Type 1 Diabetes: Living With Complications

Topic Overview

Is this topic for you?

This topic is about complications from diabetes, such as eye, kidney, heart, nerve, or blood vessel disease. If you need other diabetes information, see:

What is type 1 diabetes?

Type 1 diabetes is a lifelong disease that develops when the pancreas stops making insulin. Your body needs insulin to let sugar (glucose) move from the blood into the body's cells, where it can be used for energy or stored for later use.

If sugar cannot move from the blood into the cells, your blood sugar gets too high and your cells cannot work right. High blood sugar can harm your blood vessels and nerves and lead to problems with your eyes, heart, feet, kidneys, and other areas of the body. These problems are called complications.

What are the complications from diabetes?

The complications from diabetes are:

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 a constant struggle. It is a lot of work to monitor your health (such as foot care), 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. Getting counseling or joining a diabetes support group may also help.

What are the symptoms of diabetes complications?

Different complications have different symptoms.

  • 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 belly pain, or a racing heartbeat. Some people don't have any symptoms until they have a heart attack or 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.
  • Eye disease can cause vision problems, blindness, or (rarely) pain in your eyes.
  • Kidney disease may not cause any symptoms at first. As time goes on, you may have swelling in your feet and legs and, later, all through your body. It can also cause high blood pressure over time.
  • 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. You may not notice an injury, especially on your foot, until you have a severe infection. 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 sexual problems or problems with digestion or your bladder. You may also sweat a lot or too little, feel dizzy or weak, or faint when you stand up. It may be hard to tell when your blood sugar is low.

How are they treated?

Depending on the problem, treatment for a diabetes complication may include medicine, surgery, or other therapies. Early treatment for a complication can help slow the damage and may prevent other problems.

But there is a lot that you can do yourself. Here are seven steps you can take to help keep health problems from getting worse.

  1. Keep your blood sugar within a target range. Part of your daily routine includes checking your blood sugar levels regularly as advised by your doctor.
  2. Lose weight if you need to, get plenty of exercise, and try to eat about the same amount of carbohydrate at each meal. Making these lifestyle changes may make you feel better and help control your blood sugar.
  3. 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.
  4. Don't smoke. Smoking raises your risk for heart attack, stroke, and many other serious problems.
  5. Take medicine, if you need it, to control high blood pressure and high cholesterol. This may help prevent other problems from diabetes.
  6. 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.
  7. Have regular checkups every 3 to 6 months (or more often if you need to), and watch for signs of other problems. Also be sure to see your eye doctor and dentist regularly.

Frequently Asked Questions

Learning about diabetic complications:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with complications from diabetes:

Health Tools Health Tools help you make wise health decisions or take action to improve your health.

Health Tools help you make wise health decisions or take action to improve your health.


Actionsets help people take an active role in managing a health condition. Actionsets are designed to help people take an active role in managing a health condition.
  Diabetes: Taking care of your feet

Cause

Complications from type 1 diabetes are caused by one or both of the following:

  • Damage to the lining of the blood vessels throughout your body, causing them to become clogged with hard, fatty deposits called plaques. This process is called atherosclerosis.
  • Damage to the nerves (neuropathy) that reduces or blocks their ability to send messages to your organs, legs and arms, and other parts of your body.

This damage results from excess sugar (glucose) in your body.

Symptoms

Your symptoms depend on which complication type 1 diabetes has caused.

Eye disease

Symptoms of diabetic retinopathy are not present in the early stages of this eye disease. Symptoms that are noticed in later stages of the disease include:

  • Blurred or distorted vision or difficulty reading that does not go away. Macular edema or other changes in the retina cause these symptoms. Temporary vision problems can crop up when your blood sugar level is high.
  • Floaters or flashes of light in your field of vision. Retinal detachment or bleeding into the fluid within the eye (vitreous gel) causes these symptoms.
  • Partial or total loss of vision, or a shadow or veil across your field of vision. Retinal detachment or bleeding into the vitreous gel also causes these symptoms.
  • Pain in your eye. Neovascular glaucoma can cause this problem.

For more information, see the topic Diabetic Retinopathy.

