Type 2 Diabetes: Living With Complications

Topic Overview

Is this topic for you?

This topic provides information for people who have complications from diabetes, such as eye, heart, blood vessel, nerve, or kidney disease. If this topic does not answer your questions, see:

If you are looking for information about type 1 diabetes, see the topic Type 1 Diabetes.

What is type 2 diabetes?

Type 2 diabetes is a lifelong disease that affects the way your body uses food for energy. The disease develops when the cells of the body become resistant to insulin or when the pancreas cannot make enough insulin. Insulin is a hormone that helps your body's cells get the energy they need from sugar. When insulin is not able to do its job, too much sugar builds up in your blood. Over time, this extra sugar in your blood can lead to problems with your eyes, heart, blood vessels, nerves, and kidneys. It also makes you more likely to get severe illnesses or infections. When diabetes causes other problems, they are called complications.

What is it like to live with the complications?

Diabetes and its complications can change your life. Living with health problems caused by diabetes can be an ongoing struggle. It is a lot of work to monitor your health, keep up with your doctor appointments, and control your blood sugar. You may not always do everything exactly right. And it is normal to feel frustrated and sad at times. But don't give up. People with health problems from diabetes can still live full lives. If you are having trouble coping, talk to your doctor. Counseling or a diabetes support group may also help.

What are the complications from diabetes?

The complications from diabetes are:

What are the symptoms?

Your symptoms will vary depending on which complications you have.

  • Eye disease can cause vision problems, blindness, or (rarely) pain in your eyes.
  • Heart disease can cause chest pain (also called angina) or shortness of breath when you exercise. You may have other symptoms, such as dizziness or lightheadedness, shoulder or stomach pain, or a racing heartbeat. Some people don't have any symptoms until they have a heart attack or a stroke.
  • Circulation problems in your legs and feet (peripheral arterial disease) can cause changes in skin color, less feeling in your legs and feet, and leg cramps during exercise.
  • Nerve disease causes different symptoms depending on which nerves are affected.
    • If the nerves related to feeling and touch are affected, it can cause tingling, numbness, tightness, burning, or shooting or stabbing pain in your feet, hands, or other parts of your body, especially at night. It is possible that you may not notice an injury, especially on your foot, until a severe infection develops. A bad foot infection can spread up your leg and into your bones. If this happens, the affected limb may need to be removed (amputated).
    • If the nerves that control internal organs are damaged, you may have digestion, bladder, or sexual problems. You may also sweat a lot or too little, feel dizzy or weak, or faint when you stand up. It may become hard to tell when your blood sugar is low.
  • Kidney disease may not cause any symptoms at first. As time goes on, you may have swelling in your feet and legs and, later, throughout your body. It can also cause high blood pressure over time.

How are they treated?

The treatment for complications focuses on stopping or at least slowing down the damage. Depending on the problem, treatment may include medicine, surgery, or other therapies. Early treatment for a complication can help slow the damage and may prevent other problems.

Here are eight steps that people with diabetes can take to help keep health problems from getting worse.

  1. Keep your blood sugar within your target range. Part of your daily routine includes checking your blood sugar levels regularly as advised by your doctor.
  2. Eat a balanced diet. And, if you are overweight, reduce your calorie intake so that you can lose some weight. Losing as little as 10 to 20 pounds can improve your blood sugar levels. There are many ways to manage how much and when you eat. Your doctor, a diabetes educator, or a dietitian can help you find a plan that works for you. Making these lifestyle changes may make you feel better and help control your blood sugar.
  3. Exercise regularly. Aim for at least 2½ hours a week of moderate activity. Exercise helps control your blood sugar by using glucose for energy during and after activity. It also helps you to stay at a healthy weight, lower your total cholesterol, raise your HDL (good) cholesterol, and lower high blood pressure.
  4. Talk to your doctor about whether you should take low-dose aspirin. Daily low-dose aspirin (81 milligrams) may help prevent heart problems if you are at risk for heart attack or stroke.
  5. Don't smoke. Smoking increases your risk for heart attack, stroke, and many other serious problems.
  6. Control your cholesterol and keep your blood pressure lower than 130/80 by exercising regularly, eating a balanced diet, and taking medicine if necessary.
  7. Take care of your feet. Wash and dry them carefully every day, and look for any sores or injuries that you may not feel because of nerve damage.
  8. Have routine checkups every 3 to 6 months (or more often if needed), and watch for signs of other problems. During these visits, your doctor will review your treatment and look for other problems. Also be sure to see your eye doctor and dentist regularly.

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  Diabetes: Taking care of your feet

Cause

Complications from type 2 diabetes may be caused by one or all of the following:

  • Damage to the lining of the blood vessels throughout your body, contributing to development of plaque
  • Damage to the nerves that reduces or blocks their ability to send messages to your organs, legs and arms, and other parts of your body. Nerve damage can also affect information getting back to the brain.
  • Changes to your immune system that decrease your body's ability to fight infection
  • Damage to the filtering cells in the kidneys, causing a buildup of toxins

The damage results from hormonal and cellular changes caused by excess sugar (glucose) in your body.

