What is diabetes?

If you have diabetes, your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. A hormone called insulin helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood.

What health problems can diabetes cause?

Over time, having too much glucose in your blood can cause complications, including

• Eye disease, due to changes in fluid levels, swelling in the tissues, and damage to the blood vessels in the eyes
• Foot problems, caused by damage to the nerves and reduced blood flow to your feet
• Gum disease and other dental problems, because a high amount of blood sugar in your saliva helps harmful bacteria grow in your mouth. The bacteria combine with food to form a soft, sticky film called plaque. Plaque also comes from eating foods that contain sugars or starches. Some types of plaque cause gum disease and bad breath. Other types cause tooth decay and cavities.
• Heart disease and stroke, caused by damage to your blood vessels and the nerves that control your heart and blood vessels
• Kidney disease, due to damage to the blood vessels in your kidneys. Many people with diabetes develop high blood pressure. That can also damage your kidneys.
• Nerve problems (diabetic neuropathy), caused by damage to the nerves and the small blood vessels that nourish your nerves with oxygen and nutrients
• Sexual and bladder problems, caused by damage to the nerves and reduced blood flow in the genitals and bladder
• Skin conditions, some of which are caused by changes in the small blood vessels and reduced circulation. People with diabetes are also more likely to have infections, including skin infections.

What other problems can people with diabetes have?

If you have diabetes, you need to watch out for blood sugar levels that are very high (hyperglycemia) or very low (hypoglycemia). These can happen quickly and can become dangerous. Some of the causes include having another illness or infection and certain medicines. They can also happen if you don't get the right amount of diabetes medicines. To try to prevent these problems, make sure to take your diabetes medicines correctly, follow your diabetic diet, and check your blood sugar regularly.

Diabetes and heart disease often go hand in hand. Learn how to protect your heart with simple lifestyle changes that can also help you manage diabetes.

Heart disease is very common and serious. It’s the leading cause of death for both men and women in the United States. If you have diabetes, you’re twice as likely to have heart disease or a stroke than someone who doesn’t have diabetes—and at a younger age. The longer you have diabetes, the more likely you are to have heart disease.

But the good news is that you can lower your risk for heart disease and improve your heart health by changing certain lifestyle habits. Those changes will help you manage diabetes better too.

What Is Heart Disease?

Heart disease includes several kinds of problems that affect your heart. The term “cardiovascular disease” is similar but includes all types of heart disease, stroke, and blood vessel disease. The most common type is coronary artery disease, which affects blood flow to the heart.

Coronary artery disease is caused by the buildup of plaque in the walls of the coronary arteries, the blood vessels that supply oxygen and blood to the heart. Plaque is made of cholesterol deposits, which make the inside of arteries narrow and decrease blood flow. This process is called atherosclerosis, or hardening of the arteries. Decreased blood flow to the heart can cause a heart attack. Decreased blood flow to the brain can cause a stroke.

Hardening of the arteries can happen in other parts of the body too. In the legs and feet, it’s called peripheral arterial disease, or PAD. PAD is often the first sign that a person with diabetes has cardiovascular disease.

How Diabetes Affects Your Heart

Over time, high blood sugar can damage blood vessels and the nerves that control your heart. People with diabetes are also more likely to have other conditions that raise the risk for heart disease:

• High blood pressure increases the force of blood through your arteries and can damage artery walls. Having both high blood pressure and diabetes can greatly increase your risk for heart disease.
• Too much LDL (“bad”) cholesterol in your bloodstream can form plaque on damaged artery walls.
• High triglycerides (a type of fat in your blood) and low HDL (“good”) cholesterol or high LDL cholesterol is thought to contribute to hardening of the arteries.

None of these conditions has symptoms. Your doctor can check your blood pressure and do a simple blood test to see if your LDL, HDL, and triglyceride levels are high.

These factors can also raise your risk for heart disease:

• Smoking
• Being overweight or having obesity
• Not getting enough physical activity
• Eating a diet high in saturated fat, trans fat, cholesterol, and sodium (salt)
• Drinking too much alcohol

People with diabetes are also more likely to have heart failure. Heart failure is a serious condition, but it doesn’t mean the heart has stopped beating; it means your heart can’t pump blood well. This can lead to swelling in your legs and fluid building up in your lungs, making it hard to breathe. Heart failure tends to get worse over time, but early diagnosis and treatment can help relieve symptoms and stop or delay the condition getting worse.

Get regular checkups to keep track of your heart health.

Testing for Heart Disease

Your blood pressure, cholesterol levels, and weight will help your doctor understand your overall risk for heart disease. Your doctor may also recommend other tests to check your heart health, which could include:

• An electrocardiogram (ECG or EKG) to measure your heart’s electrical activity. Your heartbeat is the result of an electrical impulse traveling through your heart.
• An echocardiogram (echo) to examine how thick your heart muscle is and how well your heart pumps.
• An exercise stress test (treadmill test) to see how well your heart functions when it’s working hard.

Take Care of Your Heart

These lifestyle changes can help lower your risk for heart disease or keep it from getting worse, as well as help you manage diabetes:

• Follow a healthy diet. Eat more fresh fruits and vegetables, lean protein, and whole grains. Eat fewer processed foods (such as chips, sweets, and fast food) and avoid trans fat. Drink more water, fewer sugary drinks, and less alcohol.
• Aim for a healthy weight. If you’re overweight, losing even a modest amount of weight can lower your triglycerides and blood sugar. Modest weight loss means 5% to 7% of body weight, just 10 to 14 pounds for a 200-pound person.
• Get active. Being physically active makes your body more sensitive to insulin (the hormone that allows cells in your body to use blood sugar for energy), which helps manage your diabetes. Physical activity also helps control blood sugar levels and lowers your risk of heart disease. Try to get at least 150 minutes per week of moderate-intensity physical activity, such as brisk walking.
• Manage your ABCs:
  • A: Get a regular A1C test to measure your average blood sugar over 2 to 3 months; aim to stay in your target range as much as possible.
  • B: Try to keep your blood pressure below 140/90 mm Hg (or the target your doctor sets).
  • C: Manage your cholesterol levels.
  • s: Stop smoking or don’t start.
• Manage stress. Stress can raise your blood pressure and can also lead to unhealthy behaviors, such as drinking too much alcohol or overeating. Instead, visit a mental health counselor, try meditation or deep breathing, get some physical activity, or get support from friends and family.

