People with diabetes have to keep the three "hypers" under control:
Hypertension (high blood pressure)
Hyperlipidemia (high blood fats)
Hyperglycemia (high blood glucose)
High blood pressure, glucose or fat can cause problems.
Oral Health
Taking Care of Your Mouth
Poorly controlled diabetes can cause severe gum disease and abscesses in young and old. So keep monitoring your blood glucose level. Have your teeth cleaned and checked by the dentist at least every 6 months. Brush at least twice a day to fight plaque. Use a soft nylon brush with rounded ends on the bristles. Tilt the bristles at about a 45-degree angle against the gum line and brush gently in a scrubbing motion. Brush front and back and also brush the chewing surfaces. Brush the rough upper surface of your tongue. Use dental floss once a day to remove bacteria from between your teeth. Special floss holders and various types of floss are available to make flossing easier.
Call your dentist if you find:
Your gums bleed when you brush or eat
Your gums are red, swollen or tender
Your gums have pulled away from your teeth
Pus appears between your teeth and gums when the gums are touched
Any change in the way your teeth fit together when you bite
Persistent bad breath or a taste in your mouth.
Skin Care
Common Skin Problems
Diabetes can affect every part of the body, including the skin. As many as a third of people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. In fact, such problems are sometimes the first sign that a person has diabetes. Luckily, most skin conditions can be prevented or easily treated if caught early. Some of these problems are skin conditions that anyone can have, but that people with diabetes get more easily. These include bacterial infections, fungal infections, and itching. Other skin problems happen mostly or only to people with diabetes. These include diabetic dermopathy, necrobiosis lipoidica diabeticorum, diabetic blisters, and eruptive xanthomatosis.
Bacterial Infections
Several kinds of bacterial infections occur in people with diabetes. One common one is a sty. These are infections of the glands of the eyelid. Another kind of infection is boils, infections of the hair follicles. Carbuncles are deep infections of the skin and the tissue underneath. Infections can also occur around the nails. Inflamed tissues are usually hot, swollen, red, and painful. Several different organisms can cause infections. The most common ones are the Staphylococcus bacteria, also called staph. Once, bacterial infections were life threatening, especially for people with diabetes. Today, death is rare, thanks to antibiotics and better methods of glucose control. But even today, people with diabetes have more bacterial infections than other people do. Doctors believe people with diabetes can reduce their chances of these infections in several ways (see Good Skin Care below). If you think you have a bacterial infection, see your doctor.
Fungal Infections
The culprit in fungal infections of people with diabetes is often Candida albicans. This yeast-like fungus can create itchy rashes of moist, red areas surrounded by tiny blisters and scales. These infections often occur in warm, moist folds of the skin. Problem areas are under the breasts, around the nails, between fingers and toes, in the corners of the mouth, under the foreskin (in uncircumcised men), and in the armpits and groin. Common fungal infections include jock itch, athlete's foot, ringworm (a ring-shaped itchy patch), and vaginal infection that causes itching. If you think you have a yeast or fungal infection, call your doctor. You will need a prescription medicine to cure it.
Itching
Localized itching is often caused by diabetes. It can be caused by a yeast infection, dry skin, or poor circulation. When poor circulation is the cause of itching, the itchiest areas may be the lower parts of the legs. You may be able to treat itching yourself. Limit how often you bathe, particularly when the humidity is low. Use mild soap with moisturizer and apply skin cream after bathing.
Diabetic Dermopathy
Diabetes can cause changes in the small blood vessels. These changes can cause skin problems called diabetic dermopathy. Dermopathy often looks like light brown, scaly patches. These patches may be oval or circular. Some people mistake them for age spots. This disorder most often occurs on the front of both legs. But the legs may not be affected to the same degree. The patches do not hurt, open up, or itch. Dermopathy is harmless. You do not need to be treated.
