Prevention

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Some risk factors for diabetes can't be changed, such as family history of the disease, advancing age or ethnic heritage. However, evidence suggests that people who are at risk for developing diabetes may reduce their risks by controlling their weight and exercising. (Always consult with your health care professional about diet and exercise programs.)

The Diabetes Prevention Program (DPP), a major clinical trial sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), compared diet and exercise to treatment with the oral anti-diabetic drug metformin (Glucophage) in 3,234 people with impaired glucose tolerance (IGT), a condition that often precedes diabetes.

The study found that diet and exercise could delay diabetes in a diverse American population of overweight people by about 58 percent. This group got at least 150 minutes of physical activity per week, usually with walking or other moderate-intensity exercise, and lost five to seven percent of their body weight. Participants randomized to treatment with metformin reduced their risk of type 2 diabetes by 31 percent.

Screening for Diabetes

If you're overweight and age 45 or older, you should be screened for diabetes via regular office visits with your primary care physician using either the fasting blood glucose test, which identifies impaired fasting glucose, or the oral glucose tolerance test, which identifies impaired glucose tolerance.

You should also be screened if you're younger than 45 and are significantly overweight and have one or more of the following risk factors:

• A family history of diabetes

• A low HDL cholesterol and high triglycerides

• High blood pressure

• A history of gestational diabetes or giving birth to a baby weighing more than nine pounds

• Are a member of a higher-risk minority group (African Americans, American Indians, Alaska Natives, Hispanic Americans/Latinos and Asian American/ Pacific Islanders are at increased risk for type 2 diabetes.)

Treating diabetes comprehensively—that is, managing not only blood glucose, but also blood pressure and cholesterol—is crucial to helping prevent heart attack and stroke. The good news is that women with diabetes who maintain lower blood glucose, blood pressure and cholesterol levels can lower their risk of cardiovascular disease.

If you have type 1 diabetes, comprehensive diabetes treatment usually includes at least the following:

• Testing blood sugar levels at least twice a day, sometimes four or more times daily

• Three or more daily insulin injections or use of an insulin pump

• Adjustment of insulin doses according to food intake and exercise

• A diet and exercise plan

• Scheduled visits to a health care team composed of a health care professional, nurse educator, dietitian and behavioral therapist as needed

For those with type 2 diabetes, good management includes at least the following components:

• A proper diet, exercise and weight loss (if needed)

• Testing blood sugar levels per your health care professional's recommendation

• Scheduled visits to a health care team composed of a health care professional, nurse educator, dietitian and behavioral therapist as needed.

If these measures don't work, you might have to take diabetes medication or insulin shots.

Diabetes-Related Complications

If you have diabetes, you should have your eyes examined for diabetic retinopathy at least once a year by an eye specialist, or ophthalmologist. Progressive damage to the eye's retina caused by long-term uncontrolled diabetes can result in loss of vision. People with both type 1 and type 2 diabetes are at risk for developing diabetic retinopathy.

Diabetic retinopathy is a disease of the small blood vessels of the retina of the eye. When retinopathy starts, the tiny blood vessels in the retina become swollen, leaking fluid into the center of the retina. Your vision may become blurred, a condition called background retinopathy.

About 80 percent of people with nonproliferative (background) retinopathy never have serious vision problems, and the disease never goes beyond this first stage. However, if retinopathy progresses, the damage to your sight can be more serious. Abnormal blood vessels grow over the surface of the retina. These vessels may break and bleed into the clear gel that fills the center of the eye, blocking vision. Scar tissue may form near the retina, pulling it away from the back of the eye.

The incidence and severity of retinopathy increases with the duration of diabetes and appears to be worse if diabetes control is poor in the first years of onset. Typically, the disease can progress silently for many years. Symptoms of advanced disease can include decreased visual acuity and floaters (spots in front of your eyes) and loss of vision. Early detection by a dilated eye exam and treatment can prevent or significantly delay progression. The earlier treatment is begun, the better the chances for recovery.

Almost everyone who has diabetes for more than 30 years shows signs of retinal damage, and African Americans and women with diabetes are at higher risk of developing retinopathy. If you control your diabetes (and high blood pressure, if present) it may slow the progression of this condition.

Diabetic nephropathy, or kidney damage, is a leading cause of kidney failure and dialysis. Patients with diabetes should be screened with blood tests and urine tests for signs of early kidney damage, such as protein spilling into the urine. Certain medications, such as ACE inhibitors and angiotensin receptor blockers, may slow the progression of kidney failure. Aggressive control of high blood pressure, as well as smoking cessation, is also important to protect your kidneys.

Diabetic neuropathy, or nerve damage, is another major complication that can be minimized by intensive glucose management.

• Check your feet and toes daily for any cuts, sores, bruises, bumps or infections, using a mirror if necessary.

• Wash your feet daily, using warm (not hot) water and a mild soap. If you have neuropathy, you should test the water temperature with your wrist before putting your feet in the water. Health care professionals do not advise soaking your feet for long periods because keeping your feet in water for extended periods may erode protective calluses. Dry your feet carefully with a soft towel, especially between the toes.

• Cover your feet (except for the skin between the toes) with petroleum jelly, a lotion containing lanolin, or cold cream before putting on shoes and socks. In people with diabetes, the feet tend to sweat less than normal. Using a moisturizer helps prevent dry, cracked skin.

• Wear thick, soft socks and avoid wearing slippery stockings, mended stockings or stockings with seams.

• Wear shoes that fit your feet well and allow your toes to move.

• Never go barefoot, especially on the beach, hot sand or rocks.

• Cut your toenails straight across, but be careful not to leave any sharp corners that could cut the next toe.

• Use an emery board or pumice stone to file away dead skin, but do not remove calluses, which act as protective padding. Do not try to cut off any growths yourself, and avoid using harsh chemicals, such as wart remover, on your feet.

• If your feet are cold at night, wear socks. (Do not use heating pads or hot-water bottles.)

• Avoid sitting with your legs crossed. Crossing your legs can reduce the flow of blood to the feet.

• Ask your health care professional to check your feet at every visit, and call him or her if you notice that a sore is not healing well.

• If you are not able to take care of your own feet, ask your health care professional to recommend a podiatrist (specialist in the care and treatment of feet) who can help.