American Medical Association Family Medical Guide - American Medical Association [605]
• Eye damage Diabetes can damage the small blood vessels that supply the back of the eye, causing them to leak blood or other fluid into the eye. This condition, called diabetic retinopathy, is a major cause of blindness in people between ages 25 and 74. Having diabetes also increases a person’s risk of other vision-robbing eye disorders, such as cataracts (clouding of the lens of the eye) and glaucoma (buildup of pressure from excess fluid inside the eye). For this reason, if you have diabetes, you should see an eye doctor (an ophthalmologist) every year for a complete eye examination.
• Kidney disease Diabetes can cause narrowing of the blood vessels that carry blood to the kidneys, reducing their ability to filter out and eliminate wastes from the body. Diabetes can also harm the kidneys by causing frequent infections of the urinary tract. Because kidney disease seldom causes noticeable symptoms until the kidneys are seriously damaged, see your doctor regularly for urine tests and blood tests to help evaluate the health of your kidneys.
Treatment
There is no cure for diabetes. Treatment involves a combination of a carefully controlled diet and daily injections of insulin (from two to four times a day) to replace the insulin your pancreas is not producing. Keeping your blood glucose level in a normal range can keep you healthy and help you avoid potentially serious complications, such as retinopathy and kidney failure. You will require treatment for diabetes all your life. To monitor the effectiveness of your treatment, you will learn how to measure your blood glucose level at home. Self-discipline, along with the support and help you get from your health care team, is extremely important if you are to control your diabetes successfully.
If you maintain good control over your blood sugar level, you can expect to lead a full and healthy life. Intensive therapy with multiple daily injections of insulin and the insulin pump allow you flexibility with your meals and exercise and work schedules. Hypoglycemia (low blood glucose; see page 897) can be avoided by testing your blood glucose regularly, eating appropriate snacks, and using small doses of short-acting insulin when necessary. Your risk of serious complications can be reduced by having regular medical checkups and following your doctor’s recommendations. The following steps can help you stay healthy:
• Exercise regularly.
• Follow the diet your doctor or dietitian recommends.
• Maintain good control of your blood glucose level with frequent blood sugar tests at home and regular (usually every 3 months) hemoglobin A1C tests (see page 895).
• Keep your blood pressure at a healthy level—lower than 120/80 millimeters of mercury (mm Hg).
• Keep your LDL (harmful) cholesterol lower than 100.
• Take ACE inhibitors or any other heart disease or blood pressure medications your doctor prescribes.
• Don’t smoke cigarettes or cigars.
Ask your doctor the best way to engage in strenuous activities such as fast-paced sports, because exercise burns up glucose and may bring on hypoglycemia. Before exercising, your doctor may recommend that you eat extra food or adjust your dose of insulin.
Any illness, from a minor cold to a heart attack, puts stress on the body and therefore increases the amount of insulin needed. You must follow the timetable of meals and snacks recommended by your doctor to keep the supply of glucose in your blood steady. This routine will also help ensure that your regular doses of insulin always act on approximately the same amount of glucose. If you are not able to eat according to your usual schedule, take glucose drinks and monitor your blood sugar, but do not reduce your dose of insulin. Talk to your doctor immediately if your blood sugar level increases, for any reason, beyond the goals or ranges you and your doctor have discussed.