Your doctor may also prescribe medicines that can help keep your blood sugar, blood pressure, cholesterol, and triglycerides close to your target levels.

See Your Diabetes Educator

Work with a diabetes care and education specialist for help avoiding health complications such as heart disease. You’ll get support and solutions and hear about the latest advances in managing diabetes.

If you have diabetes, ask your doctor about kidney disease.

Chronic kidney disease (CKD) often develops slowly and with few symptoms. Many people don’t realize they have CKD until it’s advanced and they need dialysis (a treatment that filters the blood) or a kidney transplant to survive.

If you have diabetes, get your kidneys checked regularly, which is done by your doctor with simple blood and urine tests. Regular testing is your best chance for identifying CKD early if you do develop it. Early treatment is most effective and can help prevent additional health problems.

CKD is common in people with diabetes. Approximately 1 in 3 adults with diabetes has CKD. Both type 1 and type 2 diabetes can cause kidney disease.

Kidney Facts

• Kidney diseases are the 9th leading cause of death in the United States.
• Approximately 1 in 3 adults with diabetes has CKD.
• Every 24 hours, 170 people with diabetes begin treatment for kidney failure.

How Diabetes Causes Kidney Disease

Each kidney is made up of millions of tiny filters called nephrons. Over time, high blood sugar from diabetes can damage blood vessels in the kidneys as well as nephrons so they don’t work as well as they should. Many people with diabetes also develop high blood pressure, which can damage kidneys too.

CKD takes a long time to develop and usually doesn’t have any signs or symptoms in the early stages. You won’t know you have CKD unless your doctor checks you for it.

Tips To Keep Your Kidneys Healthy

You can help keep your kidneys healthy by managing your blood sugar, blood pressure, and cholesterol levels. This is also very important for your heart and blood vessels—high blood sugar, blood pressure, and cholesterol levels are all risk factors for heart disease and stroke.

Physical activity can help
prevent kidney disease.

• Keep your blood sugar levels in your target range as much as possible.
• Get an A1C test at least twice a year, more often if your medicine changes or if you have other health conditions. Talk to your doctor about how often is right for you.
• Check your blood pressure regularly and keep it below 140/90 mm/Hg (or the target your doctor sets). Talk to your doctor about medicines and other ways to lower your blood pressure.
• Stay in your target cholesterol range.
• Eat foods lower in sodium.
• Eat more fruits and vegetables.
• Be physically active.
• Take your medicines as directed.

Prediabetes and Kidney Disease

If you have prediabetes, taking action to prevent type 2 diabetes is an important step in preventing kidney disease. Studies have shown that overweight people at higher risk for type 2 diabetes can prevent or delay developing it by losing 5% to 7% of their body weight, or 10 to 14 pounds for a 200-pound person. You can do that by eating healthier and getting 150 minutes of physical activity each week. CDC’s National Diabetes Prevention Program lifestyle change program can help you create the healthy lifestyle habits needed to prevent type 2 diabetes. Find a program in your community or online.

High blood sugar can lead to nerve damage called diabetic neuropathy. You can prevent it or slow its progress by keeping your blood sugar as close to your target range as possible and maintaining a healthy lifestyle.

Managing your blood sugar is an essential part of your diabetes care plan. Not only does it help you with day-to-day wellness, it can help prevent serious health problems down the road.

Nerve damage is one possible complication from having high blood sugar levels for a long time. High blood sugar damages your nerves, and these nerves may stop sending messages to different parts of your body. Nerve damage can cause health problems ranging from mild numbness to pain that makes it hard to do normal activities.

Half of all people with diabetes have nerve damage. The good news is that you can help prevent or delay it by keeping your blood sugar as close to your target levels as possible. When you do this, you’ll also have more energy, and you’ll feel better!

Symptoms of nerve damage usually develop slowly, so it’s important to notice your symptoms early so you can take action to prevent it from getting more serious.

Types of Nerve Damage

There are four main types of nerve damage. You can have more than one type. Symptoms depend on the type of nerve damage you have and which nerves are affected.

Peripheral nerve damage

Have you felt “pins and needles” or tingling in your feet? Maybe you feel like you’re wearing socks or gloves when you aren’t. Your feet may be very sensitive to touch—even a bed sheet can hurt. These are all symptoms of peripheral nerve damage.

Peripheral nerve damage affects your hands, feet, legs, and arms, and it’s the most common type of nerve damage for people with diabetes. It generally starts in the feet, usually in both feet at once.

Other symptoms may include:

• Pain or increased sensitivity, especially at night.
• Numbness or weakness.
• Serious foot problems, such as ulcers, infections, and bone and joint pain.

You may not notice pressure or injuries causing blisters or sores, which can lead to infections, sores that don’t heal, or ulcers. Sometimes amputation (removal by surgery) is necessary.

Finding and treating foot problems early can lower your chances of developing a serious infection.

Nerve Damage and Digestion

Nerve damage can cause muscles in your digestive tract to slow down or stop working.

Autonomic Nerve Damage

Autonomic nerve damage affects your heart, bladder, stomach, intestines, sex organs, or eyes. Symptoms may include:

• Bladder or bowel problems that may cause urine leakage, constipation, or diarrhea.
• Nausea, loss of appetite, and vomiting.
• Changes in how your eyes adjust from light to dark.
• Decreased sexual response, including trouble getting an erection in men or vaginal dryness in women.

