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Diabetic Retinopathy: Care Instructions

Your Care Instructions

Diabetes can damage the small blood vessels in part of your eye. This part of the eye is called the retina. It detects light that enters the eye. Then it sends signals to your brain about what the eye sees.

When this type of eye damage happens, it's called diabetic retinopathy. It can lead to poor vision and even blindness. But if you keep your blood sugar and blood pressure levels in your target range, you can help avoid or slow the damage.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

Have regular eye exams. Tell your doctor about any changes in your vision.
Keep blood sugar in a target range.Eat a variety of healthy foods, and spread carbohydrate throughout the day. You may want to have a dietitian help you plan meals.

Diabetic Retinopathy

If your doctor recommends it, get more exercise. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for at least 30 minutes on most days of the week.
Be safe with medicines. Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
Check your blood sugar as often as your doctor recommends.
Eat a low-salt diet. This may help keep your blood pressure at a normal level. You may also need to take medicines to reach your goals.
Do not smoke. Smoking can make this condition worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.


Coronary Artery

When should you call for help?

Call your doctor now or seek immediate medical care if:
You have new changes in vision in either eye.

Watch closely for changes in your health, and be sure to contact your doctor if:
Your vision is getting worse.

Learning About Diabetes and Heart Disease

When should you call for help?
Call your doctor now or seek immediate medical care if:
You have new changes in vision in either eye.
Watch closely for changes in your health, and be sure to contact your doctor if:
Your vision is getting worse.

How are diabetes and heart disease connected?
Many people think diabetes and heart disease go hand in hand. But having diabetes doesn't have to mean that you are going to have a heart attack someday. Healthy living can help prevent many of the problems that come with both diabetes and heart disease.

For some people, diabetes can cause problems in your body that may lead to heart disease. Diabetes can make the problems of heart disease worse.

But here's the good news: The good things you're doing to stay healthy with diabetes—eating healthy foods, quitting smoking, getting exercise and more—are also helping your heart.

How can diabetes lead to heart disease?

The same things that make diabetes a serious condition can also lead to heart disease or make it worse.

High cholesterol causes the buildup of a kind of fat inside the blood vessel walls, making them too narrow. This reduces the flow of blood and can cause a heart attack.
High blood pressure pushes blood through the arteries with too much force. Over time, this damages the walls of the arteries.
High blood sugar can damage the lining of blood vessels. This can lead to the hardening and narrowing of the arteries, resulting in less blood flow to the heart.
Diabetes also increases your risk for kidney damage. If you have signs of kidney damage, you may also have a higher risk for heart disease. Kidney damage shares many of the risk factors for heart disease (such as high cholesterol, high blood pressure, and high blood sugar).

How can you keep your heart healthy when you have diabetes?

Managing your diabetes and keeping your heart healthy are two sides of the same coin. Here are some things you can do.

Test your blood sugar levels and get your diabetes tests on schedule. Try to keep your numbers within your target range.
Keep track of your blood pressure. The target for most people with diabetes is below 140/90. Your doctor will give you a goal that's right for you. If your blood pressure is high, your treatment may also include medicine. Changes in your lifestyle, such as staying at a healthy weight, may also help you lower your blood pressure.
Eat heart-healthy foods. These include fruits, vegetables, whole grains, fish, and low-fat or nonfat dairy foods. Limit sodium, alcohol, and sweets.
If your doctor recommends it, get more exercise. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for at least 30 minutes on most days of the week.
Do not smoke. Smoking can make diabetes and heart disease worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
Your doctor may talk with you about taking medicines for your heart. For example, your doctor may suggest taking a statin or daily aspirin.


Diabetic Neuropathy: Care Instructions

Your Care Instructions
When you have diabetes, your blood sugar level may get too high. Over time, high blood sugar levels can damage nerves. This is called diabetic neuropathy.

Nerve damage can cause pain, burning, tingling, and numbness and may leave you feeling weak. The feet are often affected. When you have nerve damage in your feet, you cannot feel your feet and toes as well as normal and may not notice cuts or sores. Even a small injury can lead to a serious infection. It is very important that you follow your doctor's advice on foot care.

