Diabetes and nerve system

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 the 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 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 healthcare 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. Keep track of your foot exams.

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What healthy food choices should I make?

Eat Less Saturated Fat

  • Eat baked, broiled, or stewed fish and meats instead of fried.
  • Use nonfat or low-fat salad dressing, mayo, and margarine.
  • Try a food lower in fat in a favorite dish—for example, make mac and cheese with fat-free or low-fat cheese and milk.

Eat Less Sugar

  • Drink water, sugar-free soda, or unsweetened iced tea instead of fruit drinks, regular soda, or sweet tea.
  • Keep cold water in the fridge.
  • Share dessert with someone else when you’re eating out, instead of having a whole dessert.

Eat Healthy Portions

  • When eating out, share a meal with someone else or put half in a box to take home.
  • Eat slowly and take a break between bites.
  • Do not skip meals—when you skip a meal, it’s easy to overeat at the next meal

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Diabetes and kidney health

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.

Taking Care of 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.

On the records page, write down the dates and the results of these tests. Ask your health care provider to explain what the results mean.

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 In Balance

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.

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Diabetes and eye health

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

Because diabetic eye disease may be developing even when your sight is good, regular dilated 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 healthcare 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 with time. Work with your health care team to keep your blood glucose levels in the target range.

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, ask your health care provider how to keep your blood pressure at a healthy level. You may need medicine to keep your blood pressure at a healthy level.

Even if you’re seeing fine, you need regular, complete dilated 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 the records. 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 year.
  • 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.

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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. If you have any signs that your glucose may below, go ahead and treat it right away.

Stay as close to your eating, activity, and medicine schedule as you can. Keep track of your blood 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. When you read the rest of this section, you may think of more questions to ask.

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 healthcare team may need to make changes in your activity, medicine, or eating.

Many people take supplies for checking their glucose to school or work so they can check if 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 check 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 contacting the Federal Aviation Administration (FAA) or 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.

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Self-care plan


Many people avoid the long-term problems of diabetes by taking good care of themselves. Work with your health care team to reach your goals:

  • Use your diabetes meal plan. If you do not have one, ask your health care team about one.
    • Make healthy food choices such as fruits and vegetables, fish, lean meats, chicken or turkey without the skin, dry peas or beans, whole grains, and low-fat or skim milk and cheese.
    • Keep fish and lean meat and poultry portion to about 3 ounces (or the size of a deck of cards). Bake, broil, or grill it.
    • Eat foods that have less fat and salt.
    • Eat foods with more fiber such as whole grains cereals, breads, crackers, rice, or pasta.
  • Get 30 to 60 minutes of physical activity on most days of the week. Brisk walking is a great way to move more.
  • Stay at a healthy weight by using your meal plan and moving more.
  • Ask for help if you feel down. A mental health counselor, support group, member of the clergy, friend, or family member who will listen to your concerns may help you feel better.
  • Learn to cope with stress. Stress can raise your blood glucose (blood sugar). While it is hard to remove stress from your life, you can learn to handle it.
  • Stop smoking. Ask for help to quit.
  • Take medicines even when you feel good. Ask your doctor if you need aspirin to prevent a heart attack or stroke. Tell your doctor if you cannot afford your medicines or if you have any side effects.
  • Check your feet every day for cuts, blisters, red spots, and swelling. Call your health care team right away about any sores that do not go away.
  • Brush your teeth and floss every day to avoid problems with your mouth, teeth, or gums
  • Check your blood glucose (blood sugar). You may want to test it one or more times a day. Use the card at the back of this booklet to keep a record of your blood glucose numbers. Be sure to take this record to your doctor visits.
  • Check your blood pressure if your doctor advises.
  • Report any changes in your eyesight to your doctor.

Actions you could take:

  • Talk with your health care team about your blood glucose targets. Ask how and when to test your blood glucose and how to use the results to manage your diabetes.
  • Discuss how your self-care plan is working for you each time you visit your health care team.

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Know Your Diabetes ABCs – A1C, Blood Pressure and Cholesterol


Talk to your healthcare team about how to manage your A1C (blood glucose or sugar), Blood pressure, and Cholesterol. This will help lower your chances of having a heart attack, a stroke, or other diabetes problems. Here’s what the ABCs of diabetes stand for:

A for the A1C test

The A1C Test shows you what your blood glucose has been over the last three months. The A1C goal for many people is below 7. High blood glucose levels can harm your heart and blood vessels, kidneys, feet, and eyes.