Proximal Nerve Damage

Proximal nerve damage affects nerves in the thighs, hips, buttocks, or legs. It can also affect the stomach and chest area. Symptoms may include:

• Severe pain in a hip and thigh or buttock.
• Trouble getting up from a sitting position.
• Severe stomach pain.

Focal Nerve Damage

Focal nerve damage affects single nerves, most often in your hand, head, torso, or leg. Symptoms may include:

• Trouble focusing your vision or having double vision.
• Aches behind one eye.
• Not being able to move one side of your face (Bell’s palsy).
• Numbness or tingling in your hands or fingers.
• Weakness in your hand that may make you drop things.

Make a note if you have any of these symptoms and share them with your doctor.

Risk Factors for Nerve Damage

Anyone with diabetes can develop nerve damage, but these factors increase your risk:

• Blood sugar levels that are hard to manage.
• Having diabetes for a long time, especially if your blood sugar is often higher than your target levels.
• Being overweight.
• Being older than 40.
• Having high blood pressure.
• Having high cholesterol.

Tips to Prevent or Delay Nerve Damage

Keeping your blood sugar as close to your target range as possible is the best way to help prevent or delay nerve damage. Other things you can do are:

• Keep your blood pressure below 140/90 mm Hg (or the target your doctor sets).
• Get regular physical activity.
• Lose weight if you’re overweight.
• Limit or avoid alcohol.
• Stop smoking or don’t start.
• Follow a healthy eating plan.
• Take medicines as prescribed by your doctor.

When to See Your Doctor

Call your doctor if you have any of the following symptoms:

• A cut or sore on your foot that’s infected or won’t heal.
• Burning, tingling, weakness, or pain in your hands or feet that interferes with daily activities or sleep.
• Changes in digestion, urination, or sexual function.
• Dizziness or fainting.

Most people with diabetes can prevent serious nerve damage complications. Regular foot care at home, going to doctor’s appointments, and getting your feet checked at every doctor’s appointment will help prevent problems. Stay on schedule with all of your self-checks, exams, and appointments with a diabetes care schedule.

High blood sugar can lead to gastroparesis, a condition that affects how you digest your food. Diabetes is the most common known cause of gastroparesis. Read how you can help prevent it from getting worse.

Nausea, heartburn, or bloating can have many causes, but for people with diabetes, these common digestion issues shouldn’t be ignored. That’s because high blood sugar can lead to gastroparesis, a condition that affects how you digest your food. Diabetes is the most common known cause of gastroparesis.

Managing your diabetes can help you manage gastroparesis. It can also help delay or prevent other serious health problems. Keeping your blood sugar as close to your target range as possible will keep you feeling better today and down the road.

What Is Gastroparesis?

Normally, your stomach muscles tighten to move food through your digestive tract. If you have gastroparesis, nerve damage from high blood sugar can cause those muscles to slow down or not work at all. Your stomach doesn’t empty properly, and your food may take a long time to leave your stomach.

Because gastroparesis affects how fast the body absorbs food, it’s hard to match insulin doses to food portions. It also affects how the body absorbs nutrients, which can lead to malnutrition if left untreated. Another symptom of gastroparesis is frequent vomiting. This is dangerous because it can cause dehydration, or extreme thirst.

Symptoms

Have you ever eaten a large meal and then felt “stuffed” afterward? With gastroparesis, you may have that same “stuffed” feeling, bloating, discomfort, or pain after eating even a small amount of food. This can happen soon after you start eating or long after you finish your meal because gastroparesis slows down stomach emptying.

Other symptoms include heartburn, nausea, vomiting, and poor appetite.

You should talk with your doctor if you have any of these symptoms so you can manage gastroparesis and keep it from worsening.

Tips to Manage Gastroparesis

There is no cure for gastroparesis, but you can lessen symptoms with the following actions:

• Keep your blood sugar levels as close to their target range as possible.
• Eat frequent, small meals that are low in fat and fiber. Fat, fiber, and large meals can delay stomach emptying and make symptoms worse.
• Drink plenty of water. For most adults, that’s 6 to 10 cups per day.
• Let your doctor and pharmacist know about all medicines you’re taking—prescription and over-the-counter, as well as any supplements.
• If medicines you’re taking seem to cause more digestion problems, talk with your doctor.
• Limit or avoid alcohol.
• Stop smoking or don’t start.
• Get at least 150 minutes of physical activity each week.

A registered dietician can help you understand and meet your diet and nutrition needs.

If you have diabetes, here’s a way to keep standing on your own two feet: check them every day—even if they feel fine—and see your doctor if you have a cut or blister that won’t heal.

There’s a lot to manage if you have diabetes: checking your blood sugar, making healthy food, finding time to be active, taking medicines, going to doctor’s appointments. With all that, your feet might be the last thing on your mind. But daily care is one of the best ways to prevent foot complications.

About half of all people with diabetes have some kind of nerve damage. You can have nerve damage in any part of your body, but nerves in your feet and legs are most often affected. Nerve damage can cause you to lose feeling in your feet.

Feeling No Pain

Some people with nerve damage have numbness, tingling, or pain, but others have no symptoms. Nerve damage can also lower your ability to feel pain, heat, or cold.

Living without pain sounds pretty good, but it comes at a high cost. Pain is the body’s way of telling you something’s wrong so you can take care of yourself. If you don’t feel pain in your feet, you may not notice a cut, blister, sore, or other problem. Small problems can become serious if they aren’t treated early.

Preventing Nerve Damage

What’s the most important thing you can do to prevent nerve damage or stop it from getting worse? Keep your blood sugar in your target range as much as possible. Other good diabetes management habits can help, too:

• Don’t smoke. Smoking reduces blood flow to the feet.
• Follow a healthy eating plan, including eating more fruits and vegetables and less sugar and salt.
• Get physically active —10 to 20 minutes a day is better than an hour once a week.
• Take medicines as prescribed by your doctor.