Symptoms

Your symptoms depend on which complication of type 2 diabetes you have.

Eye disease

Diabetic retinopathy in its early stages does not noticeably affect your vision. But if it's not treated early, diabetic retinopathy can cause symptoms such as:

  • Blurred or distorted vision or difficulty reading. This may be caused by macular edema or other changes in the retina. High blood sugar levels may cause temporary blurred vision, which will clear up after the level returns to your target range. It may take several hours after blood sugar has been corrected for your vision to return to normal. Contact your doctor if vision changes last 12 to 24 hours.
  • Floaters or flashes of light in your field of vision. These symptoms are caused by retinal detachment or bleeding into the vitreous gel.
  • Partial or total loss of vision, or a shadow or veil across your field of vision. These symptoms also are caused by retinal detachment or bleeding in the vitreous gel.
  • Pain in your eye, which can be caused by neovascular glaucoma.

For more information, see the topic Diabetic Retinopathy.

Heart and large blood vessel disease

You may develop macrovascular disease because of diabetes, but you may not have any symptoms until you have a heart attack or stroke or develop peripheral arterial disease.

Symptoms of coronary artery disease include:

  • Chest pain.
  • Shortness of breath with exertion.
  • Nausea, and discomfort that feels like heartburn.
  • Fatigue.

Symptoms of transient ischemic attack (TIA)—a temporary interruption of blood flow to part of the brain and a warning sign of an impending stroke—include:

  • Weakness on one side of the body, or inability to move a part or all of one side of the body, such as the face, arm, and leg.
  • Numbness, tingling, or a feeling of heaviness.
  • Difficulty speaking or understanding words.
  • Loss of vision or changes such as blurring or double vision.

Symptoms of peripheral arterial disease include:

  • Intermittent claudication , a tightness or squeezing pain in the calf, thigh, or buttock during exertion, such as walking.
  • Decreased leg strength and poor balance when standing.
  • Cold and numb feet or toes.
  • Loss of hair on the feet or legs.

Erection problems (erectile dysfunction) can be an early warning sign of blood vessel disease and may indicate a higher risk of heart disease.

For more information, see the topics Coronary Artery Disease, Heart Attack and Unstable Angina, Peripheral Arterial Disease of the Legs, Stroke, and Transient Ischemic Attack (TIA).

Nerve damage

Symptoms of peripheral neuropathy (affecting the nerves that control sensation, touch, and movement) include:

  • Tingling, numbness, tightness, burning, or shooting or stabbing pain that starts in the feet and may spread to the legs, hands, and arms. Usually, symptoms occur in the toes first and are worse in the evening. Ulcers and infection may develop in the feet. Bone and joint deformities also can develop, especially in the feet (Charcot foot).
  • Greatly reduced or greatly increased sensitivity to temperature changes and a sense of pain with light touch.
  • Weakness and loss of balance and coordination.

Symptoms of autonomic neuropathy (affecting the nerves that control internal functions) include:

  • Digestive problems, such as frequent bloating, belching, constipation, nausea and vomiting, diarrhea, and abdominal pain. These symptoms may mean that you have gastroparesis.
  • Temperature regulation problems, including profuse sweating on your chest, face, or neck at night or while eating certain foods, such as spicy foods and cheese. Or you may have reduced sweating, especially in your feet and legs.
  • Difficulty sensing when your bladder is full or difficulty emptying your bladder completely.
  • Sexual problems, such as erection problems in men and vaginal dryness in women.
  • Dizziness, weakness, or fainting when you stand or sit up from a reclining position (orthostatic hypotension). If you have coronary artery disease, you may not experience chest pain with a heart attack.
  • Difficulty knowing when your blood sugar is low (hypoglycemia unawareness).

Symptoms of focal neuropathy (affecting a single nerve) usually start suddenly and may include:

  • Pain, weakness, and movement difficulty in a single area of your body, such as your face.
  • Pain in and around one of your eyes (if neuropathy affects the nerves that control eye muscles), difficulty moving your eyes, and double vision.

For more information, see the topic Diabetic Neuropathy.

Kidney disease

The only sign of diabetic nephropathy in its early stage is very small amounts of protein leaking into the urine (microalbuminuria). This can be detected only by a urine test for microalbumin. Treatment at this stage can delay progression and prevent symptoms from developing. But if your kidney disease progresses, you may have:

  • Increasing tiredness or fatigue.
  • Swelling (edema) in your feet and legs and later throughout your body.
  • Increasing blood pressure.
  • Large amounts of protein leaking into your urine (macroalbuminuria). Frothy or foamy urine can be a sign of excess protein in your urine.
  • High levels of cholesterol and triglycerides in your blood.

Kidney disease increases your risk of forming blood clots. As nephropathy gets worse, kidney failure develops. Your kidneys become severely damaged. And they may not eliminate insulin from your body as quickly. Insulin can then build up in your blood and cause low blood sugar. Your insulin dose will have to be adjusted. You also may need to lower the dose of, or stop taking, other medicines. For instance, the oral diabetes medicine metformin can be deadly in people who have kidney failure.