Kidney disease

The only sign of diabetic nephropathy in its early stage is tiny amounts of protein in your urine (microalbuminuria). A urine test for protein is the only way to identify this problem. Frothy or foamy urine can be a sign of excess protein. As kidney disease gets worse, you may have:

  • Swelling (edema) in your feet and legs and later throughout your body.
  • Increasing blood pressure.
  • Large amounts of protein leaking into your urine (macroalbuminuria).
  • High levels of cholesterol and triglycerides in your blood.
  • An increased risk of developing blood clots.

Kidney damage affects your body's ability to rid itself of excess insulin. This results in low blood sugar levels. It also may mean that your doctor may want to adjust your insulin dose. As the disease gets worse, kidney failure develops. You may be tired, lose your appetite, and lose weight.

For more information, see the topic Diabetic Nephropathy.

Heart and large blood vessel disease

You may have chest pain (angina) or leg pain during exercise if you have macrovascular disease. But you may not have any symptoms until you have a heart attack, stroke, or develop peripheral arterial disease. Because diabetes can affect the nerves, you may have no pain during a heart attack. This is called a "silent heart attack."1

For more information, see the topics:

Nerve damage

Symptoms of peripheral neuropathy include:

  • Tingling, numbness, tightness, burning, or shooting or stabbing pain in the feet, hands, or other parts of your body. Usually, symptoms start in the toes and are worse in the evening. Bone and joint deformities can develop, especially of the feet (Charcot foot).
  • Reduced feeling or numbness, most often in the feet.
  • Reduced sweating, especially in your feet and legs.
  • Greatly reduced or greatly increased sense of pain from a light touch or change in temperature.
  • Weakness and loss of balance and coordination.

Symptoms of autonomic neuropathy (affecting internal functions) include:

  • Digestive problems, including frequent bloating, belching, constipation, nausea and vomiting, diarrhea, and abdominal pain. These symptoms may indicate that you have gastroparesis, a condition that causes your stomach to empty too slowly.
  • Temperature control problems, including profuse sweating on your chest, face, or neck at night or while eating certain foods, such as cheese and spicy foods.
  • Leaking urine or having 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).
  • Difficulty knowing when your blood sugar is low (hypoglycemia unawareness).

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

  • Pain, weakness, and movement difficulty in a single area of your body, such as a wrist, thigh, or foot.
  • 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.

What Happens

If complications from type 1 diabetes are found early, treatment can slow and sometimes reverse the damage. Complications that progress may cause serious disability or death.

What can be done?

If your complication is found early, you may need to make only minor lifestyle changes to stop its progression. For example, if you have early diabetic nephropathy, medicine can help prevent further damage to your kidneys. Early treatment for a complication and keeping your blood sugar at a near-normal level can help prevent new complications. The American Diabetes Association recommends a hemoglobin A1c level of less than 7%. The A1c level is a measure of your blood sugar over the past 2 or 3 months. Talk to your doctor about what A1c level is best for you.

Other ways to prevent new complications and/or to keep the complications you have from getting worse include:

  • Seeing your doctor regularly to have your treatment evaluated and to have screening exams and tests.
  • Treating high blood pressure and high cholesterol.
  • Stopping smoking.
  • Checking your feet for cuts or calluses, which can lead to infection. Good foot care also includes having a doctor check your feet regularly. Wear socks and shoes at all times to protect your feet.
  • Limiting alcohol to 1 drink a day for women and 2 drinks a day for men.

More Information:

What Increases Your Risk

These factors can contribute to your developing complications from type 1 diabetes.

  • Having one complication. If you have one complication from diabetes, you have a higher chance of getting other complications.
  • Ongoing high blood sugar over time. If your blood sugar levels are high most of the time, you have a higher chance of getting complications.
  • Length of time you have the disease. The longer you have diabetes, even if you control your blood sugar, the more likely you are to develop complications.
    • Diabetic retinopathy. About 60% of people with type 1 diabetes get diabetic retinopathy after 10 years. Almost all have it to some degree after 20 years.2 About 25% get the advanced stage (proliferative retinopathy) after 15 years.2
    • Diabetic nephropathy. Diabetic nephropathy eventually occurs in 20% to 30% of all people with type 1 and type 2 diabetes.3 Without treatment to slow kidney disease, most people with type 1 diabetes will move from the early stage to the advanced stage of nephropathy in 10 to 15 years.3 Children who get nephropathy usually show the first signs of the condition after puberty.
    • Heart and large blood vessel disease. About 73% of adults with diabetes have high blood pressure. People with diabetes are 2 to 4 times more likely to die from heart disease or to have a stroke.4
    • Diabetic neuropathy. Most people with diabetes develop some diabetic neuropathy over the years.
  • Other risk factors. Other factors that can raise your chance of getting complications include:

More Information:

When To Call a Doctor

Call 911 or other emergency services immediately if you are:

  • Unconscious or become very sleepy unexpectedly. You may have low blood sugar, called hypoglycemia. While waiting for emergency help, follow:
  • Drowsy, confused, 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.
  • Having new or sudden vision loss. You may have a retinal detachment or bleeding within the eye.
  • 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: If you have these symptoms, you should immediately chew one adult-strength aspirin (325 mg) or 4 low-dose aspirin (80 mg each) before emergency medical personnel such as paramedics arrive. This will help prevent a blood clot. Be sure to tell emergency personnel that aspirin has been taken.
  • Any loss of function. You could be having a stroke. Signs of a stroke include:
    • Numbness, weakness, or inability to move (paralysis) of 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, trouble speaking or understanding.
    • Trouble walking, dizziness, loss of balance or coordination.
    • Severe headache with no known cause.

Call your doctor immediately if you have any of the following symptoms of a new complication or one that is getting worse:

  • 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
  • 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.
  • Burning pain, numbness, or swelling in your feet or hands.
  • Frequent bloating, belching, constipation, nausea and vomiting, diarrhea, and abdominal pain, which may indicate gastroparesis.
  • Profuse sweating or reduced sweating.
  • Feeling dizzy or weak when you sit or stand up suddenly.
  • Leaking urine or having difficulty emptying the bladder completely.
  • Erection problems or vaginal dryness.
  • Difficulty knowing when your blood sugar is low (hypoglycemia unawareness).

Watchful Waiting

Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Watchful waiting for type 1 diabetes is not appropriate if you have any of the following symptoms.

  • Persistent or frequent high or low blood sugar levels. Keeping your blood sugar levels within a target range can help slow the progression of your complication and prevent the development of others. You can keep track of your blood sugar levels with home tests and hemoglobin A1c tests at your doctor's office. The A1c test gives you an average of your blood sugar levels over the past 2 or 3 months.
  • Symptoms of a new complication from diabetes. Early detection and treatment may reverse, stop, or at least slow the progression of the complication.
  • Symptoms indicating that your complication from diabetes is getting worse. Prompt treatment may help prevent serious disability or death.

See your doctor if you have any of these symptoms.

Who To See

The specialist that you need to see depends on which complication you have. The following health professionals treat complications from type 1 diabetes:

  • An ophthalmologist or optometrist can diagnose eye disease from diabetes. An ophthalmologist is the preferred specialist for retinal complications.
  • A nephrologist treats kidney disease.
  • A cardiologist or a vascular surgeon treats heart and/or circulation problems.
  • A neurologist diagnoses and treats nerve damage.
  • A podiatrist, pedorthist (a certified technician who can make special shoes or shoe inserts), or an orthopedic surgeon treats foot and ankle problems.
  • A gastroenterologist treats stomach and intestinal problems.
  • A urologist treats sexual and urinary tract problems.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Because you have a complication from type 1 diabetes, you need to have regular exams and tests to monitor its progression and screen for new complications.

Schedule of exams and tests for diabetic complications

Complication

Tests if you do not have the complication

Tests if you have the complication

Eye disease (diabetic retinopathy)

Every year, have:5

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

As often as indicated, have:

  • Pictures taken of the back of your eyes (fundus photography), to monitor diabetic retinopathy and evaluate your treatment.
  • Fluorescein angiogram, an imaging test, to find any leaking blood vessels in the retina.

Kidney disease (diabetic nephropathy)

Every year, have one of the following:5

  • A urine test for protein levels such as microalbuminuria, macroalbuminuria, or the albumin to creatinine ratio. These tests check for damage to your kidneys.
  • Creatinine, a urine or blood test that checks kidney function.