Could You Have Nerve Damage?

Anyone with diabetes can develop nerve damage, but these factors increase your risk:

• Blood sugar levels that are hard to manage
• Having diabetes for a long time, especially if your blood sugar is often higher than your target levels
• Being overweight
• Being older than 40 years
• Having high blood pressure
• Having high cholesterol

Nerve damage, along with poor blood flow—another diabetes complication—puts you at risk for developing a foot ulcer (a sore or wound) that could get infected and not heal well. If an infection doesn’t get better with treatment, your toe, foot, or part of your leg may need to be amputated (removed by surgery) to prevent the infection from spreading and to save your life.

When you check your feet every day, you can catch problems early and get them treated right away. Early treatment greatly reduces your risk of amputation.

Tips for Healthy Feet

Check your feet every day for cuts, redness, swelling, sores, blisters, corns, calluses, or any other change to the skin or nails. Use a mirror if you can’t see the bottom of your feet, or ask a family member to help.

Wash your feet every day in warm (not hot) water. Don’t soak your feet. Dry your feet completely and apply lotion to the top and bottom—but not between your toes, which could lead to infection.

Never go barefoot. Always wear shoes and socks or slippers, even inside, to avoid injury. Check that there aren’t any pebbles or other objects inside your shoes and that the lining is smooth.

Wear shoes that fit well. For the best fit, try on new shoes at the end of the day when your feet tend to be largest. Break in your new shoes slowly—wear them for an hour or two a day at first until they’re completely comfortable. Always wear socks with your shoes.

Trim your toenails straight across and gently smooth any sharp edges with a nail file. Have your foot doctor (podiatrist) trim your toenails if you can’t see or reach your feet.

Don’t remove corns or calluses yourself, and especially don’t use over-the-counter products to remove them—they could burn your skin.

Get your feet checked at every health care visit. Also, visit your foot doctor every year (more often if you have nerve damage) for a complete exam, which will include checking for feeling and blood flow in your feet.

Keep the blood flowing. Put your feet up when you’re sitting, and wiggle your toes for a few minutes several times throughout the day.

Choose feet-friendly activities like walking, riding a bike, or swimming. Check with your doctor about which activities are best for you and any you should avoid.

Be sure to ask your doctor what else you can do to keep your feet healthy.

When to See Your Doctor

If you experience any of these symptoms, don’t wait for your next appointment. See your regular doctor or foot doctor right away:

• Pain in your legs or cramping in your buttocks, thighs, or calves during physical activity.
• Tingling, burning, or pain in your feet.
• Loss of sense of touch or ability to feel heat or cold very well.
• A change in the shape of your feet over time.
• Loss of hair on your toes, feet, and lower legs.
• Dry, cracked skin on your feet.
• A change in the color and temperature of your feet.
• Thickened, yellow toenails.
• Fungus infections such as athlete’s foot between your toes.
• A blister, sore, ulcer, infected corn, or ingrown toenail.

Most people with diabetes can prevent serious foot complications. Regular care at home and going to all doctor’s appointments are your best bet for preventing foot problems (and stopping small problems from becoming serious ones).

Hearing loss happens for many reasons. You probably know that it can happen as you age or if you spend too much time around loud noises. You may not know that having diabetes puts you at risk for hearing loss. Managing your blood sugar is a critical part of your diabetes care. It can also help protect your hearing.

Read more about the signs of hearing loss and how you can help prevent it if you have diabetes.

The Diabetes and Hearing Loss Connection

Diabetes can lead to nerve damage that affects many parts of the body, including your hands, feet, eyes, and kidneys. Diabetes can also cause nerve damage in your ears.

Over time, high blood sugar levels can damage small blood vessels and nerves in the inner ear. Low blood sugar over time can damage how the nerve signals travel from the inner ear to your brain. Both types of nerve damage can lead to hearing loss.

Hearing loss is twice as common in people who have diabetes as it is in people of the same age who don’t. Even people with prediabetes (blood sugar levels higher than normal but not high enough yet to have type 2 diabetes) have a 30% higher rate of hearing loss than people with normal blood sugar levels.

Signs of Hearing Loss

Hearing loss can happen slowly, so it can be hard to notice. Often, friends and family members will notice your hearing loss before you do.

Signs of hearing loss include:

• Often asking others to repeat themselves.
• Trouble following conversations with more than one person.
• Thinking that others are mumbling.
• Problems hearing in noisy places, such as busy restaurants.
• Trouble hearing the voices of small children and others with quiet voices.
• Turning up the TV or radio volume too loud for others who are nearby.

Problems with your inner ear may also affect your balance.

How To Protect Your Ears

You can’t reverse hearing loss, but you can follow these tips to help protect your ears:

• Keep your blood sugar as close to your target levels as possible.
• Get your hearing checked every year.
• Avoid other causes of hearing loss, including loud noises.
• Ask your doctor whether any medicines you’re taking can damage your hearing and what other options are available.

You should have your hearing tested by an audiologist (a health care professional who evaluates your hearing for medical problems) when you first find out you have diabetes and then every year after. Make it part of your diabetes care schedule. If you think you have hearing loss, talk to your doctor. They can help you decide if you should see an audiologist.

Hearing loss can be frustrating for you and your family, and it can affect your social life. There are many reasons to keep your blood sugar in your target range—protecting your hearing is just one of them. Plus, you’ll feel better and have more energy while you do it!

Is mental health pretty low on your list of priorities for managing diabetes? This may change your mind.

Mental health affects so many aspects of daily life—how you think and feel, handle stress, relate to others, and make choices. You can see how having a mental health problem could make it harder to stick to your diabetes care plan.