For more information, see the topic Diabetic Nephropathy.

What Happens

You may have started to have one or more complications from type 2 diabetes before you were diagnosed. This can happen if you had diabetes for several years before being diagnosed. If your complication progresses, it may cause serious disability or may shorten your life.

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What Increases Your Risk

Factors that increase your risk for complications from type 2 diabetes include:

  • Having persistently high blood sugar over time. The higher your blood sugar and the longer it remains too high, the greater your risk of developing complications.
  • Having the disease for a long time. The longer you have diabetes, the more likely you are to have complications, even if blood sugar levels are controlled.
    • Diabetic nephropathy develops in 20% to 30% of the people who have type 2 diabetes.2
    • Diabetic retinopathy develops in more than 60% of the people who have type 2 diabetes by 20 years after diagnosis.3
    • Most people with diabetes develop some diabetic neuropathy over the years. But only about half of those people have noticeable symptoms.4
  • Having one complication. You are at a higher risk for having more complications from diabetes if you already have a complication. For example, your risk of having diabetic nephropathy is much higher if you already have diabetic retinopathy.
  • Other risk factors. Smoking, psychiatric disorders (such as depression), high blood pressure, high cholesterol, or a family history of complications from diabetes may increase your risk for developing a complication. Not having health insurance coverage for supplies and other medical expenses related to diabetes care can contribute to poorer control of the disease and to the development of complications.

When to Call a Doctor

Call 911 or other emergency services immediately if you:

  • Lose consciousness or become very sleepy unexpectedly. You may have low blood sugar, called hypoglycemia. While you wait for emergency help, follow:
  • Are drowsy, confused, and breathing fast, and your breath smells fruity. You may have high blood sugar, called hyperglycemia. A life-threatening condition called diabetic ketoacidosis could be present.
  • Have new or sudden vision loss. You may have a retinal detachment or bleeding within the eye.
  • Have chest discomfort or pain that is crushing, squeezing, or feels like a heavy weight on the chest. You could be having a heart attack. Other symptoms of a heart attack include:
    • Sweating.
    • Shortness of breath.
    • Nausea or vomiting.
    • Pain that spreads from the chest to the back, neck, jaw, upper belly, or one or both shoulders or arms. The left shoulder and arm are more commonly affected. See a picture of areas that may be affected by chest pain.
    • Dizziness, lightheadedness, or feeling like you are going to faint.
    • A fast, slow, or irregular heartbeat.
    • Note: After you call 911 or other emergency services, chew 1 adult-strength (325 mg) aspirin or 2 to 4 low-dose (81 mg) aspirin if you are not allergic to aspirin and if there is no other reason that you can't take aspirin. This can help prevent a blood clot. Be sure to tell emergency personnel that you took aspirin.
  • Have any loss of function. You could be having a stroke. Signs of a stroke include:
    • Numbness, weakness, or inability to move (paralysis) the face, arm, or leg, especially on one side of the body.
    • Trouble seeing in one or both eyes, such as dimness, blurring, double vision, or loss of vision.
    • Confusion or trouble speaking or understanding.
    • Trouble walking, dizziness, or loss of balance or coordination.
    • A severe headache with no known cause.

Call your doctor immediately if you have any of the following symptoms of a new or worsening complication:

  • Blurred or distorted vision; seeing floaters or flashes of light, large floating red or black spots, or large areas that look like floating hair, cotton fibers, or spiderwebs; or pain in the eyes
  • Signs of being dehydrated, such as a dry mouth and urinating less than usual
  • A wound that won't heal or that looks infected

Call your doctor if you:

  • Are having high blood sugar levels persistently or frequently. Your treatment may need to be changed.
  • Have burning pain, numbness, or swelling in your feet or hands.
  • Have frequent bloating, belching, constipation, nausea and vomiting, diarrhea, and belly pain, which may indicate gastroparesis.
  • Have profuse sweating or reduced sweating.
  • Feel dizzy or weak when you sit or stand up suddenly.
  • Have trouble sensing when your bladder is full or trouble emptying your bladder completely.
  • Have erection problems or vaginal dryness.
  • Have trouble knowing when your blood sugar is low (hypoglycemia unawareness).

Who to See

Depending on your complication, you may need to see one or more of the following health professionals:

Exams and Tests

You need to have routine exams and tests to monitor the progress of your complication from type 2 diabetes and to screen for other complications that may develop.

Schedule of exams and tests for diabetes complications
Complication Tests if you do not have the complication5 Tests if you have the complication

Eye disease (diabetic retinopathy)

Every year, have:

If you are at low risk for vision problems, your doctor may consider follow-up exams every 2 to 3 years.

As often as indicated, have:

  • Pictures of the back of your eyes (fundus photography) taken, to monitor diabetic retinopathy and evaluate the effectiveness of your treatment.
  • Fluorescein angiogram, to check for and locate any tiny leaking blood vessels in the retina.

