperature before putting your feet in
• Make sure you dry your feet very well, especially between the toes
• Use foot powder between the toes to keep the area dry
• Use lanolin, lotion, or petroleum jelly on the tops and bottoms of your feet to keep the skin soft
• Do not soak your feet

Toe Nail Care

• Do not cut cuticles

• Smooth the edges of the nails with an emery board
• Cut your nails after you wash your feet
• If you cannot see well or have thick, yellow nails, or problems cutting your nails, ask your provider for help
• Be careful not to cut the skin around the nail
• Do not have a professional pedicure – the instruments may not be sterile

Exercise Your Feet

• Exercising your feet is good for blood flow
• Wiggle your toes for five minutes two to three times a day
• Move your ankles up and down and in and out
• Walking, dancing, swimming and bicycling are good exercises that are easy on your feet
• Avoid activities that are hard on your feet like running and jumping

Tips

• Do not cross your legs for long times
• Put your feet up when sitting
• Do not wear tight socks, elastic or rubber bands, or garters around your legs
• Do not smoke; it decreases blood flow to your feet
• Do not go barefoot because you could step on something
• Do not cut corns or calluses or use over-the-counter treatments on corns and calluses

Call Your Provider If You Have:

• Blisters, sores, or ulcers on your feet
• Swelling, redness, or pain in your feet
• Fungus infection between your toes
• Corns or calluses
• Thick yellow nails
• Nails you can’t cut

Common Foot Problems

HIGH BLOOD SUGAR CAN DAMAGE THE COVERING OF THE NERVES.

Signs and Symptoms of Nerve Damage

• Pain, burning, tingling, and loss of feeling in your feet
• Problems swallowing
• Constipation and diarrhea
• Difficulty passing urine
• Impotence
• Neuropathy — you may not be able to feel touch, heat, or cold
• Change in shape of foot — your shoes may no longer fit correctly causing pressure areas
• Loss of feeling in feet and hands
• Bowel and bladder problems

Behaviors to Prevent Nerve Damage

• Keep blood sugar levels under control.
• Stay active and exercise.
• Do not smoke.
• Does your provider do a monofilament test to check for nerve damage?
• Even if you have lost some sensitivity, you can prevent it from getting worse by controlling your blood sugar.

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