Necrobiosis Lipoidica Diabeticorum
Another disease that may be caused by changes in the blood vessels is necrobiosis lipoidica diabeticorum (NLD). NLD is similar to diabetic dermopathy. The difference is that the spots are fewer, but larger and deeper. NLD often starts as a dull red raised area. After a while, it looks like a shiny scar with a violet border. The blood vessels under the skin may become easier to see. Sometimes, NLD is itchy and painful. Sometimes, the spots crack open. NLD is a rare condition. Adult women are the most likely to get it. As long as the sores do not break open, you do not need to have it treated. But if you get open sores, see your doctor for treatment.
Atherosclerosis
Thickening of the arteries-atherosclerosis-can affect the skin on the legs. People with diabetes tend to get atherosclerosis at younger ages than other people do. As atherosclerosis narrows the blood vessels, the skin changes. It becomes hairless, thin, cool, and shiny. The toes become cold. Toenails thicken and discolor. And exercise causes pain in the calf muscles because the muscles are not getting enough oxygen. Because blood carries the infection-fighting white cells, affected legs heal slowly when the skin in injured. Even minor scrapes can result in open sores that heal slowly. People with neuropathy are more likely to suffer foot injuries. These occur because the person does not feel pain, heat, cold, or pressure as well. The person can have an injured foot and not know about it. The wound goes uncared for, and so infections develop easily. Atherosclerosis can make things worse. The reduced blood flow can cause the infection to become severe.
Allergic Reactions
Allergic skin reactions can occur in response to medicines, such as insulin or diabetes pills. You should see your doctor if you think you are having a reaction to a medicine. Be on the lookout for rashes, depressions, or bumps at the sites where you inject insulin.
Diabetic Blisters(Bullosis Diabeticorum)
Rarely, people with diabetes erupt in blisters. Diabetic blisters can occur on the backs of fingers, hands, toes, feet, and sometimes, on legs or forearms. These sores look like burn blisters. They sometimes are large. But they are painless and have no redness around them. They heal by themselves, usually without scars, in about three weeks. They often occur in people who have diabetic neuropathy. The only treatment is to bring blood sugar levels under control.
Eruptive Xanthomatosis
Eruptive xanthomatosis is another condition caused by diabetes out of control. It consists of firm, yellow, pea-like enlargements in the skin. Each bump has a red halo and may itch. This condition occurs most often on the backs of hands, feet, arms, legs, and buttocks. The disorder usually occurs in young men with Type 1 diabetes. The person often has high levels of cholesterol and fat in the blood. Like diabetic blisters, these bumps disappear when diabetes control is restored.
Digital Sclerosis
Sometimes, people with diabetes develop tight, thick, waxy skin on the backs of their hands. Sometimes skin on the toes and forehead also becomes thick. The finger joints become stiff and no longer can move the way they should. Rarely, knees, ankles, or elbows also get stiff. This condition happens to about a third of people who have Type 1 diabetes. The only treatment is to bring blood sugar levels under control.
Disseminated Granuloma Annulare
In disseminated granuloma annulare, the person has sharply defined ring-shaped or arc-shaped raised areas on the skin. These rashes occur most often on parts of the body far from the trunk (for example, the fingers or ears). But sometimes the raised areas occur on the trunk. They can be red, red-brown, or skin-colored. See your doctor if you get rashes like this. There are drugs that can help clear up this condition.
Acanthosis Nigricans
Acanthosis nigricans is a condition in which tan or brown raised areas appear on the sides of the neck, armpits, and groin. Sometimes they also occur on the hands, elbows, and knees. Acanthosis nigricans usually strikes people who are very overweight. The best treatment is to lose weight. Some creams can help the spots look better.