Nerve Damage In Foot

Sometimes diabetes damages nerves that help the body function. If this happens, your blood pressure, sweating, digestion, and urination might be affected. Your doctor may give you a target blood sugar level that is higher or lower than you are used to. Try to keep your blood sugar very close to this target level to prevent more damage.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. It is very important that you take your insulin or diabetes pills as your doctor tells you.
Try to keep blood sugar at your target level.Eat a variety of healthy foods, with carbohydrate spread out in your meals. A dietitian can help you plan meals.
Try to get at least 30 minutes of exercise on most days.
Check your blood sugar as many times each day as your doctor recommends.
Take and record your blood pressure at home if your doctor tells you to. Learn the importance of the two measures of blood pressure (such as 130 over 80, or 130/80). To take your blood pressure at home:Ask your doctor to check your blood pressure monitor to be sure it is accurate and the cuff fits you. Also ask your doctor to watch you to make sure that you are using it right.
Do not use medicine known to raise blood pressure (such as some nasal decongestant sprays) before taking your blood pressure.
Avoid taking your blood pressure if you have just exercised or are nervous or upset. Rest at least 15 minutes before you take a reading.
Take pain medicines exactly as directed.If the doctor gave you a prescription medicine for pain, take it as prescribed.
If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
Do not smoke. Smoking can increase your chance for a heart attack or stroke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
Limit alcohol to 2 drinks a day for men and 1 drink a day for women. Too much alcohol can cause health problems.
Eat small meals often, rather than 2 or 3 large meals a day.

To care for your feet

Prevent injury by wearing shoes at all times, even when you are indoors.
Do foot care as part of your daily routine. Wash your feet and then rub lotion on your feet, but not between your toes. Use a handheld mirror or magnifying mirror to inspect your feet for blisters, cuts, cracks, or sores.
Have your toenails trimmed and filed straight across.
Wear shoes and socks that fit well. Soft shoes that have good support and that fit well (such as tennis shoes) are best for your feet.
Check your shoes for any loose objects or rough edges before you put them on.
Ask your doctor to check your feet during each visit. Your doctor may notice a foot problem you have missed.
Get early treatment for any foot problem, even a minor one.

How can you care for yourself at home?

Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. It is very important that you take your insulin or diabetes pills as your doctor tells you.
Try to keep blood sugar at your target level.Eat a variety of healthy foods, with carbohydrate spread out in your meals. A dietitian can help you plan meals.
Try to get at least 30 minutes of exercise on most days.
Check your blood sugar as many times each day as your doctor recommends.
Take and record your blood pressure at home if your doctor tells you to. Learn the importance of the two measures of blood pressure (such as 130 over 80, or 130/80). To take your blood pressure at home:Ask your doctor to check your blood pressure monitor to be sure it is accurate and the cuff fits you. Also ask your doctor to watch you to make sure that you are using it right.
Do not use medicine known to raise blood pressure (such as some nasal decongestant sprays) before taking your blood pressure.
Avoid taking your blood pressure if you have just exercised or are nervous or upset. Rest at least 15 minutes before you take a reading.
Take pain medicines exactly as directed.If the doctor gave you a prescription medicine for pain, take it as prescribed.
If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
Do not smoke. Smoking can increase your chance for a heart attack or stroke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
Limit alcohol to 2 drinks a day for men and 1 drink a day for women. Too much alcohol can cause health problems.
Eat small meals often, rather than 2 or 3 large meals a day.

To care for your feet

Prevent injury by wearing shoes at all times, even when you are indoors.
Do foot care as part of your daily routine. Wash your feet and then rub lotion on your feet, but not between your toes. Use a handheld mirror or magnifying mirror to inspect your feet for blisters, cuts, cracks, or sores.
Have your toenails trimmed and filed straight across.
Wear shoes and socks that fit well. Soft shoes that have good support and that fit well (such as tennis shoes) are best for your feet.
Check your shoes for any loose objects or rough edges before you put them on.
Ask your doctor to check your feet during each visit. Your doctor may notice a foot problem you have missed.
Get early treatment for any foot problem, even a minor one.


Diabetic Nephropathy: Care Instructions

Your Care Instructions
Finding out that your kidneys have been damaged can be very distressing. It may have taken you by surprise, since damage to kidneys usually does not cause symptoms early on. It is normal to feel upset and afraid.

Having diabetic nephropathy means that for some time you have had high blood sugar, which damages the kidneys. Healthy kidneys keep protein in your blood, where it belongs. Damaged kidneys do not work the way they should. Your kidneys are letting protein pass into your urine. Sometimes diabetic kidney disease can lead to kidney failure.