The Mind-Body Connection

Thoughts, feelings, beliefs, and attitudes can affect how healthy your body is. Untreated mental health issues can make diabetes worse, and problems with diabetes can make mental health issues worse. But fortunately if one gets better, the other tends to get better, too.

Depression: More Than Just a Bad Mood

Depression is a medical illness that causes feelings of sadness and often a loss of interest in activities you used to enjoy. It can get in the way of how well you function at work and home, including taking care of your diabetes. When you aren’t able to manage your diabetes well, your risk goes up for diabetes complications like heart disease and nerve damage.

People with diabetes are 2 to 3 times more likely to have depression than people without diabetes. Only 25% to 50% of people with diabetes who have depression get diagnosed and treated. But treatment—therapy, medicine, or both—is usually very effective. And without treatment, depression often gets worse, not better.

Symptoms of depression can be mild to severe, and include:

• Feeling sad or empty
• Losing interest in favorite activities
• Overeating or not wanting to eat at all
• Not being able to sleep or sleeping too much
• Having trouble concentrating or making decisions
• Feeling very tired
• Feeling hopeless, irritable, anxious, or guilty
• Having aches or pains, headaches, cramps, or digestive problems
• Having thoughts of suicide or death

If you think you might have depression, get in touch with your doctor right away for help getting treatment. The earlier depression is treated, the better for you, your quality of life, and your diabetes.

Stress and Anxiety

Stress is part of life, from traffic jams to family demands to everyday diabetes care. You can feel stress as an emotion, such as fear or anger, as a physical reaction like sweating or a racing heart, or both.

If you’re stressed, you may not take as good care of yourself as usual. Your blood sugar levels can be affected too—stress hormones make blood sugar rise or fall unpredictably, and stress from being sick or injured can make your blood sugar go up. Being stressed for a long time can lead to other health problems or make them worse.

Anxiety—feelings of worry, fear, or being on edge—is how your mind and body react to stress. People with diabetes are 20% more likely than those without diabetes to have anxiety at some point in their life. Managing a long-term condition like diabetes is a major source of anxiety for some.

Studies show that therapy for anxiety usually works better than medicine, but sometimes both together works best. You can also help lower your stress and anxiety by:

• Getting active: even a quick walk can be calming, and the effect can last for hours.
• Doing some relaxation exercises, like meditation or yoga.
• Calling or texting a friend who understands you (not someone who is causing you stress!).
• Grabbing some “you” time. Take a break from whatever you’re doing. Go outside, read something fun—whatever helps you recharge.
• Limiting alcohol and caffeine, eating healthy food, and getting enough sleep.

Anxiety can feel like low blood sugar and vice versa. It may be hard for you to recognize which it is and treat it effectively. If you’re feeling anxious, try checking your blood sugar and treat it if it’s low.

There will always be some stress in life. But if you feel overwhelmed, talking to a mental health counselor can help. Ask your doctor for a referral.

Diabetes Distress

You may sometimes feel discouraged, worried, frustrated, or tired of dealing with daily diabetes care, like diabetes is controlling you instead of the other way around. Maybe you’ve been trying hard but not seeing results. Or you’ve developed a health problem related to diabetes in spite of your best efforts.

Those overwhelming feelings, known as diabetes distress, may cause you to slip into unhealthy habits, stop checking your blood sugar, even skip doctor’s appointments. It happens to many—if not most—people with diabetes, often after years of good management. In any 18-month period, 33% to 50% of people with diabetes have diabetes distress.

Diabetes distress can look like depression or anxiety, but it can’t be treated effectively with medicine. Instead, these approaches have been shown to help:

• Make sure you’re seeing an endocrinologist for your diabetes care. He or she is likely to have a deeper understanding of diabetes challenges than your regular doctor.
• Ask your doctor to refer you to a mental health counselor who specializes in chronic health conditions.
• Get some one-on-one time with a diabetes educator so you can problem-solve together.
• Focus on one or two small diabetes management goals instead of thinking you have to work on everything all at once.
• Join a diabetes support group so you can share your thoughts and feelings with people who have the same concerns (and learn from them too).

Talk to Your Health Care Team

Your health care team knows diabetes is challenging, but may not understand how challenging. And you may not be used to talking about feeling sad or down. But if you’re concerned about your mental health, let your doctor know right away. You’re not alone—help is available!

A healthy mouth is important for everyone, but high blood sugar can make it harder to keep your mouth healthy. If you have diabetes, learn how you can avoid oral health problems and keep a smile on your face.

Taking good care of your mouth is essential to general health and well-being—it even affects your self-esteem. Good oral health habits can help prevent pain and infections from tooth and gum disease.

If you have diabetes, taking care of your teeth is even more important. High blood sugar can weaken white blood cells. These are your body’s main way to fight infections that can occur in the mouth.

Keep that smile on your face, though! By managing your diabetes, you manage more than your blood sugar—you’re helping to prevent gum disease and other infections in your mouth.

More Than a Sweet Tooth

If the sugar level is high in your blood, it’s high in your saliva too. Bacteria in plaque, a sticky film, use sugar as food. Some of this bacteria can cause tooth decay, cavities, and gum disease. If the tooth is not treated, it can also lead to tooth loss.

Gum disease can be more severe and take longer to heal if you have diabetes. If you have gum disease, your diabetes may be harder to manage.

Here’s a quick look at how diabetes can take its toll on your oral health:

• You may have less saliva, causing your mouth to feel dry. (Dry mouth is also caused by certain medicines.)
• Your gums may become inflamed and bleed often (signs of gum disease).
• Infections in your mouth can take longer to heal.

Keep Your Mouth Healthy and Happy

Treating gum disease may be able to help lower your blood sugar over time.

Regular dental visits are important to prevent problems. Follow your diabetes care schedule. Keep regular dental visits for professional cleanings, X-rays, and checkups. Ask your dentist how often you should have your teeth checked.

