Diabetes, heart disease, and stroke

In this section:

• What is the relationship between diabetes, heart disease, and stroke?
• What other things increase my chance of heart disease or stroke if I have diabetes?
• How can I reduce my chance of having a heart attack or stroke if I have diabetes?
• How are heart disease diagnosed in people with diabetes?
• What are the warning signs of a heart attack or stroke?
• Clinical trials

If you have diabetes , you are more likely to have heart disease or problems and a greater chance of a heart attack or stroke. People with diabetes are also more likely to have certain medical problems, or risk factors, that increase the chance of heart disease or stroke. These factors include high blood pressure or high cholesterol. If you have diabetes, you can protect your health and heart by controlling your blood glucose (also called blood sugar), as well as your blood pressure and cholesterol. If you smoke, get help to quit.

What is the relationship between diabetes, heart disease, and stroke?

Over time, the high blood glucose that results from diabetes can damage the blood vessels and nerves that control the heart and blood vessels. The longer you have diabetes, the more likely you are to have heart disease. ¹

People with diabetes tend to get heart disease at a younger age than people without diabetes. In adults with diabetes, the most common causes of death are heart disease and stroke. Adults with diabetes are almost twice as likely to die from heart problems or a stroke than people without diabetes. ^two

The good news is that the steps you take to control your diabetes also help lower your chance of heart disease or stroke .

What other things increase my chance of heart disease or stroke if I have diabetes?

If you have diabetes, there are other factors that increase your chance of having heart disease or stroke.

To smoke

Smoking increases your risk of heart disease. If you have diabetes, it is important to stop smoking because both tobacco and diabetes decrease the size of your blood vessels. Plus, it also increases your chance of having other long-term problems like lung disease. Smoking can also damage the blood vessels in the legs and increase the risk of leg infections, ulcers, and amputations.

High blood pressure

If you have high blood pressure , your heart must work harder to pump blood. High blood pressure can affect the heart, damage blood vessels, and increase the risk of heart attack, stroke, and eye or kidney problems.

Abnormal cholesterol levels

The cholesterol is a type of blood fat produced by the liver. There are two types of cholesterol in the blood: LDL and HDL.

LDL cholesterol, often called “bad” cholesterol, can build up and clog your blood vessels. High levels of LDL cholesterol increase the risk of heart disease.

Triglycerides, another type of fat in the blood, can also increase your risk of heart disease if your levels are higher than recommended by your healthcare team.

Obesity and abdominal fat or belly fat

Being overweight and obese can affect your ability to control diabetes and increase your risk for many health problems, such as heart disease and high blood pressure. If you are overweight, a healthy eating plan with fewer calories can often lower your glucose levels and your need for medicine.

Even when you’re not overweight, excess belly fat – fat in your belly or around your waist – can increase your chance of heart disease.

You have excess belly fat if your waist measures:

• over 40 inches (about 102 cm.) and is male
• over 35 inches (about 89 cm.) and is female

Family history of heart disease

A family history of heart disease can also make you more likely to have heart disease. If one or more of your family members had a heart attack before age 50, you may have an even higher chance of heart disease.

You cannot change your family history of heart disease. However, if you also have diabetes, it is even more important to take steps to protect yourself from heart disease and decrease your chance of a stroke.

How can I reduce my chance of having a heart attack or stroke if I have diabetes?

Taking care of your diabetes helps you take care of your heart. You can reduce your chance of having a heart attack or stroke by taking the following steps to control your diabetes and keep your heart and blood vessels healthy.

Control the key factors of diabetes

Knowing the key factors of diabetes will help you control your blood glucose, blood pressure, and cholesterol. If you have diabetes, it is also important to stop smoking to lower your chance of heart disease.

Blood Glucose: The A1C test shows your average blood glucose level for the past 3 months. This test is different from the blood glucose checks you do every day. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months. High blood glucose levels can damage the heart, blood vessels, kidneys, feet, and eyes.

The ideal A1C level for many people with diabetes is less than 7 percent. Some people do better with a slightly higher A1C percentage. Ask your healthcare team what your ideal level is.

Blood pressure Blood pressure is the force that blood exerts against the walls of the blood vessels. High blood pressure makes the heart work too hard. It can cause heart attack, stroke, and kidney and eye damage.

For most people with diabetes, the ideal blood pressure level is less than 140/90 mm Hg. Ask your healthcare team what your ideal level is.

Cholesterol. There are two types of cholesterol in the blood: LDL and HDL. LDL or “bad” cholesterol can build up and clog blood vessels. High levels of bad cholesterol can cause a heart attack or stroke. HDL or “good” cholesterol helps remove bad cholesterol from your blood vessels.

Ask your doctor or another member of your health care team what the ideal cholesterol level is for you. If you are over 40, you may need to take medicines, such as statins, to lower your cholesterol and protect your heart. Some people with very high LDL (“bad”) cholesterol may need to take medicine from a younger age.

Stop smoking. Quitting smoking is especially important for people with diabetes because both smoking and diabetes reduce the diameter of the blood vessels. Narrowing of the blood vessels makes the heart work harder.

If you quit smoking you can:

• lower your risk of heart attack, stroke, nerve disease, kidney disease, diabetic eye disease, and amputation
• improve your glucose, cholesterol, and blood pressure
• improve your blood circulation
• find it easier to stay physically active

If you smoke, or use other tobacco products, quit. Ask for help so you don’t have to do it alone. You can start by calling the National Smoking Cessation Line at 1-800-784-8669 (1-800-QUITNOW). In SmokeFree.gov you can find tips on how to quit smoking.

Ask your healthcare team about your target glucose, blood pressure, and cholesterol levels, and what you can do to achieve these levels.

Establish or maintain healthy lifestyle habits

Establishing or maintaining healthy lifestyle habits can help you control your diabetes and prevent heart disease.

• Follow your healthy eating plan.
• Make physical activity part of your routine.
• Maintain or reach a healthy weight.
• Get enough sleep.

Learn more about these tips for managing diabetes .

Watch a video in English about what you can do to keep your heart healthy.

Learn to manage stress

Controlling diabetes is not always easy. Feeling stressed, sad, or angry is common when you have diabetes. You may know what to do to stay healthy, but have trouble sticking to your plan all the time. Long-term stress can raise your blood glucose and blood pressure, but you can learn how to reduce stress. Try taking deep breaths, gardening, going for a walk, practicing yoga, meditating, having a hobby, or listening to your favorite music. Learn more about healthy ways to manage stress.

Take medicine to protect your heart

Medicines can be an important part of your treatment plan. Your doctor or other healthcare professional will prescribe medications based on your specific needs. Medicines can help you:

• reach your target levels of blood glucose (A1C), blood pressure and cholesterol.
• reduce your risk of blood clots, a heart attack, or a stroke.
• treat angina or chest pain that is often a symptom of heart disease. (Angina can also be an early symptom of a heart attack.)

Ask your doctor if you should take aspirin. Aspirin is not safe for everyone. Your doctor can tell you whether or not you should take aspirin and exactly how much to take.

The statins can reduce the risk of having a heart attack or stroke on in some people with diabetes. Statins are a type of medicine that is often used to help people reach their ideal cholesterol levels. Talk to your doctor about whether you should take a statin.

Talk to your doctor if you have questions about your medicines. Before starting a new medicine, ask your doctor about possible side effects and how you can avoid them. If the side effects of the medicine bother you, tell your doctor. Don’t stop taking your medicines without first talking to your doctor.

How are heart disease diagnosed in people with diabetes?