Kidney disease (diabetic nephropathy)

Every year, have one of the following:

As needed to monitor your condition, have:

  • A spot urine or 24-hour urine test, to check the total amount of protein leaking from your kidneys over 24 hours.
  • Blood electrolyte tests, to evaluate whether your kidneys are maintaining normal electrolyte balance.

If you develop kidney failure, you may need other tests. For more information, see the topic Chronic Kidney Disease.

Heart and blood vessel disease (macrovascular disease)

During every medical appointment, have:

  • Your blood pressure checked to see whether it is rising. Your blood pressure should be less than 130/80 mm Hg.

Every 1 to 2 years or more often, if indicated, have a:

  • Cholesterol and triglyceride level test, to evaluate cholesterol levels in your blood. Your LDL cholesterol level needs to be less than 100 mg/dL or aim for keeping it at 70 mg/dL. Your triglyceride level needs to be less than 150 mg/dL. And, if possible, your HDL cholesterol level needs to be more than 40 mg/dL for men and more than 50 mg/dL for women.

As indicated, have:

As indicated, have:

For more information on tests, see the topics Heart Attack and Unstable Angina, Stroke, and Peripheral Arterial Disease of the Legs.

Nerve disease (diabetic neuropathy)

Periodically, have a:

  • Physical exam to check for your response to light touch, pressure, temperature, and vibration, particularly in your feet and legs. Simple tests can be used to screen for loss of sensation. These tests should be done on both feet.
    • Touching the end of your toe with a thin plastic fiber (monofilament test) can assess your sense of light touch or pressure.
    • A cold metal tuning fork may be held to your leg to evaluate your sensation of temperature.
    • A vibrating tuning fork may be touched to your foot to assess your sensation of vibration.
  • Test of muscle strength and reflexes, especially those in your ankles and knees.
  • Careful examination of your feet for infections, injuries, or bone and joint problems. A complete exam of your feet should be done at least once a year.
  • Blood pressure and pulse check when lying down, sitting, and standing.

As indicated, have:

  • Electromyogram (EMG), to measure how well and how quickly particular nerves and muscles are working.
  • Nerve conduction studies, to test how well specific nerves conduct electrical impulses.

Tests for autonomic neuropathy (which affects internal functioning) are specific to your symptoms, such as:

  • Ultrasound of the bladder, X-ray of the entire urinary system (intravenous pyelogram), or a cystometrogram (which measures bladder storage capacity), if you have a problem with bladder control.
  • Gastric emptying study to evaluate the speed at which your stomach empties. Nerve damage from diabetes (gastroparesis) can slow this rate.

Since persistent high blood sugar levels are directly related to complications from diabetes, have a hemoglobin A1c test every 3 to 6 months to monitor your blood sugar control.

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Treatment Overview

Treatment of your complications of type 2 diabetes depends on the stage of the disease.

In general, keeping your blood sugar levels in your target range can prevent or slow the worsening of your complication and reduce the risk of developing new ones. Keeping blood sugar under control can help protect your vision and kidney function even before you develop any symptoms of eye or kidney complications.

You should see your doctor regularly to review your treatment and to have screening exams and tests for complications.

Talk to your doctor about whether you should take low-dose aspirin. Daily low-dose aspirin (81 milligrams) may help prevent heart problems if you are at risk for heart attack or stroke. People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases.6

Effective treatment of high blood pressure and high cholesterol can help decrease your risk for worsening of complications. Stopping smoking and limiting alcohol to one drink a day for women and two drinks a day for men also can help.

For eye disease (diabetic retinopathy)

Keep all appointments with your eye specialist, and call if you notice any changes in your vision. Early detection and treatment of any changes can help prevent vision loss.

  • Early (nonproliferative) diabetic retinopathy should be closely watched but may not need treatment right away. Laser treatment or surgical removal of the vitreous gel (vitrectomy) may be needed if the macula has been damaged by swelling (macular edema).
  • Late-stage (proliferative) diabetic retinopathy may require laser treatment or vitrectomy.

If you have severe vision loss, use vision aids to help you do as much of your diabetes care and remain as active as possible. Your local or state organization for the visually impaired can help you find vision aids that are right for you.

For more information, see the topic Diabetic Retinopathy.

For heart and large blood vessel disease

Don't smoke. Smoking increases your risk for heart attack.

Control your blood pressure. Keep it at 130/80 millimeters of mercury (mm Hg) or lower. Often, more than one blood pressure medicine will be needed in addition to lifestyle changes. Blood pressure medicines that can be useful include:

  • Diuretics.
  • Angiotensin-converting enzyme (ACE) inhibitors.
  • Angiotensin II receptor blockers (ARBs).
  • Beta-blockers.
  • Calcium channel blockers.

If your systolic blood pressure is between 130 mm Hg and 139 mm Hg or your diastolic blood pressure is between 80 mm Hg and 89 mm Hg, you may try some lifestyle or behavioral therapy for 3 months before starting medicine.5 For more information, see the topic High Blood Pressure (Hypertension).

