Preventing Complications

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Harvard Medical School
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Preventing Complications

Diabetes Type 1
Keep On Track
Preventing Complications
Preventing Complications
Careful management of diabetes can help to prevent, minimize or postpone related health problems.
InteliHealth Medical Content

Reviewed by the Faculty of Harvard Medical School

Preventing Complications
If you have diabetes, it cannot be cured. Still, there still are many things you can do to stay healthy. By keeping diabetes under control, you can prevent or postpone additional health problems (complications).
Your doctor may recommend tight control of your glucose. If so, it is important to try to keep blood sugar near normal. This will let you feel your best today and help to prevent further health problems.
Glucose goals are based upon convincing evidence. One major 10-year study was known as the Diabetes Control and Complications Trial. This study included about 1,400 people with type 1 diabetes. It found that "intensive" (or "tight") control of blood sugar made the risk of more health problems much lower. Compared with conventional care, intensive control includes:
  • Keeping blood sugar as close to normal as safely possible
  • Checking blood sugar more often
  • Giving insulin injections more often
Intensive control usually is not advised for young children, the elderly and some other people with type 1 and type 2 diabetes. In general, glucose goals and A1C goals for children and teens younger than age 19 are somewhat higher than the goals for adults with type 1 diabetes. This is particularly true for children under age 6, because they are vulnerable to getting low sugars. Anyone who has had repeated episodes of seriously low sugar (hypoglycemia) should have a less aggressive treatment plan for diabetes.
Medicines, exercise, diet and regular checkups all play important roles in keeping blood sugar under control and preventing more health problems.
Eat a Balanced Diet
Watching your diet is one of the most important parts of diabetes care. To help control blood sugar, your diet should include regular meals and snacks that provide recommended amounts of carbohydrates, fats and protein. Carbohydrates include whole grains, sugars, milk sugar and starches.
Carbohydrates most directly affect your sugar levels after meals. It can be helpful to eat about the same amount of carbohydrates at each meal. Otherwise, you will need to adjust your insulin doses.
If you are an overweight adult, it's important to reduce the total calories you eat. This will help you reduce your weight to a healthier level. Your diet also can help keep your blood pressure and cholesterol down.
Exercise Regularly
Aim for moderate physical activity for at least 30 minutes on most days of the week. This will help to improve cholesterol levels and lower blood sugar and blood pressure. Exercise is one of the most important parts of the treatment plan for diabetes. Our exercise recommendations can help you to design a safe activity plan. Before beginning a new exercise routine, speak with your doctor. This is especially important if you do not exercise regularly now.
Take Your Insulin Shots
Faithfully keep up your program of insulin injections and monitor your blood sugar to help keep sugar in normal ranges.
Watch Out for the Highs and Lows
Check blood sugar regularly. Make sure you know the causes and symptoms of high and low blood sugar. Report any unusual symptoms to your doctor right away. Be extra careful with sugar control if you are ill, injured or under stress. If you are a type 1 diabetic, your doctor may have provided you with test strips to detect ketones in the urine. These are produced at times when you are not getting enough insulin to manage your diabetes. Check for ketones in your urine if your blood sugar is high or you aren't feeling well.
Don't Smoke
Smoking greatly increases your risk of artery disease, heart attack and early death. Smoking also increases kidney damage in people with diabetes. If you smoke, keep trying to quit until you succeed.
Take an Aspirin
For some people, aspirin can help to reduce the risk of heart attack. If your risk of heart attack is low, aspirin's possible side effect of bleeding from the stomach or intestines probably outweighs its benefit. Benefit outweighs risk if you have a higher risk of heart attack.
Currently, daily aspirin is recommended for men over age 50 or women over age 60 who have diabetes and at least one other risk factor for heart disease. Risk factors for heart disease include:
  • Being overweight
  • Having a family history of heart disease
  • Having high blood pressure
  • Smoking
  • Having high cholesterol
If aspirin is recommended for you, you can take a daily dose of 81 milligrams ("baby aspirin").
Do not take aspirin if you have:
  • An allergy to aspirin
  • A medical problem that causes bleeding
  • Recent intestinal bleeding
  • Major liver disease
  • Age <21 years
Control Blood Pressure and Cholesterol
High blood pressure (hypertension) and abnormal cholesterol levels are common health problems. If you also have diabetes, these conditions make it more likely that you will have serious long-term health problems. These may include stroke; heart, eye and kidney disease; and even premature death. To lower these risks, specific goals have been set for blood pressure and cholesterol in people with diabetes.
Blood pressure — The blood pressure goal for someone with diabetes is less than 130/80. The first number is called systolic pressure. The second number is called diastolic pressure.
Cholesterol — Most of the recommendations for treating cholesterol come from research about type 2 diabetes, not type 1 diabetes. However, experts generally agree that cholesterol treatment should be the same for both types of diabetes.
Consider these cholesterol goals and treatment recommendations for diabetics:
    • Children under the age of 10 who have type 1 diabetes should not take a statin medicine for cholesterol. However, the American Academy of Pediatrics recommends checking cholesterol between ages 9 and 12 in children, and rechecking cholesterol after age 17. It may be worth considering cholesterol treatment in young children if there is an unusually serious cholesterol problem in a family member. If high cholesterol is found in children, extra efforts can be made to adjust diet and exercise. LDL is the "low density" or "bad" type of cholesterol. If LDL is high, the first step for all children with diabetes is to reduce cholesterol in the diet and increase exercise, before considering a cholesterol medicine. If cholesterol is not high, repeat testing should be done in five years.
    • Diabetic children age 10 and older may benefit from a statin drug for cholesterol if diet and exercise can't get the LDL cholesterol lower than 160 milligrams per deciliter (mg/dl). For children with a serious heart or cholesterol problem in a family member, the goal is less than 130 mg/dl
    • If you are an adult with diabetes, cholesterol treatment is probably appropriate for you between age 40 and 75. If your LDL cholesterol is lower than 70 mg/dL without medicine, taking a cholesterol drug is not recommended.
    • The dose of cholesterol medicine that is recommended for you depends on your overall risk for heart disease and stroke. For example, if you have coronary artery disease, or you have several risks like high blood pressure or a family history of heart disease in addition to diabetes, a high intensity statin dose is appropriate for you as long as you do not have side effects.
    • Some people should not take cholesterol medicine, even if cholesterol isn't at healthy levels. You should not take a statin if you are pregnant. Children under the age of 10 also should not take a statin
    • Triglyceride goal is less than 100 mg/dl. For most people, high triglycerides are improved by avoiding fats, avoiding added sugars in the diet, good control of blood sugar, and exercise.
Protect Your Kidneys
Studies have shown that two groups of medicines used to treat high blood pressure can prevent kidney disease in people with diabetes. These drugs are called ACE inhibitors and angiotensin-receptor blockers. ACE inhibitors also have been shown to lower your risk of dying of heart disease if you have diabetes. Ask your doctor if you should be taking one of these medicines.
Keep Up Immunizations
In addition to routine childhood vaccinations, people who have diabetes should receive:
  • A flu vaccine every year
  • A pneumococcal (pneumonia) vaccine
  • Infants and young children now receive four doses of the pneumococcal vaccine (PCV7). It is part of the regular childhood vaccine schedule. Another form of the vaccine is available for older children, teenagers and adults. Typically, one dose is given. You need a second dose if you are 65 or older and your first shot was five or more years ago.
  • The 3-shot hepatitis B vaccination series (for diabetics < age 60). This is a farily new recommendation for adults with diabetes. Due to shared use of glucose monitioring equipment in a variety of settings, people with diabetes have a higher than typical risk for exposure to hepatiatis B in their lifetime.