Good Skin Care
There are several things you can do to head off skin problems: Keep your diabetes well controlled. People with high glucose levels tend to have dry skin and less ability to fend off harmful bacteria. Both conditions increase the risk of infection. Keep skin clean and dry. Use talcum powder in areas where skin touches skin, such as armpits and groin. Avoid very hot baths and showers. If your skin is dry, don't use bubble baths. Moisturizing soaps, such as Dove or Basis, may help. Afterward, use an oil-in-water skin cream, such as Lubriderm or Alpha-Keri. But don't put lotions between toes. The extra moisture there can encourage fungus to grow. Prevent dry skin. Scratching dry or itchy skin can open it up and allow infection to set in. Moisturize your skin to prevent chapping, especially in cold or windy weather. Treat cuts right away. Wash minor cuts with soap and water. Do not use Mercurochrome antiseptic, alcohol, or iodine to clean skin because they are too harsh. Only use an antibiotic cream or ointment if your doctor says it's okay. Cover minor cuts with sterile gauze. See a doctor right away if you get a major cut, burn, or infection. During cold, dry months, keep your home more humid. Bathe less during this weather, if possible. Use mild shampoos and unscented soaps. Do not use feminine hygiene sprays. See a dermatologist (skin doctor) about skin problems if you are not able to solve them yourself. Take good care of your feet. Check them every day for sores and cuts. Wear broad, flat shoes that fit well. Check your shoes for foreign objects before putting them on.
FOOT CARE
About one in five people with diabetes enters the hospital for foot problems. Of people with diabetes who enter the hospital, about one in five do so for foot problems. But you can protect your feet by following some basic guidelines.
Inspect your feet every day, and seek care early if you do get a foot injury. Make sure your health care provider checks your feet at least once a ye you a list and explain the dos and don'ts of foot care.
Skin Changes
Diabetes can cause changes in the skin of your foot. At times your foot may become very dry. The skin may peel and crack. The problem is that the nerves that control sweating in your foot no longer work.
After bathing, dry your feet, and seal in the moisture that remains with a thin coat of a lubricant. You can use plain petroleum jelly, unscented hand creams, or other such products.
Do not put oils or creams between your toes. The extra moisture can lead to infection. Also, most health care providers believe you should not soak your feet.
Calluses
Calluses occur more often and build up faster on the feet of people with diabetes. Using a pumice stone every day will help keep calluses under control. It is best to use the pumice stone on wet skin. Put on lotion right after you use the pumice stone. Calluses, if not trimmed, get very thick, break down, and turn into ulcers (open sores). Never try to cut calluses or corns yourself ulcers and infection. Let your health care provider cut your calluses. Also, do not try to remove calluses and corns with chemical agents. These products can burn your skin.
Foot Ulcers
Ulcers occur most often over the ball of the foot or on the bottom of the big toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes. Remember, even though some ulcers do not hurt, every ulcer should be seen by your health care provider right away. Neglecting ulcers can result in infections, which in turn can lead to loss of a limb.
What your health care provider will do varies with your ulcer. Your health care provider should take X rays of your foot to make sure the bone is not infected. The health care provider will cut out any dead and infected tissue. You may need to go into the hospital for this. Also, the health care provider will culture the wound to find out what type of infection you have and which antibiotic will work best.
Keeping off your feet is very important. Walking on an ulcer can make it get larger and force the infection deeper into your foot. Your health care provider may put a special cast on your foot to protect it.
Good diabetes control is important. High blood sugar levels make it hard to fight infection.
If your ulcer is not healing and your circulation is poor, your health care provider may need to refer you to a vascular surgeon.
After the foot ulcer heals, you should still treat your foot carefully. Scar tissue under the healed wound will break down easily. You may need to wear special shoes after the ulcer is healed to protect this area and to prevent the ulcer from coming back.
Several things make some people more likely to get foot ulcers. You are more prone to foot ulcers if you are more than 40 years old, have had a foot ulcer before, have had diabetes-related changes in your eyes, or have kidney disease, nerve damage, or poor blood flow, especially to your feet.