Don’t Miss Your Visit

Keep regular dental visits for checkups and professional cleanings. Follow your diabetes care schedule to help stay on track.

Here are a few more important tips:

• Brush your teeth at least twice a day with fluoride toothpaste.
• Floss your teeth at least once a day.
• Tell your dentist if you have diabetes.
• If your gums are red, swollen, or bleed easily, see your dentist. These may be signs of gum disease. Other signs include dry mouth, loose teeth, or mouth pain.
• If you smoke, quit. Smoking increases your risk of gum disease and can worsen your diabetes.

Too much glucose, also called sugar, in your blood from diabetes can cause pain, infection, and other problems in your mouth. Your mouth includes

• your teeth
• your gums
• your jaw
• tissues such as your tongue, the roof and bottom of your mouth, and the inside of your cheeks

Glucose is present in your saliva—the fluid in your mouth that makes it wet. When diabetes is not controlled, high glucose levels in your saliva help harmful bacteria grow. These bacteria combine with food to form a soft, sticky film called plaque. Plaque also comes from eating foods that contain sugars or starches. Some types of plaque cause tooth decay or cavities. Other types of plaque cause gum disease and bad breath.

Gum disease can be more severe and take longer to heal if you have diabetes. In turn, having gum disease can make your blood glucose hard to control.

What is diabetes?

Diabetes is a disorder of metabolism, a term that describes the way our bodies chemically change the foods we eat into growth and energy. After we digest food, glucose (sugar) enters the bloodstream, where it is used by the cells for energy. For glucose to get into the cells, insulin must be present.

Insulin is a hormone produced by the pancreas, an organ located behind the stomach. It is responsible for moving glucose from the bloodstream into the cells to provide energy needed for daily life. In people with diabetes, the body produces too little or no insulin or it does not respond properly to the insulin that is produced.

• In type 1 diabetes, the body produces little or no insulin. This form of the disease typically appears in children and young adults, but it can develop at any age.
• In type 2 diabetes, the body produces insulin but not enough, and the body does not respond properly to the insulin that is produced. This form of the disease is more common in people who are older, overweight, and inactive.

What is osteoporosis?

Osteoporosis is a condition in which the bones become less dense and more likely to fracture. Fractures from osteoporosis can result in pain and disability. In the United States, more than 53 million people either already have osteoporosis or are at high risk due to low bone mass.

Risk factors for developing osteoporosis include:

• Being thin or having a small frame.
• Having a family history of the disease.
• For women, being postmenopausal, having an early menopause, or not having menstrual periods (amenorrhea).
• Using certain medications, such as glucocorticoids.
• Not getting enough calcium.
• Not getting enough physical activity.
• Smoking.
• Drinking too much alcohol.

Osteoporosis is a disease that often can be prevented. If undetected, it can progress for many years without symptoms until a fracture occurs.

The diabetes–osteoporosis link

People with diabetes, particularly type 1 diabetes, often have poorer bone quality and an increased risk of fractures. Those with long-standing disease and poor blood sugar control, and who take insulin have the highest fracture risk.

The onset of type 1 diabetes typically occurs at a young age when bone mass is still increasing. It is possible that people with type 1 diabetes achieve lower peak bone mass, the maximum strength and density that bones reach. People usually reach their peak bone mass in their 20s. Low peak bone mass can increase one’s risk of developing osteoporosis later in life.

Some of the complications of diabetes, such as nerve damage, muscle weakness, episodes of low blood sugar, and vision problems can increase the risk of falls and fractures.

Osteoporosis management strategies

Strategies to prevent and treat osteoporosis in people with diabetes are the same as for those without diabetes.

Nutrition. A diet rich in calcium and vitamin D is important for healthy bones. Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Many low-fat and low-sugar sources of calcium are available. Also, supplements can help you meet the daily requirements of calcium and other important nutrients.

Vitamin D plays an important role in calcium absorption and bone health. It is synthesized in the skin through exposure to sunlight. Although many people are able to obtain enough vitamin D naturally, older individuals are often deficient in this vitamin due, in part, to limited time spent outdoors. They may require vitamin D supplements to ensure an adequate daily intake.

Exercise. Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best exercises for your bones are weight-bearing and resistance exercise. Weight-bearing exercises force you to work against gravity. They include walking, stair climbing, and dancing. Resistance exercises – such as lifting weights – can also strengthen bones. Regular exercise can help prevent bone loss and, by enhancing balance and flexibility, reduce the likelihood of falling and breaking a bone. Exercise is especially important for people with diabetes since exercise helps insulin lower blood glucose levels.

Healthy lifestyle. Smoking is bad for bones as well as for the heart and lungs. Women who smoke tend to go through menopause earlier, triggering earlier bone loss. In addition, people who smoke may absorb less calcium from their diets. Alcohol can also negatively affect bone health. People who drink heavily are more prone to bone loss and fracture because of poor nutrition as well as an increased risk of falling. Avoiding smoking and alcohol can also help with managing diabetes.

Bone density test. Specialized tests known as bone mineral density (BMD) tests measure bone density in various parts of the body. These tests can detect osteoporosis before a bone fracture occurs and predict a person’s chances of fracturing in the future. It can measure bone density at your hip and spine. People with diabetes should talk to their doctors about whether they might be candidates for a bone density test.

Medication. Like diabetes, there is no cure for osteoporosis. However, several medications are approved by the U.S. Food and Drug Administration for the prevention and treatment of osteoporosis in postmenopausal women and men. Medications are also approved for use in both women and men with glucocorticoid-induced osteoporosis.

Sexual problems and bladder problems are common as people age, but diabetes can make these problems worse. You or your partner may have trouble having or enjoying sex. Or, you may leak urine or have trouble emptying your bladder normally.

Blood vessels and nerves can be damaged by the effects of high blood glucose, also called blood sugar. This damage can lead to sexual and bladder problems. Keeping your blood glucose levels in your target range is an important way to prevent damage to your blood vessels and nerves.