Lower high cholesterol. Strive for a goal of less than 100 milligrams per deciliter (mg/dL) or aim for keeping it at 70 mg/dL for low-density lipoprotein (LDL), or "bad," cholesterol. High-density lipoprotein (HDL)—the "good" cholesterol—should be more than 40 mg/dL for men and more than 50 mg/dL for women. Triglycerides should be less than 150 mg/dL. A low-fat diet, exercise, and weight loss can lower your cholesterol. But you may need to take lipid-lowering medicines, such as statins, to reach your goals. Statins reduce LDL levels and the risk of heart disease in people who have diabetes.7 They also have been shown to reduce the risk of heart attack and stroke by one-third in people who have diabetes, even those who do not have high LDL levels or existing heart disease.8 For more information, see the topic High Cholesterol.

For nerve disease (diabetic neuropathy)

Keeping your blood sugar levels within your target range is the only way to stop or slow the progression of neuropathy.

If you have peripheral neuropathy, you may take medicines (such as nonprescription pain relievers, creams, or prescription oral or injection medicines) to relieve pain. You also may try physical therapy or acupuncture to relieve pain and improve your physical functioning, mood, and mental well-being.

You also can make changes in your home to reduce the risk of hurting yourself because of diminished sensation. These include lowering the water temperature in your home, using pot holders to avoid burns, and removing clutter that can cause falls. For more information on making life easier when you have neuropathy, see the Home Treatment section of this topic. Also, see the topic Diabetic Neuropathy for more on this complication.

For kidney disease (diabetic nephropathy)

Early detection and treatment of kidney disease can help prevent your kidney function from getting worse. Treatment involves taking medicines that can lower blood pressure (and can protect your kidneys even if you do not have high blood pressure), keeping your blood sugar under control, and possibly limiting the amount of protein in your diet.

  • You will probably take an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) to keep your blood pressure at 130/80 millimeters of mercury (mm Hg) or less. You also may take these medicines if you do not have high blood pressure but have small amounts of protein in your urine (microalbuminuria), an early sign of kidney damage.
  • Talk to your doctor or a registered dietitian about how much protein is best for you. Limiting the amount of protein you eat may help your kidneys stay healthier longer.
  • You may need to limit salt in your diet, because it makes your body retain fluid and can increase your blood pressure.
  • It may be helpful to see a nephrologist before kidney failure occurs.

If you develop kidney failure, you may eventually need dialysis or a kidney transplant.

For more information, see the topics Diabetic Nephropathy and Chronic Kidney Disease.

For foot problems

Foot care is important for people with diabetes. You need to inspect your feet every day and protect them from injury. If you have poor eyesight, have someone else check your feet. If you develop serious infections or bone and joint deformities, you may need surgery (even amputation) to treat those problems.

To protect your feet:

  • Avoid exercise that could injure your feet. Walking is fine, but jogging may be too rough.
  • Make sure bathwater is not too hot.
  • Wash and moisturize your feet every day.
  • Do not walk barefoot.
  • Wear cotton socks, and wear shoes that fit you well.
  • Check your shoes for any loose objects or rough edges before you put them on.
  • Get early treatment for any foot problem, even a minor one. Call your doctor at the first sign of a problem with your feet. Blisters, small cuts, corns, calluses, or other problems that may seem minor can quickly become more serious.

For more information on protecting your feet, see:

Click here to view an Actionset. Diabetes: Taking care of your feet.

What to Think About

Make every effort to keep your blood sugar levels within your target range to slow the progression of your complication and reduce your risk for developing others. Eat a balanced diet with the calories you need to help you stay at a healthy weight. Or if you are overweight, eat a balanced diet and reduce your calories to help you lose some weight. Get regular physical exercise, and take your prescribed diabetes medicine or insulin. For more information, see the Home Treatment section of the topic Type 2 Diabetes: Living With the Disease.

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Prevention

You can prevent or delay complications from type 2 diabetes by keeping your blood sugar levels within your target range. Scientific evidence shows that tightly controlling blood sugar levels can prevent the development and progression of small blood vessel (microvascular) disease and nerve disease (neuropathy).

Talk to your doctor about whether you should take low-dose aspirin. Daily low-dose aspirin (81 milligrams) may help prevent heart problems if you are at risk for heart attack or stroke. People who have diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases.6

Prevention and early detection

To prevent and detect complications early:

  • Don't smoke. If you quit smoking, you will reduce your risk for early damage to the blood vessels caused by diabetes.9 For information on how to quit smoking, see the topic Quitting Smoking.
  • Inspect your feet daily, wear properly fitted shoes, do not go barefoot or use home remedies, and have a foot exam each year. If you have poor vision, have someone else examine your feet daily and help you with foot and toenail care. Keep pathways in your home clear of objects that could cause a fall.
  • Tell your doctor immediately if you have blurred vision, floaters, or flashes of light.
  • Have an eye exam once a year by an ophthalmologist or optometrist.
  • Have yearly urine tests for protein. At the first sign of small amounts of protein (microalbuminuria), talk with your doctor about whether you can take a high blood pressure medicine, such as an angiotensin-converting enzyme (ACE) inhibitor or an angiotension II receptor blocker (ARB).
  • Get effective treatment for high blood pressure and high cholesterol. You may take a diuretic, ACE inhibitor, ARB, or other medicines to keep your blood pressure consistently below 130/80 millimeters of mercury (mm Hg). You also may need to take cholesterol-lowering medicines such as statins (for example, Lipitor, Zocor, or Pravachol) to reach your goals.7
  • Have yearly exams to test for touch and feeling sensations in your feet and legs and report any symptoms of digestive, sexual, or urinary problems or signs of hypoglycemia unawareness as soon as you notice them.