Neuropathy
Although it can hurt, diabetic nerve damage (neuropathy) also can lessen your ability to feel pain, heat, and cold. Loss of feeling often means you may not feel a foot injury. You could have a tack or stone in your shoe and walk on it all day without knowing. You might not notice a foot injury until the skin breaks down and becomes infected.
Nerve damage can also lead to deformities of the feet and toes. Your toes may curl up. People with deformed feet and toes should not force them into regular shoes. Ask your health care provider about special therapeutic shoes.
Poor Circulation
Poor circulation (blood flow) can make your foot less able to fight infection and to heal. Diabetes causes blood vessels of the foot and leg to narrow and harden. You can control some of the things that cause poor blood flow. D arteries harden faster. Also, follow your health care provid your blood pressure and cholesterol under control.
If your feet are cold, you may be tempted to warm them. Unfortunately, if your feet cannot feel heat, it is easy for you to burn them with hot water, hot water bottles, or heating pads. The best way to help cold feet is to wear warm socks.
Exercise is good for poor circulation. It stimulates blood flow in the legs and feet. Walk in sturdy, good-fitting, comfortable shoes. Don't walk when you have open sores.
Some people feel pain in their calves when walking fast, up a hill, or on a hard surface. This condition is called intermittent claudication. Stopping to rest for a few moments should end the pain. If you have these symptoms, you must stop smoking. You should also see your health care provider to get started on a walking program. Some people can be helped with the medication pentoxifylline (Trental), as prescribed by their health care provider.
Amputation
People with diabetes are far more likely to have a foot or leg amputated than other people. The problem? Many people with diabetes have artery disease, which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation. Together, these problems make it easy to get ulcers and infections that may lead to amputation.
For these reasons, you should take good care of your feet and see your health care provider right away about foot problems. Always follow your health care provider's advice exactly when caring for ulcers or other foot problems.
One of the biggest threats to your feet is smoking. Smoking affects small blood vessels. It can cause decreased blood flow to the feet and make wounds heal slowly. A lot of people with diabetes who need amputations are smokers.
Often, your health care provider can prevent loss of a limb with an operation that improves blood flow in your feet.
Your Health Care Provid Because people with diabetes are more prone to foot problems, a podiatrist may be on your health care team.
Your health care provider should perform a complete foot exam at least annual foot problems.
Remember to take off your socks and shoes while you wait for your physical examination.
You should call or see your health care provider if you have cuts or breaks in the skin or have an ingrown nail. Also, tell your health care provider if the foot changes color, shape, or just feels different (for example, becomes less sensitive or hurts).
If you have corns or calluses, your health care provider can trim them for you. Your health care provider can also trim your toenails if you cannot do so safely.
Caring for Your Feet
There are many things you can do to keep your feet healthy.
Keep your blood sugar in control.
Wash your feet every day. Dry them carefully, especially between the toes.
Check your feet every day for sores, calluses, red spots, cuts, swelling, and blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for help.
Do not put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby.
If your feet are cold, wear socks. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it.
Do not cut off blood flow to your feet. Do not wear garters.
Do not use chemicals on corns, calluses, or warts. Over-the-counter products are often too strong for use by people with diabetes. They can burn your feet. Also, do not cut corns or calluses yourself.
Cut your toenails straight across and file the edges. Do not rip off hangnails.
Wear flat shoes that fit your feet. They should be comfortable when you buy them. Break in your new shoes slowly.
If you have lost feeling in your feet, ask your health care provider for advice on proper shoes.
Consider wearing comfortable walking shoes every day.
Check inside your shoes before wearing them. Make sure there are no pebbles, nails, or other sharp objects in them and that the shoe itself is not rough and the lining is not torn.
Choose socks carefully. They should not have seams or other bumpy areas. Do not wear mended socks. Pull your socks on gently to prevent ripping a toenail. Choose padded athletic socks to protect your feet and make walking more comfortable.
Never walk barefoot. You could burn or cut your feet and not notice it. Keep slippers by your bed to use when you get up at night.