Doctors diagnose diabetes-related heart disease based on:

• Your symptoms
• your medical history and family history
• your chance of having heart disease
• a physical exam
• the results of any tests and procedures you have

The results of the tests used to monitor your diabetes (A1C, blood pressure, and cholesterol) help your doctor decide if other tests are important to monitor your heart health.

What are the warning signs of a heart attack or stroke?

Call 9-1-1 right away if you have warning signs of a heart attack:

• chest pain or pressure that lasts more than a few minutes or comes and goes
• pain or discomfort in one or both arms or shoulders, or in the back, neck, or jaw
• difficulty breathing
• sweating or dizziness
• indigestion or nausea (upset stomach)
• severe fatigue or tiredness

Treatment works best when it is given right away. The warning signs may be different for different people. You may not have all of these symptoms.

If you have angina, it is important to know how and when to seek medical treatment .

Women sometimes have nausea and vomiting, feel very tired (sometimes for days), and have pain in their back, shoulders, or jaw, without any chest pain.

People with nerve damage caused by diabetes may not notice any chest pain.

Call 9-1-1 right away if you have warning signs of a stroke, including if you have a sudden

• weakness or numbness of the face, arm, or leg on one side of the body
• confusion or trouble speaking or understanding what is being said to you
• dizziness, loss of balance, or trouble walking
• difficulty seeing in one or both eyes
• intense headache

If you have any of these warning signs, call 9-1-1. You can help prevent permanent damage by arriving at a hospital within an hour of a stroke.

Clinical trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the United States National Institutes of Health (NIH) conduct and support research on many diseases and conditions.

What are clinical trials? Are They Right For You?

Clinical trials are part of clinical research and are at the core of all medical advancements. Clinical trials look for new ways to prevent, detect, or treat diseases. Researchers also use clinical trials to look at other aspects of health care, such as improving the quality of life for people with chronic diseases. Find out if clinical trials are right for you .

What clinical trials are open?

At www.ClinicalTrials.gov you can find clinical trials that are currently open and recruiting participants.

Low blood glucose (hypoglycemia)

In this page:

• What is hypoglycemia?
• What are the symptoms of hypoglycemia?
• What Causes Hypoglycemia in Diabetes?
• What other factors contribute to hypoglycemia in diabetes?
• How can I prevent hypoglycemia if I have diabetes?
• How do I treat hypoglycemia?
• What if I have severe hypoglycemia and cannot apply the treatment?

What is hypoglycemia?

Hypoglycemia, also known as low blood sugar or glucose, occurs when the level of glucose in the blood falls below normal. For many people with diabetes, that refers to a level of 70 milligrams per deciliter (mg / dL) or less. Your numbers may be different, so check with your doctor to find out which level is too low for you.

What are the symptoms of hypoglycemia?

Symptoms of hypoglycemia tend to come on quickly and can vary from person to person. You may have one or more symptoms listed in the table below and they can be mild to moderate. Some people do not feel any symptoms.

Severe hypoglycemia is when your blood glucose level drops so low that you cannot treat yourself and need help from another person. This hypoglycemia is dangerous and needs to be treated right away. This condition is more common in people with type 1 diabetes.

Some symptoms of hypoglycemia during sleep are

• Crying or having nightmares
• Sweat until your pajamas or sheets get damp
• Feeling tired, irritable, or confused after waking up

What Causes Hypoglycemia in Diabetes?

Hypoglycemia can be a side effect of insulin and other types of diabetes medicines that help your body make more insulin. Two types of diabetes pills that can cause hypoglycemia are: sulfonylureas and meglitinides. Ask your healthcare team if your diabetes medicine can cause hypoglycemia.

Although other diabetes medicines do not cause hypoglycemia on their own, they can increase your chances of hypoglycemia if you already take insulin, sulfonylurea, or meglitinide.

What other factors contribute to hypoglycemia in diabetes?

If you take insulin or diabetes medicines that increase the amount of insulin produced by your body, but do not adjust them according to your meals or physical activity, you could develop hypoglycemia. The following factors tend to cause hypoglycemia:

Not eating enough carbohydrates

When you eat carbohydrate foods , your digestive system breaks down sugars and starches into glucose. Glucose enters the blood and increases the glucose level. If you don’t eat enough carbohydrates with your medicines, your blood glucose level can drop too low.

Skipping or delaying a meal

If you skip or delay a meal, your blood glucose level may drop too low. Hypoglycemia can also occur when you are sleeping and haven’t eaten in many hours.

Increase your physical activity

Increasing your level of physical activity above your normal routine can lower your blood glucose level for up to 24 hours after the activity.

Drinking too much alcohol without having eaten enough

Alcohol makes it harder for your body to keep your blood glucose level stable, especially if you haven’t eaten in several hours. The effects of alcohol can also prevent you from experiencing the symptoms of hypoglycemia, which can result in severe hypoglycemia.

Be sick

When you are sick, you may not be eating enough or not retaining food, which can cause low blood glucose. Learn more about taking care of your diabetes while you are sick .

How can I prevent hypoglycemia if I have diabetes?

If you are taking insulin, sulfonylurea, or meglitidine, use your diabetes management plan and work with your healthcare team to adjust your plan as needed to help prevent hypoglycemia. The following actions can also help you prevent hypoglycemia:

Check blood glucose levels

Knowing your blood glucose level can help you decide how much medicine to take, what foods to eat, and how physically active you should be. To find out your blood glucose level, get checked with a blood glucose meter as often as your doctor tells you.

Asymptomatic hypoglycemia. Sometimes people with diabetes do not feel or recognize the symptoms of hypoglycemia, a problem known as asymptomatic hypoglycemia. If you’ve had hypoglycemia without experiencing any symptoms, you may need to check your blood glucose level more often so that you know when you need to treat your hypoglycemia or do something to prevent it. Make sure to check your blood glucose level before driving.

If you have had asymptomatic hypoglycemia or have often had hypoglycemia, ask your healthcare provider about the continuous glucose monitor (CGM). A CGM checks your blood glucose level regularly throughout the day and night. A CGM can tell you if your glucose level is dropping quickly and sounds an alarm if it drops too low. This alarm can wake you up if you have hypoglycemia while you sleep.

Eat regular meals and snacks

Your meal plan is the key to preventing hypoglycemia. Eating regular meals and snacks with the right amount of carbohydrates can help keep your glucose level from dropping too low. Also, if you consume alcoholic beverages, it is best to eat something at the same time.

Have safe physical activity

Physical activity can lower your blood glucose level during physical activity and for hours afterward. To help prevent hypoglycemia, you may need to check your blood glucose level before, during, and after activity, and adjust your medications or carbohydrate intake. For example, you can have a snack before physical activity or lower your insulin doses as directed by your healthcare provider, to prevent your blood glucose from dropping.

Work with your healthcare team

Tell your healthcare team if you have had hypoglycemia. He or she can adjust your diabetes medications or other aspects of your management plan. Learn to balance your medicine, eating plan, and physical activity to prevent hypoglycemia. Ask if you can have a glucagon emergency kit to carry with you at all times.

How do I treat hypoglycemia?

If you start to have one or more symptoms of hypoglycemia, check your blood glucose level . If your glucose level is below normal or below 70, eat or drink 15 grams of carbohydrate right away. Examples include

• Four glucose tablets or a tube of glucose gel
• ½ cup (4 ounces) of fruit juice, not low in calories or sugar *
• ½ can (4 to 6 ounces) soda, not low in calories or sugar
• 1 tablespoon sugar, honey, or corn syrup
• 2 tablespoons raisins

Wait 15 minutes and check your blood glucose level again. If you’re still low, eat or drink another 15 grams of glucose or carbohydrates. Check your blood glucose level after another 15 minutes. Repeat these steps until the level returns to normal.