Other preventive measures

  • Keep your immunizations up to date. Diabetes affects your immune system, increasing your risk for having a serious case of the flu, pneumonia, or other infections. For the recommended immunization schedule, see the topic Immunizations.

Home Treatment

You can live a full life even with complications from type 2 diabetes. Eating a balanced diet, getting regular exercise, taking diabetes medicine, and possibly taking insulin to keep your blood sugar levels within your target range will help you feel better and have control of your life. If you need help with these skills, see the topic Type 2 Diabetes: Living With the Disease.

Early treatment of complications can help save your vision, slow the rate of kidney failure, and reduce the risk of amputation. Keep all appointments with your doctor, specialists, and other health professionals. The exams and tests done during these visits can detect early signs of complications and monitor the progression of existing complications.

Take the following measures at home to help control complications.

Eye disease (diabetic retinopathy)

  • Call your ophthalmologist or optometrist if you notice any changes in your vision. Early detection and treatment of any changes can help prevent vision loss.
  • Avoid heavy lifting if you have advanced diabetic eye disease (proliferative retinopathy).
  • Call your ophthalmologist if you have retinopathy and become pregnant. Retinopathy can become worse rapidly during pregnancy.
  • If you have severe vision loss from diabetic retinopathy, vision aids can help you do as much of your diabetes care as possible. These include home glucose monitors with large-print displays and talking glucose monitors. Your local or state organization for the visually impaired can help you find vision aids that are right for you.

For more help, see the topic Diabetic Retinopathy.

Heart and large blood vessel disease (macrovascular disease)

  • Don't smoke. Smoking increases your risk for heart attack.
  • Talk to your doctor about whether you should take low-dose aspirin. Daily low-dose aspirin (81 milligrams) may help prevent heart problems if you are at risk for heart attack or stroke.
  • Take your blood pressure medicine as prescribed.
  • Follow a diet that is low in saturated fat and trans fat, get plenty of exercise, and lose weight (if needed) to control your cholesterol.
  • Take your cholesterol medicine as prescribed.

Nerve damage (diabetic neuropathy)

If it affects your ability to feel (peripheral neuropathy):

  • Turn down the temperature of your hot-water heater and use a bath thermometer or have someone test your bathwater to see whether it is too hot.
  • Do not go barefoot, even in the house.
  • Do not use an electric blanket.
  • To prevent falls, arrange your furniture so that walkways are free of clutter.
  • To avoid burning your hands, use pot holders when you cook.

If it affects your body's internal functioning (autonomic neuropathy):

  • Eat smaller, more frequent meals that contain less fat and fiber if you have gastroparesis or other digestive problems.
  • Drink more fluids each day if you have urinary problems or profuse sweating. This will prevent urinary tract infections and dehydration.
  • Try a device or medicines such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) for erection problems or a lubricating cream for vaginal dryness if you have sexual problems. Check with your doctor to find out whether you can take these medicines.
  • Check your blood sugar level more often if you have hypoglycemia unawareness, especially before driving.

If it affects one nerve (focal neuropathy):

  • Wear a joint splint, if your doctor advises this.
  • Take breaks when you are doing activities that require repetitive movements.
  • Make sure your work environment provides appropriate support.

For more help, see the topic Diabetic Neuropathy.

Kidney disease (diabetic nephropathy)

  • Take your blood pressure medicines, if prescribed. Your blood pressure should be 130/80 millimeters of mercury (mm Hg) or lower.
  • Talk to your doctor or a dietitian about how much protein is best for you. Limiting the amount of protein you eat may help your kidneys stay healthier longer.
  • Limit salt in your diet, because it makes your body retain fluid and can increase your blood pressure.
  • Avoid nonsteroidal anti-inflammatory drugs (NSAIDs), except aspirin (a single low-dose aspirin daily is fine). NSAIDs include ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve). These medicines can harm your kidneys.

For more help, see the topic Diabetic Nephropathy.

Foot problems

Foot care is important for people who have diabetes. You need to inspect your feet every day and protect them from injury. If you have poor eyesight, have someone else check your feet.

To protect your feet:

  • Avoid exercise that could injure your feet. Walking is fine, but jogging may be too rough.
  • Make sure that bathwater is not too hot.
  • Check your shoes for any loose objects or rough edges before you put them on.
  • Get early treatment for any foot problem, even a minor one. Call your doctor at the first sign of a problem with your feet. Blisters, small cuts, corns, calluses, or other problems that may seem minor can quickly become more serious.

For more information on protecting your feet, see:

Click here to view an Actionset. Diabetes: Taking care of your feet.

