Comprehensive Care To Prevent More Health Problems

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Comprehensive Care To Prevent More Health Problems

Diabetes Type 2
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Comprehensive Care To Prevent More Health Problems
Comprehensive Care To Prevent More Health Problems
Your efforts to control your diabetes also can prevent or delay related health problems.
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Reviewed by the Faculty of Harvard Medical School

Comprehensive Care To Prevent More Health Problems
If you have diabetes, there are many ways to guard your health. Your efforts will help to control diabetes. They also can prevent or delay related health problems (complications).
Top-notch diabetes care uses every available strategy to lower your risk of complications:
Eat a Reduced-Calorie Diet
Watching your diet is one of the most important parts of diabetes care. A reduced-calorie diet lowers blood-sugar levels. This diet decreases insulin resistance. It also can improve blood pressure and cholesterol.
Try to exercise for at least 30 minutes on most days of the week. This can improve:
  • Cholesterol
  • Blood-sugar levels
  • Insulin resistance
  • High blood pressure
Exercise is one of the mainstays of treatment for diabetes. Our exercise recommendations can help you to design a safe activity plan.
Use Medicines To Lower Blood Sugar
Diet and exercise usually are combined with medicines. They should help you to reach your blood-sugar goal safely.
Avoid Smoking
Smoking multiplies your risk of artery disease. Your risk of heart attack or early death may be as much as 40% higher if you smoke. Smoking also increases kidney damage in people with diabetes. If you smoke, keep trying to quit until you succeed.
If You Have Extra Risk, Take an Aspirin
Heart and artery disease risk is 2 to 4 times higher in people with diabetes. In fact, 68% of deaths in people with diabetes after age 65 are from heart attacks. About 16% are from strokes. Daily aspirin is an important way to prevent these events, for those who are at highest risk.
In 2010, three major groups agreed on updated advice about aspirin use for adults with diabetes. The groups were the American Diabetes Association, the American Heart Association and the American College of Cardiology Foundation.
People who have already had a heart attack or stroke have the highest risk of another one. Daily aspirin is recommended for this group.
But the benefits of using aspirin to prevent a first heart attack or stroke don't always outweigh the risk of side effects. The main concern is potential bleeding problems.
Adults who have diabetes do not all need to take daily aspirin. People with no history of heart or blood vessel disease should take aspirin only if they have a high risk of a heart attack or stroke in the next 10 years. Most men older than 50 and most women older than 60 are considered high-risk if they also have one or more of these major risk factors:
  • Smoking
  • High blood pressure
  • Cholesterol problems
  • Family history of heart disease at an early age
  • Protein in the urine from diabetic kidney disease
If you take aspirin, use a daily dose of either 75 to 81 milligrams (baby aspirin) or 162 milligrams (half of a regular-strength aspirin).

Do not take aspirin if you have any of the following:

    • An allergy to aspirin
    • A medical problem that causes bleeding
    • Recent bleeding in the intestines
    • Significant liver disease
    • A history of hemorrhagic stroke (a stroke caused by bleeding in the brain)

Control Blood Pressure and Cholesterol
Blood pressure and cholesterol problems are common. If you have diabetes, you should treat your blood pressure and cholesterol with medicines if this is recommended by your doctor.
For people with diabetes, lowering blood pressure reduces:
  • Strokes
  • Early death
  • Heart disease
  • Eye disease
  • Kidney disease
The blood-pressure goal for someone with diabetes is less than 140/90. The first number is called systolic pressure. The second number is called diastolic pressure.
Drugs that treat cholesterol reduce your heart attack and stroke risk. The best is a statin drug. Most people with diabetes should take a statin even if blood cholesterol is normal or close to normal.
Everyone should:
  • Limit the amount of saturated fat in the diet.
  • Eat plenty of fruits and vegetables.
  • Exercise regularly.
  • Keep weight under control.
Cholesterol should be monitored regularly after age 40. Most people with diabetes have cholesterol tested about once per year. Consider these additional cholesterol treatment recommendations for diabetics:
  • For diabetics younger than age 40, taking a statin drug is recommended if your LDL (sometimes called "bad cholesterol") is higher than 190 milligrams per deciliter of blood (mg/dl) without treatment.
  • For diabetics from age 40 to 75, taking a statin drug is recommended if your LDL is higher than 70 mg/dl without treatment.
  • For diabetics over age 75, doctors do not always recommend monitoring cholesterol or starting cholesterol medicine. However, if you have had a heart attack or stroke, taking medicine after this age may be appropriate. Some people who began taking cholesterol medicine before age 75 choose to continue the medicine after age 75.
  • Triglycerides are a fat related to cholesterol. A healthy level for triglycerides is less than 100 mg/dl, according to the American Heart Association. You can reduce your triglyceride level by controlling your blood sugar, exercising regularly and avoiding fatty foods and added sugar in your diet. For people with very high triglyceride levels, medication may be appropriate.
Protect Your Kidneys
Certain medicines are recommended for diabetics who have evidence of early kidney disease or high blood pressure. These drugs are called ACE inhibitors and angiotensin-receptor blockers.
Medicines from these groups reduce kidney damage. ACE inhibitors also have been shown to reduce your risk of dying of heart disease if you have diabetes.
Keep Up Your Shots
Besides routine childhood vaccinations, diabetics should receive:
    • A flu vaccine every year
    • A pneumococcal pneumonia vaccine once. If you are over 65 and it has been more than five years since your vaccine, you should receive a second vaccination as a booster.
    • Three vaccinations against hepatitis B, for diabetics who are younger than age 60. Glucose monitoring devices can become contaminated, and this can lead to hepatitis B infection in diabetes.


Have Regular Eye, Foot and Dental Examinations

Have your eyes examined by an ophthalmologist or optometrist once a year. It's best to diagnose eye damage from diabetes (retinopathy) before it causes symptoms. In this case, laser treatment can reduce your risk of severe vision loss in half.

Have your feet examined once a year by your primary-care doctor or by a podiatrist. The doctor will look for:

  • Foot pressure points (shown by redness or calluses)
  • Bony deformities
  • Areas of the foot with no feeling
  • Skin or nail infections

Any of these can put you at risk for serious problems if they are not quickly treated. If you have poor blood flow, minor foot problems can lead to ulcers or gangrene. Part of the foot or limb might eventually need to be amputated, if problems are not prevented. A yearly exam can promote early treatment. Proper foot care at home can help to prevent problems before they start.

Talk with your dentist about when you need cleanings and check-ups. Most people go to the dentist two times a year. Some people need to go more often. Having healthy teeth and gums can make it easier to control your blood sugar. Good control of blood sugar may lower your risk of periodontal disease. This is an infection that starts in the gums. It can lead to tooth loss. It also makes blood sugar control more difficult. Plus, some studies have shown that people with periodontal disease are more likely to have clogged arteries and heart disease.

Plan Before Pregnancy
Keep careful control of diabetes before and during pregnancy. This can reduce the risk of birth defects as well as your own dangers from pregnancy.
    • Use a reliable form of birth control if you are not prepared for pregnancy.
    • Discuss your medicines with your doctor before trying to become pregnant.
    • Have your eyes and kidneys carefully evaluated before making a decision to become pregnant. Eye and kidney disease can get worse faster in pregnant women with diabetes.
To make sure you are keeping up with your diabetes fully, print out our Diabetes Care Checklist. Review it with your doctor during appointments.


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Last updated August 11, 2014

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