If your next meal is more than 1 hour away, have a snack to keep your blood glucose level normal. Try some cookies or a piece of fruit.

People with kidney disease should not drink orange juice in its 15 grams of carbohydrates because it contains a lot of potassium. Apple, grape, or cranberry juices are good options.

Treating hypoglycemia if you take acarbose or miglitol

If you take acarbose or miglitol with your diabetes medicines that can cause hypoglycemia, you will need to take glucose tablets or gel, in case your blood glucose level drops. Eating or drinking other sources of carbohydrates will not raise your glucose level quickly enough.

What if I have severe hypoglycemia and cannot apply the treatment?

Someone will need to give you a glucagon injection if you have severe hypoglycemia. This injection will quickly raise your blood glucose level. Discuss with your healthcare provider when and how to use the glucagon emergency kit. If you have this kit, check the date on the packaging to make sure it has not expired.

If you are prone to severe hypoglycemia, teach your family, friends, and co-workers when and how to give you a glucagon injection. Also, tell them to call 911 right away, after giving you the injection or if you don’t have a glucagon emergency kit with you.

If you are hypoglycemic often or have had severe hypoglycemia, you should wear a medical alert bracelet or necklace. A Medical Alert ID lets others know that you have diabetes and need immediate care. Getting care quickly can help prevent serious problems caused by hypoglycemia.

Diabetic neuropathies: nerve damage

Kidney disease caused by diabetes

In this section:

• What is kidney disease caused by diabetes?
• How does diabetes cause kidney disease?
• What increases my risk for kidney disease caused by diabetes?
• How do I know if I have kidney disease caused by diabetes?
• How can I keep my kidneys healthy if I have diabetes?
• How can I manage the stress of managing diabetes?
• Does kidney disease caused by diabetes get worse over time?

What is kidney disease caused by diabetes?

Diabetes is the leading cause of kidney disease . Kidney disease means that the kidneys are damaged and cannot filter the blood as they should. About one in four adults with diabetes has kidney disease. ¹

The main job of the kidneys is to filter waste and excess water in the blood in the form of urine. The kidneys also help control blood pressure and make the hormones the body needs to stay healthy.

If the kidneys are damaged, they cannot filter the blood as they should. This can cause waste to build up in the body. Damage to the kidneys can also cause other health problems.

Kidney damage caused by diabetes usually occurs slowly over the years. You can take steps to protect your kidneys and prevent or delay kidney damage.

Watch a video in English about diabetes and kidney disease .

What are other names for kidney disease caused by diabetes?

Kidney disease caused by diabetes is also known as diabetic nephropathy, chronic kidney disease, chronic kidney disease, chronic kidney disease, CKD, kidney disease caused by diabetes, and diabetic nephropathy, among other names.

How does diabetes cause kidney disease?

High blood sugar, also known as blood glucose, can damage the blood vessels in the kidneys. When blood vessels are damaged, they don’t work as well. Also, many people with diabetes have high blood pressure, which can also damage the kidneys. Learn more about high blood pressure and kidney disease .

What increases my risk for kidney disease caused by diabetes?

Having diabetes for a long time increases the risk of kidney damage. If you have diabetes, you are more likely to develop kidney problems if you have:

• too much sugar in the blood
• high blood pressure (hypertension)

African Americans, American Indians, and Hispanics / Latinos have a higher rate of diabetes, kidney disease, and kidney failure compared to whites and non-Hispanics.

You are also more likely to have kidney problems if you have diabetes and:

• smokes
• you don’t follow your diabetes meal plan
• eat foods high in salt
• does not do physical activity
• Have overweight
• have heart problems
• have a family history of kidney failure

How do I know if I have kidney disease caused by diabetes?

Most people with kidney disease caused by diabetes have no symptoms. The only way to know if you have this disease is by doing laboratory tests.

Healthcare providers use blood and urine tests to find out if you have kidney disease caused by diabetes. Your healthcare provider will do a urine test to see if you have albumin in your urine and also a blood test to see if your kidneys are filtering your blood well.

You should get tested every year to see if you have kidney problems if:

• have type 2 diabetes or
• have had type 1 diabetes for more than 5 years.

How can I keep my kidneys healthy if I have diabetes?

The best way to stop or prevent kidney disease caused by diabetes is to try to keep your blood sugar and blood pressure under control. Following healthy lifestyle habits and taking your medications as directed by your healthcare provider can help you reach your target levels and improve your overall health.

Achieve Your Ideal Blood Glucose Levels

Your healthcare provider will test your A1C. A1C is a blood test that shows the average level of sugar in your blood over the past 3 months. This test is different from blood sugar checks that you can do yourself. The higher your A1C number, the higher your blood sugar levels have been during the past 3 months.

The ideal A1C level for most people with diabetes is less than 7 percent. Ask your healthcare team what your ideal level is. Reaching this ideal level will help protect your kidneys.

To reach your target A1C levels, your healthcare provider may ask you to check your blood sugar levels. Work with your health care team so that the results are used as a guide in the decisions you need to make about food, physical activity, and your medicines. Ask your healthcare team how often to check your blood sugar levels .

Check your blood pressure

Blood pressure is the force that blood exerts against the walls of the blood vessels. High blood pressure makes the heart work too hard. It can cause heart attacks, strokes, and kidney disease.

Your healthcare team will also work with you to help you establish and achieve your ideal blood pressure level. For most people with diabetes, the ideal blood pressure level is less than 140/90 mm Hg. Ask your healthcare team what your ideal level is.

Medicines that lower blood pressure can also help reduce kidney damage. There are two types of blood pressure medicine that play a special role in protecting the kidneys. These are angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARBs). Each of these medicines has been found to help prevent kidney damage from progressing very quickly in people with diabetes who have high blood pressure and kidney disease caused by diabetes. The names of these medicines end in -pril or -sartan. ACE inhibitors and ARBs should not be taken in pregnant women.

Establish or maintain healthy lifestyle habits

Healthy lifestyle habits can help you reach your ideal blood sugar and blood pressure levels. Following the steps below will also help keep your kidneys healthy:

• Stop smoking.
• Work with a nutritionist or dietitian to create a diabetes meal plan and limit salt and sodium.
• Make physical activity part of your routine.
• Maintain or reach a healthy weight.
• Get enough sleep. Try to get 7 to 8 hours of sleep every night.

Learn more about these tips for managing diabetes .

Take medicines as directed by your healthcare provider

Medicines can be an important part of your treatment plan. Your healthcare provider will prescribe medications based on your specific needs. Medicines can help you reach your target blood sugar and blood pressure levels. You may need to take more than one type of medicine to control your blood pressure.

How can I manage the stress of managing diabetes?

Controlling diabetes is not always easy. Feeling stressed, sad, or angry is common when you have diabetes. You may know what to do to stay healthy, but it’s hard for you to stick to your plan all the time. Long-term stress can raise your blood sugar and blood pressure, but you can learn how to reduce stress. Try taking deep breaths, gardening, going for a walk, doing yoga, meditating, doing a hobby, or listening to your favorite music. Learn more about healthy ways to manage stress.

Does kidney disease caused by diabetes get worse over time?

The damage to the kidneys caused by diabetes can get worse over time. However, you can take steps to keep your kidneys healthy so that kidney damage does not progress too quickly to prevent or delay kidney failure. Kidney failure is considered when the kidneys have lost most of their ability to function, that is, they have less than 15 percent of normal kidney function. However, most people with diabetes and kidney disease do not have kidney failure.

If you have kidney damage as a result of diabetes, learn how to manage kidney disease .

Bibliography

[1] Afkarian M, Zelnick LR, Hall YN, et.al. Clinical manifestations of kidney disease among US adults with diabetes. Journal of the American Medical Association. 2016;316(6):602–610.