Do not smoke.
See your health care provider at the first sign of infection or inflammation.
Smoking
The How and Why of Quitting
Kicking the habit is hard-but worth the work. Tobacco has many bad health effects, particularly for people with diabetes. No matter how long you've smoked, your health will improve when you quit.
Nicotine, the drug in tobacco, is one of the most addictive substances known. Besides the physical addiction, many smokers also become psychologically hooked on cigarettes. So kicking the habit is hard-but worth the work. There are many methods you can try that can help you quit and stay quit.
Smoking Hurts Your Health
The best-known effect of smoking is that it causes cancer. Smoking can also aggravate many of the problems that people with diabetes already face, such as heart and blood vessel disease:
Smoking cuts the amount of oxygen reaching tissues. The decrease in oxygen can lead to a heart attack, stroke, miscarriage, or stillbirth. Smoking increases your cholesterol levels and the levels of some other fats in your blood, raising your risk of a heart attack. Smoking damages and constricts the blood vessels. This damage can worsen foot ulcers and lead to blood vessel disease and leg and foot infections. Smokers with diabetes are more likely to get nerve damage and kidney disease.
Smokers get colds and respiratory infections easier.
Smoking increases your risk for limited joint mobility.
Smoking can cause cancer of the mouth, throat, lung, and bladder.
People with diabetes who smoke are three times as likely to die of cardiovascular disease as are other people with diabetes.
Smoking increases your blood pressure.
Smoking raises your blood sugar level, making it harder to control your diabetes.
Smoking can cause impotence.
Why Quitting Is So Hard
People keep smoking for two reasons. First, nicotine is highly addictive. Often, a person who quits smoking goes through withdrawal. Symptoms of withdrawal include being irritable; sweating; having headaches, diarrhea, or constipation; and feeling restless, tired, or dizzy. Withdrawal is usually worst the second day after quitting and usually gradually lessens.
Second, many people also become psychologically tied to smoking. It is part of the ritual of their day. It helps them wake up in the morning, comforts them when they are upset, and rewards them for a job well done. Smoking also has pleasurable physical effects. It relaxes people and perks them up.
These factors make it easy to smoke and hard to quit. The pleasures of smoking start within seconds of lighting up; the bad effects can take years to make themselves known. On the other hand, when you try to quit, your first experience is the bad feeling of withdrawal. Only later do you begin to enjoy the benefits of quitting, such as more pep.
Preparing to Quit
The first step in getting ready to quit is to study your own smoking habits. What events or activities make you light up? How often do you smoke?
Once you have an idea of when and why you smoke, you can look for replacements for smoking. For example, smoking may relax you. If so, before quitting, learn and practice another way to relax, such as deep breathing and relaxation exercises. If smoking gives you energy, try standing and stretching or taking a walk when you start to feel the urge to smoke. Exercise can make you more alert.
Perhaps you enjoy the feeling of holding the cigarette, lighting it, gesturing with it, and tapping off the ashes. To keep your hands busy without a cigarette, try a strand of beads, a polished stone, or a pen.
Before you quit, it's also a good idea to plan rewards for sticking to your goal. For example, you might go to a movie to reward yourself for each week you don't smoke. Or you might put your cigarette money into a jar and use it to buy books or CDs or clothes-or save it for a trip.
Also, set up a cheerleading squad-family or friends who will give you support. Former smokers understand what you're going through and may be especially supportive. The more people you tell that you are quitting, the more your pride will help you resist lighting up.
Finally, set a date to quit. Choose a time when you expect your life to be fairly calm. That way, stress won't tempt you to smoke. And if you do have withdrawal symptoms, they won't interfere with your life as much.
Be a Quitter
There are many ways to quit-cold turkey or gradually, with a group or by yourself. Talk to your health care provider about your decision to quit. He or she can help you choose the best way for you. Remember, what works for one person may not work for another. Don't be discouraged if the first method you try fails. Some other method may be the one you need to kick the habit for good.