As needed to check on your condition, have:

  • A 24-hour urine test to check the total amount of protein leaking from your kidneys. A result of 300 mg or greater of protein in 24 hours shows that the kidneys are leaking large amounts of protein (macroalbuminuria).5
  • Blood urea nitrogen (BUN) and creatinine levels, to help estimate how well your kidneys are removing wastes from the bloodstream.
  • Blood electrolyte tests, to check whether your kidneys are keeping normal levels of electrolytes (salts) in your blood.

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. Your blood pressure should be less than 130/80 mm Hg.6

At least every year, or more often, if indicated, have a:5

  • Cholesterol and triglyceride level test, to evaluate cholesterol levels in your bloodstream. 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. Women may consider an HDL goal of more than 50 mg/dL.

Have an:5

  • Exercise electrocardiogram (treadmill EKG or cardiac stress test) if you have not been active and plan to begin a vigorous exercise program.

As indicated, have:

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

Nerve disease (diabetic neuropathy)

Periodically, have a:

  • Physical examination to check your response to light touch, pressure, temperature, and vibration, particularly in your feet and legs. Simple tests can screen for loss of sensation. Have these tests done on both feet.
    • Touching the end of your toe with a cotton wisp or a thin plastic fiber (called a monofilament test) assesses your sense of light touch or pressure.
    • A cold metal tuning fork held to your leg evaluates your sensation of temperature.
    • A vibrating tuning fork touched to your foot assesses your sensation of vibration.
  • Checkup on your muscle strength and reflexes, especially those in your ankles and knees.
  • Careful exam of your feet for corns, calluses, infections, injuries, or bone and joint problems. Have a complete exam of your feet at least once a year.7
  • Measurement of your blood pressure and pulse when lying down, sitting, and standing.

As indicated, have:

  • Electromyogram (EMG), to measure how well and how quickly particular nerves and muscles are working.

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

Other tests

Because persistent high blood sugar levels are directly related to getting diabetic complications, you need hemoglobin A1c and blood glucose tests every 3 to 4 months to monitor your blood sugar control.

You may need a thyroid-stimulating hormone (TSH) test when type 1 diabetes is diagnosed and then every 1 to 2 years. This test checks for thyroid problems, which are common among people with diabetes.

Treatment Overview

Treatment for your complication from type 1 diabetes depends on the stage of the disease.

For eye disease (diabetic retinopathy)

Keep all appointments with your eye specialist, and call if you notice any changes in your vision. Vision changes may mean your diabetic retinopathy is getting worse. Early detection and treatment of any changes can help prevent vision loss.

  • If you have diabetic retinopathy in an early stage (nonproliferative stage), you need no treatment unless it is affecting the macula, the part of the retina that provides central vision. If the macula is damaged by swelling (macular edema), you may have laser treatment to seal leaking blood vessels, surgical removal (vitrectomy) of the fluid within the eye (vitreous gel), or steroid injections into the fluid of the eye.
  • If the eye disease is advanced (proliferative stage), you may have either laser treatment or vitrectomy.

If you have severe vision loss, vision aids can help. Your local or state organization for the visually impaired can help you find these aids.

For more information, see the topic Diabetic Retinopathy.

For kidney disease (diabetic nephropathy)

Keep all appointments with your doctor, because the blood and urine tests done during these visits will monitor any kidney damage. Also, follow your doctor's instructions on taking your medicines (if you take any), because this can help slow damage.

If you have small amounts of protein in your urine (microalbuminuria), which is an early sign of kidney damage, you may be given an angiotensin-converting enzyme (ACE) inhibitor. Angiotensin II receptor blockers (ARBs) also treat kidney disease. These medicines are usually the first choice for people with type 1 diabetes who have microalbuminuria. Treatment for high blood pressure and high cholesterol may also help your kidneys work better.3 If you develop kidney failure, you may need dialysis, a kidney transplant, or possibly a pancreas-kidney transplant.8

You can also:

  • Limit your intake of protein. This may help you preserve kidney function. Talk to your doctor or dietitian about how much protein is best for you.
  • Limit salt in your diet because it makes your body retain fluid and can increase your blood pressure.