Diabetes and foot problems

In this section:

• How can diabetes affect the feet?
• What can I do to keep my feet healthy?
• When should you see the doctor about foot problems?
• Clinical trials

Foot problems are common in people with diabetes. Perhaps you are afraid of losing a toe, foot, or leg, or perhaps you know someone who has been through it. However, you can reduce the chance of foot problems with good daily foot care. Controlling your blood glucose (blood sugar) levels can also help you keep your feet healthy.

How can diabetes affect the feet?

Over time, diabetes can cause nerve damage, also known as diabetic neuropathy , which can cause pain and a tingling sensation, and can cause you to lose feeling in your feet. When you lose feeling in your feet, you may not feel a pebble in your sock or a blister on your foot, which can cause cuts and sores. Cuts and sores can become infected.

Diabetes can also decrease the amount of blood flow to the feet. If you don’t have enough blood flow to your legs or feet, it is more difficult for a sore or infection to heal. Sometimes a serious nerve infection never goes away. The infection can cause gangrene.

If gangrene and foot ulcers do not improve with treatment, your toe, foot, or part of your leg may be amputated. A surgeon may do an amputation to prevent a serious infection from spreading to the rest of your body, which could save your life. Good foot care is very important to prevent serious infections and gangrene.

Although it does not occur often, nerve damage from diabetes can cause foot deformities, such as Charcot’s foot. Charcot’s foot can start with redness, warmth, and swelling. Then the bones and toes of the foot begin to shift or break, causing the foot to take on an odd shape, like “clubfoot.”

What can I do to keep my feet healthy?

Work with your healthcare team to create a diabetes self-care plan, which is an action plan on how to manage diabetes. The plan should include foot care. A podiatrist (foot doctor) and other specialists may be part of your health care team.

Include these steps in your foot care plan:

Tips for foot care

• Check your feet every day.
• Wash your feet every day.
• Gently file corns and calluses.
• Cut your toenails in a straight line.

• Always wear shoes and socks.
• Protect your feet from heat and cold.
• Help maintain blood flow to the feet.
• Have your feet checked at every doctor visit.

Check your feet every day

You may have foot problems and may not feel pain. Checking your feet every day will help you find problems early before problems get worse. A good way to remember this is to check your feet every night when you remove your shoes. Also check the area between the toes. If you have trouble bending over to see your feet, try using a mirror or have someone check your feet.

Be on the lookout for issues like:

• cuts, sores, or red spots
• swelling or blisters with fluid
• ingrown toenails, when the edges of the nails grow buried in the skin
• Corns and calluses, which are circular lesions of hardened skin caused by too much rubbing or pressure in the same place
• plantar warts, which are flesh-colored growths on the soles of the feet
• athlete’s foot
• hot areas on the feet

If you have certain foot problems that increase your chance of developing foot sores, your doctor may recommend that you take skin temperatures on different parts of your feet. A “hot spot” may be the first sign that a blister or ulcer is beginning to develop.

Cover blisters, cuts, or sores with a bandage. File corns and calluses as explained below.

Wash your feet every day

Wash your feet with warm (not hot) water and soap. Feel the temperature of the water to make sure it is not too hot. You can use your elbow or a thermometer (90-95 ° F or 32-35 ° C is a safe temperature) to feel the temperature of the water. Do not soak your feet as it will dry out your skin.

After washing and drying your feet, put talcum powder or cornstarch between your toes. The skin between the toes tends to retain moisture. The powder will keep your skin dry, which will help prevent infection.

Gently file corns and calluses

Thick layers of skin known as corns or calluses can appear on the feet. If you have them, talk to your podiatrist about the best way to take care of these foot problems. If you have nerve damage, these layers can turn into ulcers.

If your doctor tells you to, use a pumice stone to file corns and calluses after a bath or shower. Pumice stone is a type of rock that is used to file the skin. Rub it gently, in one direction only, to avoid breaking the skin.

It is important that you DO NOT:

• cut corns and calluses
• use callus patches, which are medicated pads
• use callus remover liquid

Over-the-counter products or products to cut or remove corns can damage the skin and cause infections.

To keep skin smooth, apply a thin layer of lotion, cream, or petroleum jelly on top and bottom of your feet. Do not rub lotion or cream between your toes because the moisture could cause an infection.

Cut your toenails in a straight line

Trim your toenails, as needed, after washing and drying your feet. Trim your toenails in a straight line with a toe clipper. Don’t cut the corners of your toenails. Gently file each nail with a cardboard file or a nail file that is not too sharp. Cutting your nails this way helps prevent skin cuts and ingrown toenails.

Ask your podiatrist to trim your toenails if:

• you cannot see, feel, or reach your feet
• have thick or yellowish toenails
• nails are curved or are ingrown

If you want to get a pedicure in a salon, you should bring your own nail tools to avoid getting an infection. You can ask your healthcare team about other steps you can take in the salon to prevent infection.

Always wear shoes and socks

Always wear shoes and socks. Do not walk barefoot or in socks only, even in confined spaces. You could step on something and hurt your feet. You may not feel pain and may not realize that you hurt yourself.

Before putting on your shoes, check the inside to make sure the lining is smooth and free of pebbles or other objects.

Be sure to wear socks, stockings, or nylons with your shoes so you don’t get blisters or sores. Wear clean, lightly padded, well-fitting socks. Seamless socks are the best option.

Wear shoes that fit well and protect your feet. Here are some suggestions for finding the right footwear:

• Walking or sports shoes are a good option for everyday use. They offer good support for the feet and allow them to “breathe.”
• Do not wear vinyl or plastic shoes, because they do not stretch or allow your feet to “breathe”.
• When shopping for footwear, make sure you are comfortable in your shoes and have enough room for your toes. Buy shoes at the end of the day, when your feet are most swollen, so you can find the one that fits you best.
• If you have bunions, or hammer toes, that cause your toes to curl under your feet, you may need wider or deeper shoes. ¹ Do not wear shoes with a pointed or narrow toe or high heels, as these put a lot of pressure on the toes.
• If you have foot deformities, such as Charcot’s foot, you may need special shoes or inserts, known as orthopedics. You may also need insoles if you have bunions, hammer toes, or other foot problems.

To soften or shape new shoes, wear them for only a few hours at first, then check your feet for painful areas.

Medicare Part B insurance and other health insurance programs can help you pay for these special shoes or inserts. Ask your insurance plan if it covers special shoes or inserts.

Protect your feet from heat and cold

If you have nerve damage from diabetes, you could burn your feet without knowing it. Take the following steps to protect your feet from heat:

• Wear shoes on the beach or hot pavement.
• Wear sunscreen on the tops of your feet to avoid sunburn.
• Keep feet away from heaters and campfires.
• Don’t put hot water bottles or heating pads on your feet.

Wear socks to sleep if your feet get cold. In the winter, wear waterproof boots with an inner lining to keep your feet warm and dry.

Help maintain blood flow to the feet

Follow the suggestions below to improve blood flow to your feet:

• Put your feet up when sitting.
• Wiggle your toes for a few minutes during the day. Kick Your Heels – Raise, lower, bend toward you, and move away to help blood flow to your feet and legs.
• Do not wear tight socks or elastic stockings. Do not try to hold loose socks with rubber bands.
• Get more physical activity . Choose activities that don’t put a lot of stress on your feet, such as walking, dancing, yoga or stretching, swimming, or cycling.
• Stop smoking.

Smoking can reduce the amount of blood flow to your feet. If you smoke, get help to quit. You can get help by calling the National Smoking Cessation Line at 1-855-335-3569 or 1-855-QUIT IT-NOW. For tips on how to quit smoking, visit smokefree Spanish .