Have Regular Eye, Foot and Dental Examinations
    • People with type 1 diabetes should begin having eye exams once they are at least 10 years old and have been diagnosed with diabetes for at least 3 to 5 years. After this, you should have your eyes examined by an ophthalmologist or optometrist every year. An eye exam can find damage from diabetes (retinopathy) before it causes symptoms. Early laser treatment can cut your chances of severe visual 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.

    • 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.
Get Tested
Have your blood tested for hemoglobin A1C two to four times a year. A test every six months is the minimum that is recommended. Testing more often is a good idea if your sugar is not in good control. Get a urine test for microalbumin at least once a year. This protein can indicate early kidney disease.
Plan Before Pregnancy
  • Always use a reliable form of birth control if you do not want to become pregnant.
  • Have your eyes and kidneys carefully evaluated before deciding to become pregnant. Eye or kidney disease can get worse quickly in pregnant women with diabetes.
  • Talk to your doctor before you try to become pregnant. The discussion should include your exercise and diet habits, and your current medicines. Statins for cholesterol can't be safely taken during pregnancy. Neither can ACE inhibitors or angiotensin-receptor blockers, which are used to protect the kidneys.
  • Keep careful control of your diabetes before and during pregnancy. This can reduce the risk of birth defects and other dangers for the baby. It also can decrease the risks of pregnancy for your own health.


Last updated July 19, 2014

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