Work with your health care team to help prevent or treat sexual and bladder problems. These problems may be signs that you need to manage your diabetes in a different way. Remember, a healthy sex life and a healthy bladder can improve your quality of life, so take action now if you have concerns.

Yes. Changes in sexual function or bladder habits may be a sign that you have diabetes. Nerve damage caused by diabetes, also called diabetic neuropathy, can damage parts of your body—like your genitals or urinary tract. For example, men with diabetes may develop erectile dysfunction (ED) 10 to 15 years earlier than men without diabetes.

Talk with a health care professional if you have any symptoms of diabetes, including sexual and bladder problems.

Diabetes can damage your eyes over time and cause vision loss, even blindness. The good news is managing your diabetes and getting regular eye exams can help prevent vision problems and stop them from getting worse.

Eye diseases that can affect people with diabetes include diabetic retinopathy, macular edema (which usually develops along with diabetic retinopathy), cataracts, and glaucoma. All can lead to vision loss, but early diagnosis and treatment can go a long way toward protecting your eyesight.

Diabetic Retinopathy

This common eye disease is the leading cause of blindness in working-age adults. Diabetic retinopathy is caused when high blood sugar damages blood vessels in the retina (a light-sensitive layer of cells in the back of the eye). Damaged blood vessels can swell and leak, causing blurry vision or stopping blood flow. Sometimes new blood vessels grow, but they aren’t normal and can cause further vision problems. Diabetic retinopathy usually affects both eyes.

Risk Factors for Diabetic Retinopathy

Anyone with type 1, type 2, or gestational diabetes (diabetes while pregnant) can develop diabetic retinopathy. The longer you have diabetes, the more likely you are to develop it. These factors can also increase your risk:

• Blood sugar, blood pressure, and cholesterol levels that are too high.
• Smoking.
• Race/ethnicity: African Americans, Hispanics/Latinos, and American Indians/Alaska Natives are at higher risk.

Help for Low Vision

If you have diabetic retinopathy, low-vision aids such as magnifying glasses and special lenses can help. Ask your eye doctor to refer you to a low-vision specialist.

Stages of Diabetic Retinopathy

Diabetic retinopathy has 2 main stages:

Early stage (nonproliferative): Blood vessel walls in the retina weaken and bulge, forming tiny pouches (you won’t be able to detect them, but your eye doctor can). These pouches can leak blood and other fluid, which can cause a part of the retina called the macula to swell (macular edema) and distort your vision. Macular edema is the most common cause of blindness in people with diabetic retinopathy. About half of people with diabetic retinopathy will develop macular edema.

Advanced stage (proliferative): In this stage, the retina begins to grow new blood vessels. These new vessels are fragile and often bleed into the vitreous (the clear gel between the lens and retina). With minor bleeding, you may see a few dark spots that float in your vision. If there’s a lot of bleeding, your vision may be completely blocked.

You may not notice symptoms in the early stage. That’s why it’s very important to get a dilated eye exam at least once a year to catch any problems early when treatment is most effective.

Symptoms in the advanced stage can include:

• Blurry vision
• Spots or dark shapes in your vision (floaters)
• Trouble seeing colors
• Dark or empty areas in your vision
• Vision loss

How Diabetic Retinopathy Is Diagnosed

During your eye exam, your eye doctor will check how well you see the details of letters or symbols from a distance. Your doctor will also look at the retina and inside of your eyes and may use a dye to reveal leaky blood vessels. If it turns out you have diabetic retinopathy, your eye doctor may want to check your vision more often than once a year.

You should be checked for diabetic retinopathy immediately if you’re diagnosed with type 2 diabetes. If you have type 1 diabetes, you should be checked within 5 years of your diagnosis and then regularly thereafter, typically every year. The sooner you’re treated for diabetic retinopathy, the better that treatment will work.

Call your eye doctor if you notice changes in your vision, especially if they happen suddenly. Changes may include:

• Blurring
• Spots
• Flashes
• Blind spots
• Distortion
• Difficulty reading or doing detail work

Diabetic Retinopathy Treatment

Treating diabetic retinopathy can repair damage to the eye and even prevent blindness in most people. Treatment can start before your sight is affected, which helps prevent vision loss. Options include:

• Laser therapy (also called laser photocoagulation). This creates a barrier of scar tissue that slows the growth of new blood vessels.
• Medicines called VEGF inhibitors, which can slow down or reverse diabetic retinopathy.
• Removing all or part of the vitreous (vitrectomy).
• Reattachment of the retina (for retinal detachment, a complication of diabetic retinopathy).
• Injection of medicines called corticosteroids.

Other Eye Diseases

Cataracts

A cataract is the clouding of the normally clear lens in your eye. Though everyone’s lenses tend to get cloudy as they get older, people with diabetes are more likely to have cataracts, and at a younger age. One reason is that high blood sugar can cause deposits to build up in the lenses and make them cloudy.

Other risk factors include high blood pressure, having obesity, too much sun exposure over time, and smoking.

Surgery is the only way to treat cataracts, but you usually don’t have to have surgery right away. Using brighter lights in your home and anti-glare sunglasses outside can help early on. If your cataracts get in the way of doing everyday activities, it may be time for surgery. The good news is the surgery is very safe, and most people have better vision afterwards!

Glaucoma

Glaucoma is a group of eye diseases that damage the optic nerve, usually because of too much pressure in the eye. Many types of glaucoma don’t have symptoms, and vision loss can happen so slowly that you don’t notice it.

People with diabetes are twice as likely to develop open-angle glaucoma, the most common type. Other risk factors include having a family history of glaucoma, being over age 60, and being African American, Asian, or Hispanic/Latino.

Diabetes can also cause neovascular glaucoma. This happens sometimes with diabetic retinopathy when new and abnormal blood vessels grow on the iris (the colored part of the eye). The new vessels can block off the flow of fluid out of the eye, which raises eye pressure.