Have your feet checked at every doctor visit

Ask your healthcare team to check your feet at every visit. Take off your shoes and socks when you are in the examination room so they will remember to check your feet. At least once a year, have a complete foot exam, including checking your feet for sensation and pulse.

Get your feet checked at every doctor visit if:

• see changes in the shape of the foot
• have loss of feeling in your feet
• have peripheral artery disease
• have had foot ulcers or an amputation in the past ¹

Ask your healthcare team to show you how to take care of your feet.

When should you see the doctor about foot problems?

Call your doctor right away if you have:

• a cut, blister, or bruise on your foot that doesn’t start to heal after a few days
• redness, warmth, or pain on the skin of the feet, signs of a possible infection
• a callus with dried blood inside, which can often be the first sign of a lesion under the callus
• a foot infection that turns black and smells bad, signs that you might have gangrene

Ask your doctor for a referral to a podiatrist or podiatrist, if necessary.

Bibliography

[1] American Diabetes Association. Microvascular complications and foot care. Diabetes Care. 2016;39(Suppl. 1):S78.

Clinical trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other National Institutes of Health (NIH) organizations conduct and assist research on many diseases and medical conditions.

What are clinical trials, and would they be a good fit for you?

Clinical trials are part of clinical research and at the root of all medical advances. Clinical trials look for new ways to prevent, detect, or treat disease. Researchers also use clinical trials to study other aspects of clinical care, such as how to improve the quality of life for people with chronic diseases. Find out if clinical trials are right for you .

What clinical trials are available?

For more information on the clinical trials that are available and recruiting visit: www.clinicaltrials.gov .

Diabetic eye diseases

In this section:

• What are diabetic eye diseases?
• How does diabetes affect my eyes?
• Are eye diseases associated with diabetes common?
• Who is most likely to develop diabetic eye disease?
• What are the symptoms of diabetic eye diseases?
• When should you see a doctor right away?
• How do doctors diagnose eye problems associated with diabetes?
• How do doctors treat vision problems associated with diabetes?
• What can I do to protect my eyes?
• What if I have already lost some of my vision from diabetes?

What are diabetic eye diseases?

Diabetic eye diseases are a group of eye problems that can affect people with diabetes. These diseases include diabetic retinopathy, diabetic macular edema, cataracts, and glaucoma.

Over time, diabetes can cause eye damage that can lead to low vision or even blindness. However, you can take steps to prevent or stop diabetic eye disease from progressing by taking care of your diabetes.

The best ways to control diabetes and keep your eyes healthy are:

• control blood glucose, blood pressure, and cholesterol, known as the key factors in diabetes management
• seek help to quit smoking, if you smoke
• have a dilated eye exam once a year

When damage is just beginning to develop, there are often no warning signs of diabetic eye disease or vision loss. A comprehensive dilated eye exam helps your doctor find and treat eye problems early, often before you have significant vision loss.

How does diabetes affect my eyes?

Diabetes can affect eye health when blood glucose, also known as blood sugar, is too high.

In the short term, you are unlikely to have any vision loss from high blood glucose. When people change their diabetes care plan or diabetes medicines, they sometimes have blurred vision for a few days or weeks. High glucose can change fluid levels or cause eye tissues that help to focus to swell , causing blurred vision. This type of blurring is temporary and disappears as the glucose level returns to normal.

If the level of glucose in the blood remains high for a long time, it can damage the small blood vessels at the back of the eyes. This damage can start during prediabetes, when your glucose level is higher than normal, but not high enough for you to be diagnosed with diabetes. Fluid can leak from damaged blood vessels causing swelling. New, weak blood vessels can also start to form. These blood vessels can bleed in the middle of the eye, form scar tissue, or cause pressure to rise to a dangerous level in the inner part of the eye.

Most of the eye diseases associated with diabetes begin with blood vessel problems. The four eye diseases that can pose a threat to sight are:

Diabetic retinopathy

The retina is the inner membrane at the back of each eye. The retina is sensitive to light and converts it into signals that the brain decodes so that we can see the world around us. Damaged blood vessels can cause damage to the retina, causing a disease known as diabetic retinopathy.

During the early stage of diabetic retinopathy, blood vessels can become weak, bulge, or leak fluid into the retina. This stage is known as nonproliferative diabetic retinopathy.

As the disease progresses, some blood vessels close, causing new blood vessels to form, or proliferate, on the surface of the retina. This stage is known as proliferative diabetic retinopathy. These abnormal blood vessels can cause serious vision problems.

Diabetic macular edema

The part of the retina that is needed for reading, driving, and seeing faces is known as the macula. Diabetes causes swelling of the macula, which is known as diabetic macular edema. Over time, this disease can destroy clear vision in this part of the eye, causing partial vision loss or blindness. Macular edema usually develops in people who already have other signs of diabetic retinopathy.

Glaucoma

Glaucoma is a group of eye diseases that can damage the optic nerve (the bundle of nerves that connects the eye to the brain). Diabetes doubles the chances of getting glaucoma, which can cause vision loss and blindness if not treated early. Symptoms depend on the type of glaucoma you have. Learn more about glaucoma .

The falls

The lenses that we have inside our eyes, called crystalline lenses, are transparent structures that allow us to have clear vision. However, these tend to cloud over as we age. People with diabetes are more likely to have cloudy lenses. Cloudy lenses are known as cataracts. People with diabetes can develop cataracts at a younger age than people without it. Researchers think that high glucose levels cause deposits to build up on the lens.

Are eye diseases associated with diabetes common?

Diabetic retinopathy

About one in three people with diabetes over the age of 40 already have some symptoms of diabetic retinopathy. ¹ Diabetic retinopathy is the most common cause of vision loss in people with diabetes. However, each person’s future prospects largely depend on regular care. Detecting and treating diabetic retinopathy early can reduce the risk of blindness by 95 percent.

Glaucoma and cataracts

If you have diabetes, you are twice as likely to have glaucoma or cataracts as people who do not have diabetes.

Who is most likely to develop diabetic eye disease?

Anyone with diabetes can develop diabetic eye disease. Your risk increases if you don’t treat:

• high blood glucose level
• high blood pressure

High blood cholesterol and smoking can also increase the risk of developing diabetic eye disease.

Some people are more affected than others. African Americans, American Indians and Alaska Natives, Hispanics / Latinos, Pacific Islanders, and older people are at increased risk of vision loss or blindness from diabetes.

If you have diabetes and become pregnant, you can develop eye problems quickly during pregnancy. If you already have early diabetic retinopathy, it can progress during pregnancy. Changes that occur in the body to support the growth of the developing baby can affect the blood vessels in the eyes. Your healthcare team will suggest that you have regular eye exams during pregnancy to detect and treat any problems early and protect your eyesight.

Diabetes that occurs only during pregnancy, known as gestational diabetes , usually does not cause eye problems. Researchers are still not sure why this is.

Your chances of developing diabetic eye disease increase the longer you have had diabetes.

What are the symptoms of diabetic eye diseases?

Often when these diseases are early, they have no symptoms. Especially with diabetic retinopathy, you may not feel pain or have vision changes as damage begins to increase in the inner part of the eye.

When symptoms do occur, they may include:

• blurred or wavy vision
• frequent vision changes, sometimes from day to day
• dark areas or vision loss
• poor color vision
• black spots or dark filaments (also known as floaters)
• flashes of light.

Talk to your eye doctor if you have any of these symptoms.

When should you see a doctor right away?

Call your doctor right away if you notice sudden changes in your vision, including flashes of light or more black spots (floaters) than normal. You should also see your doctor right away if you feel a curtain is drawn over your eyes. These vision changes can be symptoms of retinal detachment, which is a medical emergency.