If smoking is merely a habit for you, something that you can take or leave, cold turkey may work best for you. But if you are very dependent on cigarettes, gradually weaning yourself from cigarettes may work best.
One method that helps you quit gradually is nicotine replacement. When you wear a nicotine patch or chew nicotine gum, some of the nicotine enters your blood. The patch and gum let you taper off from the physical addiction slowly. They blunt your craving for cigarettes and reduce withdrawal symptoms.
You do not wear the patch forever. Instead, you use a series of patches with decreasing nicotine doses. After a few weeks, you've been weaned totally from nicotine.
Nicotine replacement is especially good for people who are physically addicted to nicotine. These are people who smoke more than 20 cigarettes a day, who have their first cigarette within 30 minutes of waking up, and who have had strong withdrawal symptoms when they tried to quit before. Research shows that a smoker who uses a patch is twice as likely to quit successfully as someone who doesn't use a patch.
Patches aren't perfect. They raise blood sugar levels in some people with diabetes. And you must not smoke while wearing the patch.
If you think that you would find it easier to quit with a group of people, think about joining a class. Your company, health plan, or a local hospital may sponsor such courses. If not, organizations such as the Seventh-Day Adventist Church, the American Lung Association, and the American Cancer Society may run free or low-cost classes in your town. (The American Heart Association and the American Lung Association also have self-help materials.) Check your phone book for the number of the local affiliates in your area, and look in the Yellow Pages under Smokers Information & Treatment Centers. Ask what the focus of the class is. Some classes target getting you ready to quit, and others try to help you stay off cigarettes.
Hypnosis helps some people stop smoking. It is most useful for helping you avoid the things that trigger you to smoke. If you are interested in hypnosis, choose a hypnotist with a clinical degree (for example, a physician or psychologist).
Another method is acupuncture. In acupuncture, fine needles are placed in various parts of your body. For some people, acupuncture stops the craving to smoke. If it's going to work for you, it probably will do so in seven treatments or fewer.
However you decide to quit, there are several ways to help yourself keep at it. Throw away your cigarettes, lighters, and ashtrays at work and at home to make it hard to give into the urge to smoke. At first, avoid situations in which you enjoy smoking. Give yourself the rewards you planned. When you are tempted to smoke, make a list of reasons for not smoking. For example, your breath and hair smell fresher, you are saving lots of money, you are setting an example for loved ones, you aren't coughing like you used to, or food tastes better.
Once You've Quit
Once you've quit, the next step is to stay off. The first three months or so after quitting are the hardest time. Most people who return to smoking do so then. During those first three months, they've broken the physical addiction but not yet shaken their psychological dependence on cigarettes.
It often takes just one cigarette to put you back on the smoking treadmill. So have some ideas up your sleeve to fight temptation. For example, plan to take a bath, chew sugarless gum, sip some water, find something to do with your hands, or step outside for some fresh air when the urge to smoke hits you.
If you know you are going to be around smokers, be prepared. Practice an answer for when you're offered a cigarette. Seek out nonsmokers in the group. Don't apologize for not smoking.
If you do smoke a cigarette, then you need to renew your decision to quit. Focus on learning from your slip, not on berating yourself for it. Figure out why you slipped up and how you might avoid doing so again.
Once your body's metabolism returns to normal, you may put on a little weight. The average is about 7 pounds. If you are worried about gaining weight, talk to your dietitian about changing your meal and exercise plans.
You also need to stay in touch with your health care provider after you quit. Your diabetes control will probably improve. If so, your health care provider may want to change your insulin dose or diabetes pill schedule. Similarly, if you are being treated for high blood pressure or high cholesterol levels, your condition may improve so much that your health care provider may want to change your treatment.
And remember-quitting smoking is probably the most important thing you can do for your health and for those around you.My special Thanks goes to
for the information on this page.
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