There isn’t a way to prevent glaucoma, but treatment can help stop it from getting worse. That’s why catching glaucoma early is so important. Treatment options include medicines, laser treatment, and surgery. Talk to your eye doctor about what choices are best for you.

Prevent or Delay Eye Diseases

You can protect your vision and lower your chance for vision loss with these steps:

• Get a dilated eye exam at least once a year so your eye doctor can spot any problems early when they’re most treatable.
• Keep your blood sugar levels in your target range as much as possible. Over time, high blood sugar not only damages blood vessels in your eyes, it can also affect the shape of your lenses and make your vision blurry.
• Keep your blood pressure and cholesterol levels in your target range to lower your risk for eye diseases and vision loss. Also good for your health in general!
• Quit smoking. Quitting lowers your risk for diabetes-related eye diseases and improves your health in many other ways too.
• Get active. Physical activity protects your eyes and helps you manage diabetes.
• Ask your doctor for a referral to diabetes self-management education and support (DSMES) services. People who receive less diabetes education are twice as likely to get diabetic retinopathy as people who receive more education.

Get Your Eyes Checked

Eye problems are common in people with diabetes, but treatments can be very effective. Only your eye doctor can diagnose eye diseases, so make sure to get a dilated eye exam at least once a year. The earlier eye problems are found and treated, the better for your eyesight.

Encouraging news: People with diabetes are living longer, healthier lives with fewer complications. What’s the driving force? Greater awareness and better management of risk factors. Find out what you can do to prevent or delay diabetes health problems.

We’ve come a long way in reducing the impact of diabetes on people’s lives. In the last 20 years, rates of several major complications have decreased among US adults with diabetes. The greatest declines were for two leading causes of death: heart attack and stroke. (People with diabetes are at higher risk for heart disease, and they may get it more severely and at a younger age than people who don’t have diabetes.) This is real progress.

Diabetes Complications Are Related

Diabetes complications often share the same risk factors, and one complication can make other complications worse. For example, many people with diabetes also have high blood pressure, which in turn worsens eye and kidney diseases. Diabetes tends to lower HDL (“good”) cholesterol and raise triglycerides (a kind of blood fat) and LDL (“bad”) cholesterol. These changes can increase the risk for heart disease and stroke. Smoking doubles the risk of heart disease in people with diabetes.

Take a closer look at these major diabetes complications:

• Heart disease and stroke: People with diabetes are two times more likely to have heart disease or a stroke as people without diabetes.
• Blindness and other eye problems:
  • Damage to blood vessels in the retina (diabetic retinopathy)
  • Clouding of the lens (cataract)
  • Increase in fluid pressure in the eye (glaucoma)
• Kidney disease: High blood sugar levels can damage the kidneys and cause chronic kidney disease (CKD). If not treated, CKD can lead to kidney failure. A person with kidney failure needs regular dialysis (a treatment that filters the blood) or a kidney transplant to survive. About 1 in 3 adults with diabetes has CKD. You won’t know if you have CKD unless your doctor tests you for it.
• Nerve damage (neuropathy): One of the most common diabetes complications, nerve damage can cause numbness and pain. Nerve damage most often affects the feet and legs but can also affect your digestion, blood vessels, and heart.
• Amputations: Diabetes-related damage to blood vessels and nerves, especially in the feet, can lead to serious, hard-to-treat infections. Amputation can be necessary to stop the spread of infection.
• And more:
  • Gum disease can lead to tooth loss and increased blood sugar, making diabetes harder to manage. Gum disease can also increase the risk of type 2 diabetes.
  • Diabetes increases the risk of depression, and that risk grows as more diabetes-related health problems develop.
  • Gestational diabetes, diagnosed during pregnancy, can cause serious complications for mothers or their babies, such as preeclampsia (high blood pressure caused by pregnancy), injury from giving birth, and birth defects.

Complications usually develop over a long time without any symptoms. That’s why it’s so important to make and keep doctor and dentist appointments even if you feel fine. Early treatment can help prevent or delay diabetes-related health conditions and improve your overall health.

Your Prevention Toolkit

A healthy lifestyle is your road map for managing diabetes, which is the key to preventing or delaying complications:

• Follow a healthy eating plan.
• Be physically active for at least 150 minutes a week (just 30 minutes, 5 days a week).
• Manage your ABCs:
  • A: Get a regular A1C test to measure your average blood sugar over 2 to 3 months; aim to stay in your target range as much as possible.
  • B: Try to keep your blood pressure below 140/90 mm Hg (or the target your doctor sets).
  • C: Control your cholesterol levels.
  • s: Stop smoking or don’t start.

  Your doctor may also prescribe medicines that can help you manage your blood sugar, blood pressure, cholesterol, and triglyceride levels.

• Lose weight if you’re overweight—just a 5% to 7% weight loss lowers the risk for complications. That’s 10 to 14 pounds for someone who weighs 200 pounds.
• Take medicines as instructed, and talk to your doctor if you have questions about or problems with your medicine.
• Make and keep appointments with your health care team (primary care doctor, dentist, foot doctor, eye doctor, and dietitian).

In Charge, But Not Alone

You’re in the driver’s seat when it comes to managing your diabetes—watching what you eat, making time for physical activity, taking medicine, checking your blood sugar. Also be sure to talk with your health care team to keep going in the right direction.

Everyone’s diabetes is different. Some people will still have complications even with good management. Maybe that’s you—you’ve been trying hard but not seeing results. Or you’ve developed a health problem related to diabetes in spite of your best efforts.

If you feel discouraged and frustrated, you may slip into unhealthy habits, stop monitoring your blood sugar, even skip doctors’ appointments. That’s when your team can help you get back on track, from setting goals and reminding you of your progress to offering new ideas and strategies.