How do doctors diagnose eye problems associated with diabetes?

Having a comprehensive dilated eye exam is the best way to detect eye problems caused by diabetes. The doctor will put drops in your eyes to enlarge the pupils. This allows the doctor to use a special loupe to examine a larger area at the back of each eye. Your vision will be blurred for a few hours after your pupils have been dilated.

Also, the doctor:

• examine your eyesight
• measure the pressure in your eyes.

Your doctor may also suggest other tests, depending on your medical history.

Most people with diabetes should see an eye care professional once a year for a complete eye exam. Your healthcare team may suggest a different plan, depending on the type of diabetes and how long it has been since you were first diagnosed with the disease.

Diabetes eye exam guidelines: ^2,3,4

• Type 1: Annual eye exams should begin within 5 years of diagnosis.
• Type 2: Annual eye exams should be started right after diagnosis.
• Pregnancy: Women with type 1 and type 2 diabetes need to have an eye exam before becoming pregnant or in the first 3 months of pregnancy. The doctor may want to repeat the test later in the pregnancy and until the baby is 1 year old.

Women with gestational diabetes do not normally need an eye exam because they do not develop any diabetic eye disease during pregnancy. If you have questions, ask your doctor.

How do doctors treat vision problems associated with diabetes?

Your doctor may recommend that you have eye exams more than once a year, in addition to monitoring your diabetes. This means managing key diabetes management factors, including hemoglobin A1c, blood pressure, and cholesterol, and quitting smoking. Ask your healthcare team what you can do to reach your target levels.

Doctors can treat late-stage eye problems with medicine, laser treatments, surgery, or a combination of these options.

Medicines

Your doctor may treat your eyes with anti-vascular endothelial growth factor (VEGF) medications, such as aflibercept, bevacizumab, or ranibizumab. These medicines block the growth of abnormal blood vessels in the eye. Anti-VEGF medicines can stop fluid leakage, which can help treat diabetic macular edema .

The doctor will inject the anti-VEGF medicine into your eyes during the office visit. You will receive several treatments during the first few months and then less frequently until the first series of therapy is finished. The doctor will use medicine that numbs your eyes so you don’t feel pain. The needle is the thickness of a human hair.

Anti-VEGF treatments can stop further vision loss and, in some people, can improve vision.

Laser treatment

Laser treatment, also known as photocoagulation, involves making small burns in the eye with a beam of light. This method treats blood vessels that are leaking fluids and edema, or fluid build-up. Your doctor usually administers this treatment over several office visits and uses medicine to numb your eyes. Laser treatment can prevent the disease from progressing, which is important to prevent vision loss or blindness. However, you are less likely to regain vision that you have already lost with laser treatment compared to anti-VEGF medicines.

There are two types of laser treatment :

• focal or grid treatment, which works on a small area of ​​the retina and treats diabetic macular edema.
• scattered laser treatment, also known as panretinal photocoagulation (PRP), which covers a larger area of ​​the retina. This method treats the growth of abnormal blood vessels, known as proliferative diabetic retinopathy.

Vitrectomía

Vitrectomy is a surgery that removes the clear, jelly-like matter that fills the space inside the eye, known as the vitreous humor. The procedure treats severe bleeding problems or scar tissue caused by proliferative diabetic retinopathy. Scar tissue can cause the retina to peel off the back tissue, such as wallpaper peeling off the wall. A loosening or detaching retina can cause blindness.

During vitrectomy, a saline solution is slowly injected into the eye to maintain eye pressure during surgery and replace the removed vitreous humor. Vitrectomy is done in a surgical center or hospital, with pain relievers.

Cataract lens surgery

In a surgical center or hospital, the doctor can remove the cloudy lens from the eye, where the cataract has formed, and replace it with an artificial lens. Generally, after cataract surgery, most people have better eyesight. After your eye has healed, you may need a new prescription for your glasses. Your vision after cataract surgery may also depend on treating any damage from diabetic retinopathy or macular edema.

What can I do to protect my eyes?

To prevent or prevent diabetic eye disease from progressing, monitor key diabetes management factors: A1c, blood pressure, and cholesterol; and quit smoking, if you do. Read more about how to manage diabetes .

Also, get a dilated exam once a year, or more often if your eye care professional recommends it. These measures are great ways to protect eye health and can prevent blindness.

The sooner you start managing diabetes and other diseases, the better. And even if your health has been difficult to manage in the past, better care now can protect your eyes in the future. It is never too late to start.

What if I have already lost some of my vision from diabetes?

Ask your eye care professional to help you find a low vision and rehab clinic. Specialized eye care professionals can help you manage vision loss that cannot be corrected with glasses, contact lenses, medicine, or surgery. Special appliances and training can help you make the most of what’s left of your sight so you can be active, enjoy your hobbies, visit friends and family, and live without the help of others.

Bibliography

[1] Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014.

[2] Diabetic retinopathy preferred practice pattern guidelines. American Academy of Ophthalmology website. https://www.aao.org/preferred-practice-pattern/diabetic-retinopathy-ppp . Updated December 2017. Information obtained on February 22, 2018.

[3] Fraser CE, D’Amico DJ. Diabetic retinopathy: prevention and treatment. Updated website https://www.uptodate.com/contents/diabetic-retinopathy-prevention-and-treatment . September 28, 2016. Information obtained on June 2, 2017.

[4] American Diabetes Association. Standards of medical care in diabetes—2016 abridged for primary care providers. Clinical Diabetes. 2016 Jan;34(1):3–21.

Keep your mouth healthy

In this section:

• How can diabetes affect the mouth?
• What if I have a badge?
• What are the most common mouth problems caused by diabetes?
• How do I know if I have mouth problems caused by diabetes?
• How can I prepare for a visit to the dentist?
• What if my mouth is sore after dental work?
• How does smoking affect the mouth?
• How can I keep my mouth healthy?

How can diabetes affect the mouth?

Too much glucose, also called sugar, in your blood from diabetes can cause pain, infection, and other problems in your mouth. The mouth includes

• teeth
• the gums
• the jaw
• tissues such as the tongue, the roof of the mouth, the bottom of the mouth, and the inside of the cheeks

Glucose is present in saliva, which is the liquid that keeps your mouth moist. When diabetes is not controlled, high glucose levels in saliva help harmful germs called plaque to grow. Plaque also results from eating foods that contain sugars or starches. Some types of plaque cause tooth decay or damage. Other types of plaque cause gum disease.

If you have diabetes, gum disease can happen more often, be more serious, and take longer to heal. In turn, gum disease can make it difficult to control blood glucose. Some studies show that treating gum disease makes it easier to control blood glucose.

What if I have a badge?

If the plaque is not removed, over time it hardens and accumulates on the edge of the gum. The hardened plaque makes it difficult to brush and clean between teeth. The gums become red, swollen, and bleed easily. These are signs of the first stage of gum disease, called gingivitis.

When gingivitis is not treated, it can turn into periodontitis. In periodontitis, the gums separate from the teeth and form spaces or pockets that become infected. The body fights off germs as the plaque spreads and grows below the edge of the gum. But the germs and your body’s response to this infection begin to destroy the bone and tissue that hold your teeth in place. If periodontitis is not treated, the gums, bones, and tissue that support the teeth are destroyed. Teeth can loosen and may need to be extracted. If you have periodontitis, your dentist may refer you to a periodontist, who is an expert in treating gum disease.

What are the most common mouth problems caused by diabetes?

This table shows the most common mouth problems caused by diabetes.