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

For heart and large blood vessel disease (macrovascular disease)

You can treat heart and large blood vessel disease by:

  • Controlling high blood pressure. You may try some lifestyle or behavioral therapy for 3 months before starting medicine 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.5 Angiotensin-converting enzyme (ACE) inhibitors or other medicines can keep your blood pressure consistently below 130/80 mm Hg. Angiotensin II receptor blockers (ARBs) also help treat high blood pressure and kidney disease in people with diabetes. ARBs are used alone or along with an ACE inhibitor. For more information, see the topic High Blood Pressure (Hypertension).
  • Controlling high cholesterol. Cholesterol-reducing medicines can keep your LDL cholesterol level less than 100 mg/dL. Or you can aim for keeping your LDL at 70 mg/dL, your triglyceride level less than 150 mg/dL, and if possible, your HDL cholesterol level more than 40 mg/dL in men. Women may want to keep their HDL higher than 50 mg/dL. For more information, see the topic High Cholesterol.
  • 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. For more information, see the topics Coronary Artery Disease, Heart Attack and Unstable Angina, Peripheral Arterial Disease of the Legs, and Stroke.
  • Not smoking. Smoking increases your risk for heart attack and stroke and makes many health problems worse. Quitting can lower your risk.9
  • Exercising. Try to do at least 2½ hours a week of moderate activity. One way to do this is to be active 30 minutes a day, at least 5 days a week. Take steps to exercise safely.

For nerve disease (diabetic neuropathy)

Keeping your blood sugar levels within a target range (hemoglobin A1c of 7% or less) is the only treatment that can stop or slow the progression of neuropathy.

If you have peripheral neuropathy, your doctor may suggest medicines (such as nonprescription pain relievers, creams, or prescription oral or injected medicines). Physical therapy or acupuncture may relieve pain and stiffness and/or improve your mood and mental well-being.

To help prevent injuries:

  • Turn your water heater down, and use a bath thermometer or have someone test your bath water to make sure that it is not too hot. Don't use an electric blanket.
  • Arrange your furniture so that the walkways through your house are free of clutter, preventing falls.

If you have focal neuropathy (affecting one nerve), your doctor may suggest a joint splint.

If you have autonomic neuropathy (affecting internal functioning), your doctor may suggest the following:

  • For digestive problems: Eat smaller, more frequent meals that contain less fat and fiber. You can also take medicine for gastroparesis, such as metoclopramide (Reglan) and erythromycin. If gastroparesis becomes severe, you may need surgery to place a feeding tube in the small intestine.
  • For urinary problems: Drink more fluids each day to prevent urinary tract infections.
  • For profuse sweating: Drink more fluids when you are outside in hot weather to prevent dehydration.
  • For sexual problems: Try a device for erection problems or a lubricating cream for vaginal dryness. Medicines for erection problems include sildenafil citrate (Viagra), tadalafil (Cialis), and vardenafil (Levitra). But all of these medicines can make heart problems worse. Do not take them if you take nitrate medicines (such as nitroglycerin). Talk to your doctor about which medicine would work best for you.
  • For hypoglycemia unawareness: Check your blood sugar level more often to prevent very low blood sugar levels.

Your doctor may refer you to a specialist for treatment of specific complications.

For more information, see the topic Diabetic Neuropathy.

For foot problems

Have your doctor do a thorough foot exam yearly. If you develop serious infections or bone and joint deformities, you may need surgery (possibly amputation). You can prevent many foot problems by inspecting your feet daily and protecting them from injury.

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

What To Think About

The most important thing you can do is to keep your blood sugar within a target range. This slows the progression of your complication from diabetes and lowers your risk for developing others. Continue eating a diet that spreads carbohydrate throughout the day, get regular exercise, and take your prescribed insulin. You can take insulin by injection or through an insulin pump. For more information, see the Home Treatment section of the topic Type 1 Diabetes: Living With the Disease.

Prevention

You can slow the progression of your complication from type 1 diabetes and prevent or delay other complications by keeping your blood sugar within a target range.