B for Blood pressure.

The blood pressure goal for most people with diabetes is below 140/90. It may be different for you. Ask what your goal should be.

High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.

C for Cholesterol.

Ask what your cholesterol numbers should be.

LDL or “bad” cholesterol can build up and clog your blood vessels. It can cause a heart attack or a stroke. HDL or “good” cholesterol helps remove cholesterol from your blood vessels.

Actions you could take:

  • Ask your health care team:
    • What your A1C, blood pressure, and Cholesterol numbers are
    • What should your ABC numbers be
    • What you can do to reach your targets

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Diabetes and heart health

To protect your heart and blood vessels, eat right, get physical activity, don’t smoke, and maintain healthy blood glucose, blood pressure, and cholesterol levels. 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. Quit smoking if you currently do. Get a hemoglobin A1C test at least twice a year to determine what your average blood glucose level was for the past 2 to 3 months. Get your blood pressure checked at every doctor’s visit, and get your cholesterol checked at least once a year. Take medications if prescribed by your doctor.

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How to manage your diabetes?


Healthy eating, physical activity, and insulin injections are the basic therapies for type 1 diabetes. The amount of insulin taken must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose testing.

Healthy eating, physical activity, and blood glucose testing are the basic therapies for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.

People with diabetes must take responsibility for their day-to-day care, and keep blood glucose levels from going too low or too high.

People with diabetes should see a health care provider who will monitor their diabetes control and help them learn to manage their diabetes. In addition, people with diabetes may see endocrinologists, who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists for routine foot care; and dietitians and diabetes educators who teach the skills needed for daily diabetes management.


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Type 2 Diabetes

A diagnosis of type 2 diabetes can be unexpected for many, it brings doubts, fears and there is no better way to start this path other than knowing the correct information. Learning about your health condition will give you the necessary tools to have an active role in your healthcare.

We have compiled a list of valuable information, to help you in the learning process.

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Why do I need to know my blood sugar numbers?

Your blood sugar numbers show how well your diabetes is managed. And managing your diabetes means that you have less chance of having serious health problems, such as kidney disease and vision loss.

As you check your blood sugar, you can see what makes your numbers go up and down. For example, you may see that when you are stressed or eat certain foods, your numbers go up. And, you may see that when you take your medicine and are active, your numbers go down. This information lets you know what is working for you and what needs to change.

How is blood sugar measured?

There are two ways to measure blood sugar.

Blood sugar checks that you do yourself. These tell you what your blood sugar level is at the time you test.

The A1C (A-one-C) is a test done in a lab or at your provider’s office. This test tells you your average blood sugar level over the past 2 to 3 months.

How do I check my blood sugar?

You use a blood glucose meter to check your blood sugar. This device uses a small drop of blood from your finger to measure your blood sugar level. You can get the meter and supplies in a drugstore or by mail.

What are target blood sugar levels for people with diabetes?

A target is something that you aim for or try to reach. Your health care team may also use the term goal. People with diabetes have blood sugar targets that they try to reach at different times of the day. These targets are:

Right before your meal: 80 to 130

Two hours after the start of the meal: Below 180

Talk with your health care team about what blood sugar numbers are right for you.

How often should I check my blood sugar?

The number of times that you check your blood sugar will depend on the type of diabetes that you have and the type of medicine you take to treat your diabetes. For example, people who take insulin may need to check more often than people who do not take insulin.

The common times for checking your blood sugar are when you first wake up (fasting), before a meal, 2 hours after a meal, and at bedtime. Talk with your health care team about what times are best for you to check your blood sugar.

What should I do if my blood sugar gets too high?

High blood sugar is also called hyperglycemia (pronounced hye-per-gly-see-mee-uh). It means that your blood sugar level is higher than your target level or over 180. Having high blood sugar levels over time can lead to long-term, serious health problems.

If you feel very tired, thirsty, have blurry vision, or need to pee more often, your blood sugar may be high.

Call your health care team if your blood sugar is high more than 3 times in 2 weeks and you don’t know why.

What should I do if my blood sugar gets too low?

Low blood sugar is also called hypoglycemia (pronounced hye-poh-gly-see-mee-uh). It means your blood sugar level drops below 70. Having low blood sugar is dangerous and needs to be treated right away. Anyone with diabetes can have low blood sugar. You have a greater chance of having low blood sugar if you take insulin or certain pills for diabetes.