Other signs of mouth problems include

• pain in the mouth, face, or jaw that does not go away
• loose teeth
• pain when chewing
• change in taste
• dark spots or holes in the teeth
• a sore (ulcer) that does not heal

How do I know if I have mouth problems caused by diabetes?

Check your mouth for signs of problems caused by diabetes. If you notice any problems, see your dentist immediately. Some of the first signs of disease are swollen, tender, or bleeding gums. Sometimes there are no signs of gum disease. You may not know you have it until you have serious damage. Your best defense is to see the dentist twice a year for a cleaning and checkup.

How can I prepare for a visit to the dentist?

Plan ahead. Before your visit, talk with your doctor and dentist about the best way to control your blood glucose level during dental work.

You may be taking diabetes medications that make your blood glucose level too low, which is called hypoglycemia. If you use insulin or other diabetes medications, take them and eat the way you normally do before going to the dentist. You may need to bring your diabetes medicine and something to eat when you go to the dentist’s office.

If your glucose level is not under control, you may need to postpone any non-emergency dental work.

If you feel nervous about your visit to the dentist, tell the dentist and staff how you feel. Your dentist can tailor the treatment according to your needs. Don’t let your nerves keep you from getting regular checkups. Waiting too long to take care of your mouth can make things worse.

What if my mouth is sore after dental work?

If your mouth is sore after dental work, you may not be able to eat or chew for several hours or days. Ask your doctor how you can change your daily routine while your mouth is healing:

• what foods or drinks you can consume
• whether you need to change the times you take your diabetes medicines
• whether you need to change the dose of your diabetes medicines
• how often to check your blood glucose level

How does smoking affect the mouth?

Smoking makes mouth problems worse. It also increases the chance of getting gum disease, cancer of the mouth or throat, and yeast infections in the mouth. Smoking also stains teeth and causes bad breath.

Smoking and diabetes are a dangerous mix. Smoking increases your risk of developing many of the problems caused by diabetes. If you stop smoking,

• decrease your risk of heart attack, stroke, nerve disease, kidney disease, and amputation
• could improve your cholesterol level and blood pressure
• improve blood circulation

If you smoke, ask your doctor to help you quit or call 1–800–784–8669 (1–800-QUITNOW).

How can I keep my mouth healthy?

You can keep your mouth healthy by following these steps:

• Keep your blood glucose level as close to your ideal value as possible. Your doctor will help you set this ideal glucose value and teach you what to do if your blood glucose is too high or too low.
• Eat healthy and follow the meal plan that you and your doctor or dietitian have developed.
• Brush your teeth at least twice a day with fluoride toothpaste. Fluoride protects teeth from cavities.
  • Try to brush as soon as you wake up in the morning, before bed at night, and after every meal and snack.
  • Use a soft brush.
  • Gently brush the edge of the gum.
  • Use short, circular motions.
  • Brush the front, back, and top of each tooth. Brush your tongue too.
  • Change your toothbrush every three months or sooner if the toothbrush looks worn or the bristles are widely spaced. A new toothbrush removes more plaque.

• Drink water that has added fluoride or ask your dentist which fluoride mouthwash they recommend to prevent cavities.
• Ask your dentist about anti-plaque or anti-gingivitis rinses to control plaque or prevent gum disease.
• Use dental floss to clean between teeth at least once a day. Flossing helps prevent plaque build-up on your teeth. When the silk is passed:
  • slide it up and down and then curl around the base of each tooth
  • use clean sections of floss as you move from tooth to tooth

• Another way to remove plaque between your teeth is to use a toothpick or an interdental brush. These are thin utensils designed to clean between the teeth, which can be purchased at drug stores or supermarkets.
• If you wear dentures, keep them clean. Have them adjusted if they become loose or feel uncomfortable.
• Call your dentist right away if you have any signs of a mouth problem.
• Visit your dentist twice a year for your cleaning and checkup. Your dentist may suggest more visits if he thinks you need them.

• Follow your dentist’s recommendations.
  • If the dentist tells you you have a problem, take care of it right away.
  • Follow the steps or treatments your dentist suggests to keep your mouth healthy.
• Tell your dentist that you have diabetes.
  • Tell your dentist if there have been any changes in your health or in the medications you take.
  • Share with him the results of some of your blood tests for diabetes, such as the A1C test or the fasting glucose test.
  • If your diabetes is not well controlled, ask if you need antibiotics before and after dental work.
• If you smoke, get help to quit.

Diabetes, sexual and bladder problems

In this page:

• Can bladder and sexual problems be symptoms of diabetes?
• When should the patient see a doctor about their sexual or bladder problems?
• What makes the patient more prone to developing sexual or bladder problems?
• What sexual problems can men with diabetes have?
• What sexual problems can women with diabetes have?
• What bladder problems can men and women with diabetes have?
• How can the patient prevent and treat sexual or bladder problems?

Sexual problems and bladder problems are common as people age, but diabetes  can make them worse. The patient or their partner may have trouble having or enjoying sex, or may have urine leakage or difficulty emptying the bladder normally.

The effects of high blood glucose, also known as blood sugar, can damage blood vessels and nerves. This damage can cause bladder and sexual problems. Keeping blood glucose concentrations within the target range is an important way to prevent blood vessel and nerve damage.

The patient should work with their healthcare team to help prevent or treat bladder and sexual problems . These problems could be a sign that the patient needs to control his diabetes in a different way. The patient should be aware that a healthy sex life and a healthy bladder can improve their quality of life, so take action now if you are concerned about these issues.

Can bladder and sexual problems be symptoms of diabetes?

Yes. Changes in sexual function or bladder habits can be a sign that the patient has diabetes. Nerve damage caused by diabetes, also known as diabetic neuropathy , can damage parts of the body, such as the genital organs or urinary tract. For example, men with diabetes can develop erectile dysfunction  10 to 15 years earlier than men without diabetes. ¹

The patient should see a healthcare professional if they have symptoms of diabetes , including bladder and sexual problems.

When should the patient see a doctor about their sexual or bladder problems?

The patient should consult with a healthcare professional if he or she has problems with sexual intercourse or with the bladder. These problems could be a sign that the patient needs to control his diabetes in a different way. It may be embarrassing and difficult for you to talk about these things; however, keep in mind that health care professionals are trained to talk to people about all kinds of health problems. All people deserve to have healthy relationships and enjoy the activities they enjoy.

What makes the patient more prone to developing sexual or bladder problems?

The patient is more likely to develop sexual or bladder problems if they have diabetes and:

• a high blood glucose level that is not well controlled, also known as high blood sugar
• have nerve damage, also known as neuropathy
• have high blood pressure that is not being treated
• have high cholesterol that is not being treated
• are overweight or obese
• are not physically active
• are taking certain medications
• drink too many alcoholic beverages
• smokes

Research also suggests that certain genes can make people more likely to develop diabetic neuropathy. ^two

What sexual problems can men with diabetes have?

Changes in blood vessels, nerves, hormones, and emotional health during diabetes can make it difficult for men to have satisfying sex. Also, diabetes and its related challenges could make it harder for them to have a child.

Erectile dysfunction

The patient has erectile dysfunction if he cannot achieve or maintain an erection firm enough to have satisfactory intercourse. More than half of men with diabetes will develop erectile dysfunction. Men with diabetes are more than 3 times more likely to develop erectile dysfunction than men without diabetes. ¹ Good diabetes control  can help prevent and treat erectile dysfunction caused by nerve damage and circulation problems. A doctor can help treat erectile dysfunction with medicine or a change in your diabetes care plan.

Retrograde ejaculation

In rare cases, diabetes can cause retrograde ejaculation , which occurs when some or all of the semen enters the bladder during ejaculation instead of exiting the penis. During retrograde ejaculation, semen enters the bladder, mixes with urine, and comes out during urination without problem. A urine sample after ejaculation can indicate whether the patient has retrograde ejaculation. Some men with retrograde ejaculation may not ejaculate at all.