  • Keeping your blood sugar at normal or near-normal levels (tight control) may prevent the development and progression of small blood vessel disease and nerve disease (neuropathy).
  • Tight control of blood sugar may reduce your risk of heart and large blood vessel disease from diabetes.10

You can:

  • Have regular eye exams by an ophthalmologist or optometrist, even if you do not have symptoms. Immediately report any symptoms, such as blurred vision, floaters, or flashes of light. Early treatment can prevent vision loss.
  • Detect kidney disease early by having your urine tested for small amounts of protein (microalbuminuria). At the first sign of microalbuminuria, talk with your doctor about whether you can take a high blood pressure medicine. Angiotensin-converting enzyme (ACE) inhibitors are the preferred medicines for people with type 1 diabetes who have microalbuminuria, even if their blood pressure is normal. If you cannot take an ACE inhibitor, your doctor may prescribe an angiotensin II receptor blocker (ARB) to prevent further kidney damage.
  • Prevent heart and blood vessel problems by getting effective treatment for high blood pressure and high cholesterol.10 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
  • Detect nerve problems through yearly exams that check sensations in your feet and legs. As soon as you notice them, report any symptoms of digestive, sexual, or urinary problems or signs of hypoglycemia unawareness.
  • Prevent foot problems by inspecting your feet daily, wearing shoes that fit well, not going barefoot, not using home remedies, and having yearly foot examinations. Talk with your doctor about treatment for even minor problems, such as corns or calluses. Catching problems early prevents minor injuries from turning into major problems.
    Click here to view an Actionset.Diabetes: Taking care of your feet

Other preventive measures

  • Quit smoking. If you quit smoking, you decrease your risk for developing early damage to the blood vessels caused by diabetes.9 For more information, see the topic Quitting Smoking.
  • Keep your immunizations up to date. Diabetes affects your immune system, increasing your risk for having a serious case of the fluor pneumonia. Ask your doctor if you should have a flu vaccination. For more information, see the topic Immunizations.

Home Treatment

The most important measures you can take at home if you have one or more complications from type 1 diabetes are:

  • Keep your blood sugar within a target range. Keep track of your blood sugar levels with home tests and hemoglobin A1c (A1c) tests at your doctor's office. The A1c test gives you an average of your blood sugar levels over the past 2 or 3 months. The American Diabetes Association recommends a hemoglobin A1c level of less than 7%. Talk to your doctor about what A1c level is best for you.
  • Eat a diet that spreads carbohydrate throughout the day.
  • Get regular exercise.
  • Take your prescribed insulin either by injection or through an insulin pump.
  • Do not smoke.

For more information, see the Home Treatment section of the topic Type 1 Diabetes: Living With the Disease.

Other measures to care for and protect yourself depend on which complication you have.

Eye disease (diabetic retinopathy)

Call your eye specialist if you notice any changes in your vision. Vision changes may mean that diabetic retinopathy is getting worse. Early detection and treatment can help prevent vision loss.

If you have severe vision loss from diabetic retinopathy, vision aids can help. Your local or state organization for the visually impaired can help you find these aids.

For more information, see the topic Diabetic Retinopathy.

Kidney disease (diabetic nephropathy)

  • Take your blood pressure medicines, if prescribed. Your blood pressure should be less than 130/80 mm Hg. Ask your doctor if you need to monitor your blood pressure at home.
  • If diabetes has affected your kidneys, limiting your intake of protein may help you preserve kidney function. Talk to your doctor or dietitian about how much protein is best for you.
  • Limit salt in your diet because it makes your body retain fluid and can increase your blood pressure.

For more information, see the topic Diabetic Nephropathy.

Heart and large blood vessel disease

Even if you don't have heart and blood vessel problems, you are at risk for them.

  • Don't smoke. Smoking increases your risk of a heart attack or stroke, and makes many health problems worse.
  • Take your blood pressure medicine, if prescribed.
  • Take your cholesterol-lowering medicine, if prescribed.
  • Eat a heart-healthy diet.
  • Talk to your doctor about whether you should take low-dose aspirin.
  • Limit alcohol. Drink no more than 1 drink a day for women and no more than 2 drinks a day for men. Discuss with your doctor whether you should drink alcohol.

Nerve damage (diabetic neuropathy)

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

  • Turn your water heater down, and use a bath thermometer or have someone test your bath water to make sure it is not too hot.
  • Don't go barefoot. Always wear shoes, even in the house.
  • Don't use an electric blanket.
  • Arrange your furniture so that the walkways through your house are free of clutter.

