1. Lesson 11: Preventing, Detecting & Treating Chronic Diabetes Complications

2. LEARNING OBJECTIVES Understand the following conditions:
Diabetic Peripheral Neuropathy
Diabetic Eye Disease
Diabetic Kidney Complications
Diabetic Cardiovascular Problems
Signs & symptoms of each of conditions
How to protect yourself against complications

3. DIABETIC PERIPHERAL NEUROPATHY
Chronic high blood glucose levels damage the delicate coating of nerves.
60 to 70% of all people with diabetes will develop DPN.
Damaged nerves cannot effectively carry messages between your brain and other parts of your body.
Signs include:
Pain
Burning
Tingling
Loss of feeling in feet and hands
Abnormal sweating
Hard to tell when blood sugar is low
Feeling light-headed when standing up
Loss of balance, muscle weakness, and loss of coordination
OTHER PROBLEMS INCLUDE:
Problems swallowing & keeping food down
Painful bowel problems
Difficulty urinating
Dribbling with urination
Bladder and kidney infections
Trouble having sex
Erectile Dysfunction (for men

4. PROTECTING YOUR NERVES FROM DAMAGE
KEEP YOUR BLOOD GLUCOSE UNDER CONTROL
HAVE A PHYSICAL ACTIVITY PLAN
Increases circulation in feet
Exercise feet even when unable to walk...refer back to Lesson 3
Ask about activity that is healthy for you
FOOT EXAMS
Damage happens slowly, may not be aware you are losing feeling
4 x year need complete check feet & nerves
Once per year test for how well you sense temperature, pinprick, vibration, & position in your feet
If have signs of nerve damage…HCP might want more tests
Keep track of your foot exams!

5. DIABETIC EYE DISEASE OR DIABETIC RETINOPATHY
Can lead to loss of sight
Study shows keeping blood glucose close to normal can prevent or delay onset
Finding and treating eye problems early can help save sight
Can develop even when sight is good
SIGNS OF DIABETIC EYE DISEASE
Vision changes
Trouble reading
Blurry vision
Seeing rings around lights, dark spots, or flashing lights

6. PROTECTING YOUR SIGHT
If you have lost your sight from diabetic eye disease, still need regular eye care; get an exam you if any of these apply to you…
Have had type 1 more than 5 years
Have type 2 diabetes
Going through puberty and have diabetes
Pregnant and have diabetes
Planning on becoming pregnant and have diabetes
> 65 YOA Medicare pay for eye exams
KEEP YOUR BLOOD GLUCOSE UNDER CONTROL
KEEP YOUR BLOOD PRESSURE UNDER CONTROL
GET YEARLY DILATED EYE EXAM

7. TREATING DIABETIC EYE DISEASE
Laser surgery may help those with advanced eye disease; Vitrectomy surgery clears bleeding within the eye.
Physician who is expert in low vision may be able to give glasses or other devices to use limited vision more fully.
Ask about job training or support groups for people with poor vision.

8. KIDNEY PROBLEMS
MICROALBUMIN (protein) in the urine is an early sign of diabetic kidney disease; get this checked yearly.
HCP can also perform yearly blood test to measure kidney function.
If test shows Microalbumin in urine or if kidney function isn’t normal, will need to be checked more often.
PROTECT YOUR KIDNEYS
Keep blood glucose under control.
Keep your blood pressure in balance.

9. STEPS TO LOWER BLOOD PRESSURE
Maintain a healthy weight.
Be active every day.
Eat fewer foods high in salt/sodium.
Eat more fruits and vegetables.
Take your medicine the way doctor tells you.
Have your blood pressure checked at least 4 x per year.

10. SIGNS OF A KIDNEY INFECTION
Call your HCP right away if you have any signs of a kidney infection.
Back pain
Chills
Fever
Ketones in the urine
Your HCP will test your urine; if you have a bladder or kidney infection, you’ll be given medicine to stop the infection.
After you take all of the medicine, have your urine rechecked to make sure infection is gone.

11. HEART AND BLOOD VESSEL PROBLEMS
MAIN CAUSE OF SICKNESS & DEATH among people with diabetes
Can lead to HIGH BLOOD PRESSURE, HEART ATTACKS, STROKES AND POOR CIRCULATION (blood flow) in legs & feet
You are more likely to have if…
Smoke cigarettes
Have high blood pressure
Too much cholesterol/fats in blood
Talk to Health care team about what you can do to lower risk for heart & blood pressure problems.

12. Any of these signs, go to emergency room or call 9-1-1.
SLURRED SPEECH
CHEST PAIN OR
CHEST PRESSURE
SWOLLEN ANKLES
FEELING DIZZY
NUMBNESS OR WEAKNESS
ONE ARM / ONE LEG
SHORTNESS
OF BREATH
IRREGULAR
HEARTBEAT
SUDDEN LOSS OF SIGHT

13. Preventing & Controlling Heart & Blood Vessel Problems
EAT RIGHT & GET PHYSICAL ACTIVITY
Follow dietary recommendations; eat plenty of fruits & vegetables, maintain low-fat diet.
CHECK YOUR BLOOD PRESSURE
CHECK YOUR CHOLESTEROL
DON’T USE TOBACCO
Risk of heart and blood pressure problems is even greater if you have diabetes and use tobacco.