Carry supplies for treating low blood sugar with you. If you feel shaky, sweaty, or very hungry, check your blood sugar. Even if you feel none of these things, but think you may have low blood sugar, check it.

If your meter shows that your blood sugar is lower than 70, do one of the following things right away:

  • chew 4 glucose tablets
  • drink 4 ounces of fruit juice
  • drink 4 ounces of regular soda, not diet soda or
  • chew 4 pieces of hard candy

After taking one of these treatments, wait for 15 minutes, then check your blood sugar again. Repeat these steps until your blood sugar is 70 or above. After your blood sugar gets back up to 70 or more, eat a snack if your next meal is 1 hour or more away.

If you often have low blood sugar, check your blood sugar before driving and treat it if it is low.

What do I need to know about the A1C test?

The A1C test tells you and your healthcare team your average blood sugar level over the past 2 to 3 months. It also helps you and your team decide the type and amount of diabetes medicine you need.

What is a good A1C goal for me?

For many people with diabetes, the A1C goal is below 7. This number is different from the blood sugar numbers that you check each day. You and your healthcare team will decide on an A1C goal that is right for you.

How often do I need an A1C test?

You need to get an A1C test at least 2 times a year. You need it more often if:

  • your number is higher than your goal number
  • your diabetes treatment changes

What if I have trouble getting to my blood sugar goals?

There may be times when you have trouble reaching your blood sugar goals. This does not mean that you have failed. It means that you and your health care team should see if changes are needed. Call your health care team if your blood sugar is often too high or too low. Taking action will help you be healthy today and in the future.

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What is Prediabetes?


Prediabetes is a condition in which blood glucose or A1C levels—which reflect average blood glucose levels—are higher than normal but not high enough for a diagnosis of diabetes. Prediabetes is becoming more common in the United States. The U.S. Department of Health and Human Services estimates that at least 86 million U.S. adults ages 20 or older had prediabetes in 2012.1 People with prediabetes are at increased risk of developing type 2 diabetes and CVD, which can lead to heart attack or stroke.

What are the symptoms of insulin resistance and prediabetes?

Insulin resistance and prediabetes usually have no symptoms. People may have one or both conditions for several years without knowing they have them. Even without symptoms, health care providers can identify people at high risk by their physical characteristics, also known as risk factors. The section “Who should be tested for prediabetes?” lists these risk factors.

People with a severe form of insulin resistance may have dark patches of skin, usually on the back of the neck. Sometimes people have a dark ring around their neck. Dark patches may also appear on elbows, knees, knuckles, and armpits. This condition is called acanthosis nigricans.

Who should be tested for prediabetes?

The American Diabetes Association (ADA) recommends that testing to detect prediabetes be considered in adults who are overweight or obese and have one or more additional risk factors for diabetes. The section “Body Mass Index (BMI)” explains how to determine if a person is overweight or obese. However, not everyone who is overweight will get type 2 diabetes. People without these risk factors should begin testing at age 45.

Risk factors for prediabetes—in addition to being overweight or obese or being age 45 or older—include the following:

  • being physically inactive
  • having a parent or sibling with diabetes
  • having a family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander American
  • giving birth to a baby weighing more than 9 pounds
  • being diagnosed with gestational diabetes—diabetes that develops only during pregnancy
  • having high blood pressure—140/90 mmHg or above—or being treated for high blood pressure
  • HDL cholesterol level below 35 mg/dL or a triglyceride level above 250 mg/dL
  • having polycystic ovary syndrome (PCOS)
  • having prediabetes, impaired fasting glucose (IFG), or impaired glucose tolerance (IGT) on an earlier testing
  • having other conditions associated with insulin resistance, such as obesity or acanthosis nigricans
  • having CVD

If test results are normal, testing should be repeated at least every 3 years. Testing is important for early diagnosis. Catching prediabetes early gives people time to change their lifestyle and prevent type 2 diabetes and CVD. Health care providers may recommend more frequent testing depending on initial results and risk status.

In addition to weight, the location of excess fat on the body can be important. A waist measurement of 40 inches or more for men and 35 inches or more for women is linked to insulin resistance and increases a person’s risk for type 2 diabetes. This is true even if a person’s BMI falls within the normal range.

How to Measure the Waist

To measure the waist, a person should

  • place a tape measure around the bare abdomen just above the hip bone
  • make sure the tape is snug but isn’t digging into the skin and is parallel to the floor
  • relax, exhale, and measure
Drawing of the side silhouettes of a man and a woman with a dotted line through their waists.

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