Medications

You may be taking more than one oral medicine to treat your type 2 diabetes. You may be taking insulin by injection or through an insulin pump alone or along with oral diabetes medicine. Taking these medicines as prescribed can help keep your blood sugar levels within your target range. For information on these medicines, see the Medications section of the topic Type 2 Diabetes: Living With the Disease.

You may need to take:

  • Aspirin. Talk to your doctor about whether you should take low-dose aspirin. Daily low-dose aspirin (81 milligrams) may help prevent heart problems if you are at risk for heart attack or stroke.5
  • A diuretic, an angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker, or other medicine if you have high blood pressure or have protein in your urine. These medicines can slow or prevent further damage to your kidneys.
  • Medicines for digestive problems. The type of medicine will depend on the problem you are having. For example, if you have gastroparesis, you may take metoclopramide (Reglan) or erythromycin.
  • Nonprescription pain relievers, creams, or prescription oral or injection medicines if you have pain from peripheral neuropathy.
  • Medicines such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) if you have erection problems. These medicines can make heart problems worse in some people, especially those who take nitrate medicines (such as nitroglycerin). Check with your doctor before taking any of these medicines.

Medication Choices

Medicines for some complications include:

What to Think About

Keep your blood sugar levels tightly within your target range by taking your oral diabetes medicine (and, in some cases, insulin) as prescribed.

If you have high cholesterol, take cholesterol-reducing medicines (such as statins) to keep your LDL cholesterol level less than 100 mg/dL or aim for keeping it at 70 mg/dL, your triglyceride level less than 150 mg/dL, and if possible, your HDL cholesterol level more than 40 mg/dL for men, and more than 50 mg/dL for women. See the topic High Cholesterol.

If you have high blood pressure, take medicines to keep your blood pressure consistently below 130/80 mm Hg. If your systolic blood pressure is between 130 mm Hg and 139 mm Hg or your diastolic blood pressure is between 80 mm Hg and 89 mm Hg, you may try some lifestyle or behavioral therapy for 3 months before starting medicine.5 For more information, see the topic High Blood Pressure (Hypertension).

Surgery

Some complications from type 2 diabetes may need surgical treatment at some time. For example, surgery to remove the vitreous gel (vitrectomy) may be needed for diabetic retinopathy. Foot problems caused by diabetic neuropathy may lead to a need for amputation. Cardiovascular problems may require heart surgery.

For more information on possible surgery for complications from diabetes, see the topics Diabetic Retinopathy, Diabetic Nephropathy, and Diabetic Neuropathy. If you have heart and blood vessel disease, see the topics Coronary Artery Disease, Heart Attack and Unstable Angina, and Peripheral Arterial Disease of the Legs.

Other Treatment

Avoid products that promise a cure for type 2 diabetes complications or are advertised by testimonials of satisfied customers. These products or remedies may be harmful and costly. If you have questions about a product for diabetes, check with your local American Diabetes Association office, your doctor, or a diabetes educator.

Other types of meal plans

Talk with a registered dietitian before following other types of meal plans or using low glycemic index foods to prevent high blood sugar levels after meals.

Complementary therapies

Other types of treatment for diabetes complications are provided by therapists or others who do not operate within mainstream medical practice. Their unconventional approaches may be attractive, especially if you have complications from diabetes. None of these complementary therapies has been proved to be effective in treating diabetes or its complications. But you may benefit from safe nontraditional therapies that complement conventional medical treatment for your disease.

Do not use complementary therapies alone to treat your diabetes or its complications.

Talk with your doctor if you are using the following or other complementary or alternative therapies:

Other Places To Get Help

Organizations

American Diabetes Association (ADA)
1701 North Beauregard Street
Alexandria, VA  22311
Phone: 1-800-DIABETES (1-800-342-2383)
E-mail: AskADA@diabetes.org
Web Address: www.diabetes.org
 

The American Diabetes Association (ADA) is a national organization for health professionals and consumers. Almost every state has a local office. ADA sets the standards for the care of people with diabetes. Its focus is on research for the prevention and treatment of all types of diabetes. ADA provides patient and professional education mainly through its publications, which include the monthly magazine Diabetes Forecast, books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also provides information for parents about caring for a child with diabetes.


National Diabetes Education Program (NDEP)
1 Diabetes Way
Bethesda, MD  20814-9692
Phone: 1-800-438-5383 to order materials
(301) 496-3583
E-mail: ndep@mail.nih.gov
Web Address: http://ndep.nih.gov
 

The National Diabetes Education Program (NDEP) is sponsored by the U.S. National Institutes of Health (NIH) and the U.S. Centers for Disease Control and Prevention (CDC). The program's goal is to improve the treatment of people who have diabetes, to promote early diagnosis, and to prevent the development of diabetes. Information about the program can be found on two Web sites: one managed by NIH (http://ndep.nih.gov) and the other by CDC (www.cdc.gov/team-ndep).