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 for erection problems or a lubricating cream for vaginal dryness, if you have sexual problems. Talk to your doctor about medicine for erection problems (Cialis, Levitra, Viagra). For more information, see the topic Erection Problems.
  • Check your blood sugar level frequently during the day and during the night sometimes, if you have hypoglycemia unawareness.

For more information, see the topic Diabetic Neuropathy.

Foot problems

Daily care of your feet is very important. Because diabetic neuropathy and diabetic damage to the blood vessels in your legs can lead to severe infections and deformities of your feet, seek treatment for any foot problem, no matter how minor it seems. Even a small foot injury can lead to serious complications.

For more information, see:

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

Medications

Insulin prescribed for type 1 diabetes by an injection or through an insulin pump helps keep your blood sugar level tightly controlled and within a target range. You may also take:

  • An angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker, or other medicine, if you have high blood pressure or small amounts of protein in your urine (microalbuminuria). These medicines can slow or prevent further damage to your kidneys if you have microalbuminuria, even if you don't have high blood pressure.
  • Low-dose 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
  • Sildenafil citrate (Viagra), tadalafil (Cialis), or vardenafil (Levitra), if you have erection problems and don't have medical reasons why you can't take them. These medicines can make heart problems worse in some people, so you should not take them if you are taking nitrate medicines, such as nitroglycerin. Check with your doctor before taking these medicines. Also, you can try a device for improving erections before you try medicine.
  • Medicines for digestive problems. The type of medicine will depend on the problem you're 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.
  • Statins (such as lovastatin and simvastatin) to help decrease "bad" cholesterol (LDL).

Medication Choices

For your diabetes:

Insulin

For some complications:

What To Think About

Take cholesterol-reducing medicines, if you have high cholesterol, to keep your LDL cholesterol level less than 100 mg/dL. Or aim for keeping your LDL at 70 mg/dL, your triglyceride level less than 150 mg/dL, and if possible, your HDL cholesterol level more than 40 mg/dL in men. Women may want to consider an HDL of more than 50 mg/dL. For more information, see the topic High Cholesterol.

Keep your blood sugar levels within your target range. Your target range may be close to normal blood sugar levels. If you frequently have low blood sugar levels, call your doctor. You and your doctor may decide to make your target range higher than the normal range to avoid low blood sugar emergencies.

Surgery

Some complications from type 1 diabetes may need surgical treatment. For example, surgery to remove the vitreous gel (vitrectomy) may improve eye disease, diabetic retinopathy.

For more information, see the topics:

For more information on heart and blood vessel disease, see the topics:

If you have kidney damage from diabetes and are considering a kidney transplant, you may be eligible for surgery to replace your pancreas (pancreas transplant) at the same time. In either case, you need to meet specific criteria to be considered for the surgery.

The only other surgery for type 1 diabetes is the insertion of working pancreas cells (islet cell transplant) into your body. Islet cell transplant surgery is experimental at this time, and you also need to meet specific criteria.

Surgery Choices

Pancreas transplant surgery
Pancreatic islet cell transplantation

What To Think About

Pancreas and islet cell transplants are very expensive. After having one of these surgeries, you must take immunosuppressive medicines to keep your body from rejecting the new tissue.

The success rate for pancreas transplants is improving because of new surgical techniques and new medicines. But islet cell transplants may replace pancreas transplants in the future.11 People with complications from diabetes aren't always eligible for islet cell transplants.

Other Treatment

You may hear about products that promise a “cure” for type 1 diabetes complications. No such cure exists. Also, avoid products for diabetes that are advertised by "satisfied customers." These products or remedies may be harmful and costly. They also might cause you to delay or avoid getting treatments that do work. If you have questions about a product for treating diabetes, check with your local American Diabetes Association office, your doctor, or a diabetes educator.

Other types of meal plans

You may hear of people with diabetes following other types of meal plans or using low glycemic-index foods to control their blood sugar levels. Talk with a registered dietitian before trying one of these plans.

Complementary therapies

Complementary therapies are used in addition to traditional treatment. Acupuncture and biofeedback are examples of treatments that may relieve stress and muscle tension. They can help you feel better overall, but they don't treat the underlying disease. Don't use complementary therapies alone to treat your diabetes or its complications. Ask your health professional which therapies might help in your particular situation.