Curvature of the penis

Men with diabetes are more likely to have Peyronie’s disease  , also known as curvature of the penis, than men who do not have diabetes. ³ Men with Peyronie’s disease have scar tissue, or plaque, on the penis, which makes it curved when erect. The curvature in the penis can make intercourse painful or difficult. Some men with Peyronie’s disease may have erectile dysfunction.

Low testosterone level

Concentrations of testosterone in men naturally decrease with age. However, in some men these lower-than-normal testosterone concentrations may be the cause of erectile dysfunction, or it may explain why some men often feel tired, depressed , or have low sex drive. Men with diabetes, especially those who are older and overweight, are more likely to have low testosterone or “low T.”

If the doctor thinks the patient may have a low testosterone level, he or she will likely order a blood sample, and a health care professional will do a physical exam. Your doctor may suggest that you treat your low testosterone with a prescription gel, injection, or patch.

Several studies show that, along with good diabetes control, testosterone therapy can decrease sexual problems for men. ⁴ However, testosterone therapy can have serious risks and may not be safe for all men. The patient should consult with his doctor about the side effects of testosterone therapy and if it is suitable for him.

Fertility problems

Some studies show that men with diabetes can have problems with their sperm that make it harder to conceive. The sperm may move slowly or not at all, or it may not be able to fertilize the egg well. ⁵ Working closely with your partner and with a health care professional who specializes in fertility issues may help.

If the couple wants to conceive a child, the doctor can treat retrograde ejaculation caused by diabetes with medicine or by changing the diabetes care plan. The couple can also speak with an expert fertility urologist who could collect the sperm from the patient’s urine and then use it to do artificial insemination .

What sexual problems can women with diabetes have?

Lack of sexual desire and response, vaginal dryness, and painful intercourse can be caused by nerve damage, decreased blood flow to the genitals, and hormonal changes. Other conditions can cause these problems too, including menopause . If the patient notices a change in her sexual life, she should consult with her healthcare team. A physical exam, which will include a pelvic exam, and blood and urine tests may help the doctor determine the cause of the problems.

Lack of sexual desire and response

Lack of sexual desire and response can include:

• not being able to get aroused or stay aroused
• not having enough vaginal lubrication
• have little or no sensation in the genitals
• not being able to or rarely have an orgasm

With diabetes, your body and mind will likely go through many changes. For example, high and low blood glucose levels can affect how aroused the patient is, whether she becomes aroused, or it can make her feel more tired than usual or depressed and anxious , making her less interested. in sex.

Your health care team can help you make changes to your diabetes care plan so that you are in control. Women who keep blood glucose levels in their target range are less likely to suffer nerve damage, which can cause a lack of sexual desire and response.

Painful intercourse

Some women with diabetes report uncomfortable or painful sex. Diabetes can damage the nerves that tell the vagina to lubricate during stimulation. A prescription or over-the-counter vaginal lubricant may help if the patient has vaginal dryness. Controlling your blood glucose well over a period of many weeks, months, and years can help prevent nerve damage.

Vaginal yeast infection and bladder infections

Women with diabetes are more likely to develop vaginal yeast infections, because the yeast yeast organisms can grow more easily when blood glucose levels are higher. Vaginal yeast infection can be uncomfortable or painful and prevent you from enjoying activities, including sex.

Although some vaginal yeast infections can be treated at home, the patient should first consult with a health care professional about her symptoms. Some symptoms of vaginal yeast infection are similar to other types of infections, even sexually transmitted diseases.

Concerns about pregnancy and fertility problems

If the patient has diabetes and plans to become pregnant , it is important to keep her blood glucose levels near her target range before becoming pregnant. A high level of glucose in the blood can harm the baby during the first weeks of pregnancy, even before the patient knows she is pregnant.

If the patient has diabetes and is already pregnant, she should see her doctor as soon as possible to make a plan to control her diabetes. Working with your health care team and following your diabetes management plan can help you have a healthy pregnancy and a healthy baby.

Conditions like obesity and polycystic ovary syndrome that are linked to diabetes can make it harder to conceive a child. The patient should consult with a health care professional, such as a gynecologist or fertility specialist, if she is having trouble conceiving.

What bladder problems can men and women with diabetes have?

Diabetes can cause nerve damage in the urinary tract , and therefore bladder problems. Being overweight and obese can also increase bladder problems, such as urinary incontinence . Controlling diabetes is an important part of preventing problems that can cause excess urination.

The healthcare team can help the patient control blood glucose levels and lose weight  , if necessary. Doctors use blood and urine tests to diagnose bladder problems or conditions with similar symptoms. Doctors can also use urodynamic tests  to determine what type of bladder problem the patient has.

Frequent and urgent urination

Some people with diabetes who regularly have high blood glucose levels may have to urinate a lot, known as urinary frequency. Even men and women with diabetes who keep their blood glucose levels within their target range sometimes feel a sudden urge to urinate, known as urge incontinence. This can happen at night as well. Medicines  can help reduce symptoms of bladder control problems.

Urination problems

The patient may find that diabetes causes him to no longer feel when the bladder is full. Many people with diabetes report having urination problems. Over time, having an overly full bladder can cause damage to the bladder muscles that expel urine. When these muscles don’t work properly, urine can stay in the bladder for too long, known as urinary retention  . Urinary retention can cause bladder infections, urine leakage, and the feeling that you always have to urinate.

Urine leak

People with diabetes are more likely to develop other types of urinary incontinence, such as stress incontinence. Nerve damage , obesity, and bladder infections, which are linked to diabetes, are often linked to bladder control problems. Leakage of urine can cause the patient to avoid previously enjoyed activities, including sexual intercourse.

If the patient is overweight, losing weight may help reduce urine leakage. Avoiding weight gain can prevent urinary incontinence. Studies suggest that as the body mass index increases, the likelihood of urine leakage increases. ⁶ If the patient is overweight or obese, you should consult with the doctor about how to lose weight  .

The patient should work with their healthcare team to help control and prevent urine leakage. Bladder control problems are often treatable and very common, even among people who do not have diabetes. The patient should not be content with having to run to the bathroom at all hours to avoid urine leakage.

Bladder infections

People with diabetes are more likely to develop urinary tract infections, also known as bladder infections  or cystitis . The patient should see a doctor immediately if he has frequent and urgent urination that can be painful. Bladder infections can turn into kidney infections  and can worsen bladder symptoms, such as leaks and urine retention. Also, bladder infections can interfere with daily life, even intimacy. Controlling blood glucose levels can help prevent bladder infections.

How can the patient prevent and treat sexual or bladder problems?

The diabetes control  can help prevent nerve damage and other problems diabetes can cause sexual and bladder problems. Together with their healthcare team, the patient can help prevent and treat sexual or bladder control problems:

• keeping your blood glucose, blood pressure, and cholesterol concentrations close to ideal numbers
• staying physically active
• maintaining a healthy weight
• quitting smoking , if you smoke
• seeking help for any emotional or psychological problems

Having sex is a physical activity, so the patient should check his blood glucose level before and after having sex, especially if he takes insulin. Both high blood glucose levels and low blood glucose levels  (hypoglycemia) can cause problems during sex.

Counseling can also be helpful when the patient notices changes in sexual function or desire. These types of changes are very common as people age or adjust to health problems.

If the patient has a partner, he or she can also be an important member of your healthcare team. It can be helpful to share your concerns and have that person accompany you to the doctor’s office or to counseling. Family and friends may also be able to support you if you have bladder problems.

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Source Agency: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)