National Diabetes Information Clearinghouse (NDIC)
1 Information Way
Bethesda, MD  20892-3560
Phone: 1-800-860-8747
Fax: (703) 738-4929
TDD: 1-866-569-1162 toll-free
E-mail: ndic@info.niddk.nih.gov
Web Address: http://diabetes.niddk.nih.gov
 

This clearinghouse provides information about research and clinical trials supported by the U.S. National Institutes of Health. This service is provided by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), a part of the National Institutes of Health (NIH).


National Library Service for the Blind and Physically Handicapped (NLS), Library of Congress
1291 Taylor Street NW
Washington, DC  20011
Phone: 1-888-NLS-READ (1-888-657-7323)
(202) 707-5100
Fax: (202) 707-0712
TDD: (202) 707-0744
E-mail: nls@loc.gov
Web Address: www.loc.gov/nls/index.html
 

The National Library Service has established a national network of cooperating libraries to provide a free library program of braille and audio materials. Materials, including some magazines, in braille, large print, or cassette can be borrowed postage-free by people who are eligible for the service.


Prevent Blindness America
211 West Wacker Drive
Suite 1700
Chicago, IL  60606
Phone: 1-800-331-2020
Web Address: www.preventblindness.org
 

Prevent Blindness America assists the visually impaired and provides consumer information on vision problems and vision aids. Its Web site has information about eye health and safety for children and adults. Many states have local affiliates.


References

Citations

  1. National Institutes of Health (2006). Diabetic retinopathy fact sheet. Available online: http://www.nih.gov/about/researchresultsforthepublic/DiabeticRetinopathy.pdf.
  2. American Diabetes Association (2004). Nephropathy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79–S83.
  3. American Diabetes Association (2004). Retinopathy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84–S87.
  4. American Diabetes Association (2005). Diabetic neuropathies. Position statement. Diabetes Care, 28(4): 956–962.
  5. American Diabetes Association (2009). Standards of medical care in diabetes. Clinical Practice Recommendations 2009. Diabetes Care, 32(Suppl 1): S13–S61.
  6. American Diabetes Association (2004). Aspirin therapy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S72–S73.
  7. American Diabetes Association (2004). Dyslipidemia management in adults with diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S68–S71.
  8. Collins R, et al. (2003). MRC/BHF heart protection study of cholesterol-lowering with simvastatin in 5,963 people with diabetes: A randomised placebo-controlled trial. Heart Protection Study Collaborative Group. Lancet, 361(9374): 2005–2016.
  9. American Diabetes Association (2004). Smoking and diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74–S75.

Other Works Consulted

  • American Diabetes Association (2005). Diabetes complications and prevention. In American Diabetes Association Complete Guide to Diabetes, 4th ed., pp. 303–335. Alexandria, VA: American Diabetes Association.
  • Chalmers KH (2005). Medical nutrition therapy. In Joslin's Diabetes Mellitus, 14th ed., pp. 611–631. Philadelphia: Lippincott Williams and Wilkins.
  • Glaser B, Liebowitz G (2005). Hypoglycemia. In Joslin's Diabetes Mellitus, 14th ed., pp. 1148–1175. Philadelphia: Lippincott Williams and Wilkins.
  • Johnstone MT, Nesto R (2005). Diabetes mellitus and heart disease. In Joslin's Diabetes Mellitus, 14th ed., pp. 975–998. Philadelphia: Lippincott Williams and Wilkins.
  • Mahimo H, et al. (2005). Effects of diabetes mellitus on the digestive system. In Joslin's Diabetes Mellitus, 14th ed., pp. 1070–1102. Philadelphia: Lippincott Williams and Wilkins.
  • McFarlane SI, et al. (2005). Hypertension in diabetes mellitus. In Joslin's Diabetes Mellitus, 14th ed., pp. 969–974. Philadelphia: Lippincott Williams and Wilkins.
  • Brownlee M, et al. (2008). Complications of diabetes mellitus. In PR Larsen et al., eds., Williams Textbook of Endocrinology, 11th ed., pp. 1417–1498. Philadelphia: Saunders Elsevier.
  • Grundy SM, et al. (2002). Diabetes and cardiovascular disease: Lifestyle and medical management of risk factors. AHA Conference Proceedings. Circulation, 105(18): E153–E158.
  • Grundy SM, et al. (2002). Prevention conference IV: Diabetes and cardiovascular disease. Executive summary. Circulation, 105(18): 2231–2239.
  • Hunt D (2009). Diabetes: Foot ulcers and amputations, search date November 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  • Masharani U, German MS (2007). Pancreatic hormones and diabetes mellitus. In DG Gardner et al., eds., Greenspan's Basic and Clinical Endocrinology, 8th ed., pp. 716–746. New York: McGraw-Hill.
  • Purnell JQ (2008). Obesity. In DC Dale, DD Federman, eds., ACP Medicine, section 3, chap. 10. Hamilton, ON: BC Decker.
  • Sigal R, et al. (2006). Prevention of cardiovascular events in diabetes, search date November 2004. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

Credits

Author Christine Wendt, R.D., L.D.
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer Matthew I. Kim, MD - Endocrinology & Metabolism
Last Updated August 8, 2009

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