Talk with your doctor before using these 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.


Juvenile Diabetes Research Foundation International
120 Wall Street
New York, NY  10005-4001
Phone: 1-800-533-CURE (1-800-533-2873)
Fax: (212) 785-9595
E-mail: info@jdrf.org
Web Address: http://www.jdrf.org
 

The Juvenile Diabetes Research Foundation International is dedicated to finding a cure for type 1 diabetes and its complications. The organization funds research on type 1 diabetes, including research on prevention and treatment. This organization publishes a wide variety of booklets, magazines, and e-newsletters on complications and treatments of type 1 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).


References

Citations

  1. Tabibiazar R, Edelman S (2003). Silent ischemia in people with diabetes: A condition that must be heard. Clinical Diabetes, 21(1):5–9.
  2. American Diabetes Association (2004). Retinopathy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S84–S87.
  3. American Diabetes Association (2004). Nephropathy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S79–S83.
  4. American Diabetes Association (2008). All About Diabetes. Available online: http://www.diabetes.org/about-diabetes.jsp.
  5. American Diabetes Association (2008). Standards of medical care in diabetes. Clinical Practice Recommendations 2008. Diabetes Care, 31(Suppl 1): S12–S54.
  6. American Diabetes Association (2004). Hypertension management in adults with diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S65–S67.
  7. American Diabetes Association (2004). Preventive foot care in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S63–S64.
  8. Nathan DM (2003). Isolated pancreas transplantation for type 1 diabetes. JAMA, 290(21): 2861–2863.
  9. American Diabetes Association (2004). Smoking and diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74–S75.
  10. Sigal R, et al. (2006). Prevention of cardiovascular events in diabetes, search date November 2004. Online version of Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  11. Sutherland DE, et al. (2001). Lessons learned from more than 1,000 pancreas transplants at a single institution. Annals of Surgery, 233(4): 463–501.

Other Works Consulted

  • ACE Inhibitors in Diabetic Nephropathy Trialist Group (2001). Should all patients with type 1 diabetes mellitus and microalbuminuria receive angiotensin-converting enzyme inhibitors? Annals of Internal Medicine, 134(5): 370–379.
  • Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group (2002). Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA, 287(19): 2563–2569.
  • Gerstein HC, et al. (2001). Cardiovascular disease. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 488–514. Hamilton, ON: BC Decker.
  • Goguen JM, Leiter LA (2001). Alternative therapy: The role of selected minerals, vitamins, fiber, and herbs in treating hyperglycemia. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 295–322. Hamilton, ON: BC Decker.
  • Harvey DT (2001). Classification and risk of musculoskeletal impairment associated with diabetes. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 523–530. Hamilton, ON: BC Decker.
  • Heaton JPW, et al. (2001). Erectile dysfunction. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 531–544. Hamilton, ON: BC Decker.
  • Hunt D (2008). Diabetes: Foot ulcers and amputations, search date September 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  • Ludwig DS (2002). The glycemic index: Physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA, 287(18): 2414–2423.
  • Mendrinos E, et al. (2008). Diabetic nephropathy, search date March 2007. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  • Molitch ME, Genuth S (2006). Complications of diabetes mellitus. In DC Dale, DD Federman, eds., ACP Medicine, section 9, chap. 3. New York: WebMD.
  • Patel J (2008). Diabetes: Managing dyslipidaemia, search date June 2007. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  • Pickup J, Keen H (2002). Continuous subcutaneous insulin infusion at 25 years. Diabetes Care, 25(30): 593–598.
  • Shlipak M (2008). Diabetic nephropathy, search date November 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  • Steele AW (2001). Kidney disease. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 429–465. Hamilton, ON: BC Decker.
  • Vijan S, (2008). Diabetes: Treating hypertension, search date February 2007. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

Credits

Author Caroline Rea, RN, BS, MS
Editor Maria Essig
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 November 18, 2008

related physicians

related services

Bon Secours International| Sisters of Bon Secours USA| Bon Secours Health System

This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Privacy Policy. How this information was developed to help you make better health decisions.

© 1995-2010 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.