Your doctor will tell you how you might be able to slow damage to your kidneys. In many cases, prompt and regular treatment can prevent kidney failure. You will need to take medicine and may need to make a number of changes in your normal routines. If you can keep your blood sugar and blood pressure under control and take certain medicines, you may reduce your chance of kidney failure.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

Take your medicines exactly as prescribed. It is very important that you take your insulin or other diabetes medicine as your doctor tells you. Call your doctor if you think you are having a problem with your medicine.
Try to keep blood sugar in your target range.Eat a variety of foods, with carbohydrate spread out in your meals. Your doctor may restrict your protein. A dietitian can help you plan meals.
If your doctor recommends it, get more exercise. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for at least 30 minutes on most days of the week.

Check your blood sugar as often as your doctor recommends.
Take and record your blood pressure at home if your doctor tells you to. Learn the importance of the two measures of blood pressure (such as 130 over 80, or 130/80). To take your blood pressure at home:Ask your doctor to check your blood pressure monitor. He or she can make sure that it is accurate and that the cuff fits you. Also ask your doctor to watch you to make sure that you are using it right.

Diabetes Affects the Kidneys


Do not eat, use tobacco products, or use medicine known to raise blood pressure (such as some nasal decongestant sprays) before taking your blood pressure.
Avoid taking your blood pressure if you have just exercised or are nervous or upset. Rest at least 15 minutes before taking a reading.
Eat a low-salt diet to help keep your blood pressure in your target range.
Do not smoke. Smoking raises your risk of many health problems, including diabetic nephropathy. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
Do not take ibuprofen, naproxen, or similar medicines, unless your doctor tells you to. These medicines may make kidney problems worse.
When should you call for help?
Call 911 anytime you think you may need emergency care. For example, call if:

You passed out (lost consciousness).
Call your doctor now or seek immediate medical care if:

You have not urinated at all in the last 24 hours.
You have trouble urinating or can urinate only very small amounts.
You are confused or have trouble thinking clearly.
You are very thirsty, lightheaded, or dizzy, or you feel like you may pass out (lose consciousness).
You have a weak, fast heartbeat.
You have swelling in your hands or feet.
You have blood in your urine.
You are extremely tired or weak.
You have shortness of breath.
You have chest pain.
Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.


Diabetic Renal Diet: Care Instructions

 Purple XrayYour Care Instructions

You may already be spreading carbohydrate throughout your daily meals. When you also have kidney disease, you need to avoid foods that make your kidneys worse. Keep your blood sugar and blood pressure as near normal as you can to reduce your chance of kidney failure.

Your doctor and dietitian will help you make an eating plan. It will be based on your body weight, size, and medical condition. You may need to limit salt, fluids, and protein. You also may need to limit minerals such as potassium and phosphorus. It takes planning, but there are plenty of tasty, healthy foods you can eat. Always talk with your doctor or dietitian before you make changes in your diet.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

Work with your doctor or dietitian to create a food plan that guides your daily food choices.
Eat regular meals. Do not skip meals or go for many hours without eating. To help control your blood sugar, try to eat several small meals during the day, rather than three large ones.
You can use margarine, mayonnaise, and oil to add calories to your diet for energy. The healthiest oils are olive, canola, and safflower oils.
Talk to your dietitian about eating sweets, including honey and sugar.
Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.
Do not take any other medicine without talking to your doctor first. This includes over-the-counter medicines, vitamins, and herbal products.
Limit alcohol to no more than 1 drink per day. Count it as part of your fluid allowance.

To get the right amount of protein

Ask your doctor or dietitian how much protein you can have each day. You need some protein to stay healthy.
Include all sources of protein in your daily protein count. Besides meat, poultry, and fish, protein is found in milk and milk products, breads, cereals, and most vegetables.

To limit salt

Do not add salt to your food. Avoid foods that list salt, sodium, or MSG as an ingredient. And look for "reduced salt" or "low sodium" on labels.
Do not use a salt substitute or lite salt unless your doctor says it is okay. (These products are high in potassium.)
Avoid or use very small amounts of condiments and marinades. These include soy sauce, fish sauce, and barbecue sauce. They are high in sodium.
Avoid salted pretzels, chips, and other salted snacks.
Check food labels to become more aware of the sodium content of foods. Foods that are high in sodium include soups; many canned foods; cured, smoked, or dried meats; and many packaged foods.

To control carbohydrate

Spread carbohydrate throughout the day. This helps to prevent high blood sugar after meals. Ask your dietitian how much carbohydrate you can have. Carbohydrate foods include:Whole-grain and refined breads and cereals, and some vegetables such as peas and beans.
Fruits, milk, and milk products (except cheese).
Candy, table sugar, and regular carbonated drinks.

To limit fluids

Know what your fluid allowance is. Fill a pitcher with that amount of water every day. If you drink another fluid (such as coffee) that day, pour an equal amount out of the pitcher.
Foods that are liquid at room temperature count as fluids. These include ice cream and gelatin desserts such as Jell-O.

To limit potassium
Fruits that are low in potassium include blueberries and raspberries.
Vegetables that are low in potassium include cucumber and radishes.

To limit phosphorus
Follow your doctor's or dietitian's plan for your limit on milk and milk products in your diet.
Avoid nuts, peanut butter, seeds, lentils, beans, organ meats, and sardines.
Avoid cola drinks.
Avoid bran breads or bran cereals. They are high in phosphorus.


Diabetic Ketoacidosis (DKA): Care Instructions

Your Care Instructions
Diabetic ketoacidosis (DKA) happens when the body does not have enough insulin and can't get the sugar it needs for energy. When the body can't use sugar for energy, it starts to use fat for energy. This process makes fatty acids called ketones. The ketones build up in the blood and change the chemical balance in your body.

This problem can be very dangerous and needs to be treated. Without treatment, it can lead to a coma or death.DKA occurs most often in people with type 1 diabetes. But people with type 2 diabetes also can get it. DKA can be caused by many things. It can happen if you don't take enough insulin. It can also happen if you have an infection or illness like the flu. Sometimes it happens if you are very dehydrated.DKA can only be treated with insulin and fluids. These are often given in a vein (IV).Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

To reduce your chance of ketoacidosis:
Take your insulin and other diabetes medicines on time and in the right dose.If an infection caused your DKA and your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
Test your blood sugar before meals and at bedtime or as often as your doctor advises. This is the best way to know when your blood sugar is high so you can treat it early. Watching for symptoms is not as helpful. This is because you may not have symptoms until your blood sugar is very high.

Or you may not notice them.
Teach others at work and at home how to check your blood sugar. Make sure that someone else knows how do it in case you can't.
Wear or carry medical identification at all times. This is very important in case you are too sick or injured to speak for yourself.
Talk to your doctor about when you can start to exercise again.
Eat regular meals that spread your calories and carbohydrate throughout the day. This will help keep your blood sugar steady.
When you are sick:Take your insulin and diabetes medicines. This is important even if you are vomiting and having trouble eating or drinking. Your blood sugar may go up because you are sick. If you are eating less than normal, you may need to change your dose of insulin. Talk with your doctor about a plan when you are well. Then you will know what to do when you are sick.
Drink extra fluids to prevent dehydration. These include water, broth, and sugar-free drinks. If you don't drink enough, the insulin from your shot may not get into your blood. So your blood sugar may go up.
Try to eat as you normally do, with a focus on healthy food choices.
Check your blood sugar at least every 3 to 4 hours. Check it more often if it's rising fast. If your doctor has told you to take an extra insulin dose for high blood sugar levels (for example, above 240 mg/dL) be sure to take the right amount. If you're not sure how much to take, call your doctor.
Check your temperature and pulse often. If your temperature goes up, call your doctor. You may be getting worse.
If you take insulin, check your urine or blood for ketones, especially when you have high blood sugar (for example, above 240 mg/dL). Call your doctor if your ketone level is moderate or high.
If you know your blood sugar is high, treat it before it gets worse.If you missed your usual dose of insulin or other diabetes medicine, take the missed dose or take the amount your doctor told you to take if this happens.
If you and your doctor decide on a dose of extra-fast-acting insulin, give yourself the right dose. If you take insulin and your doctor has not told you how much fast-acting insulin to take based on your blood sugar level, call your doctor.
Drink extra water or sugar-free drinks to prevent dehydration.
Wait 30 minutes after you take extra insulin or missed medicines. Then check your blood sugar again.
If symptoms of high blood sugar get worse or your blood sugar level keeps rising, call your doctor. If you start to feel sleepy or confused, call 911.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:
You start to feel like you did the last time you had DKA. Symptoms may include:Flushed, hot, dry skin.
Blurred vision.
Trouble staying awake or being woken up.
Fast, deep breathing.
Breath that smells fruity.
Belly pain, not feeling hungry, and vomiting.
Feeling confused.

Collage of People
Watch closely for changes in your health, and be sure to contact your doctor if:
You have a lot of problems with high or low blood sugar levels. Your insulin or other medicine may need to be changed.
You have trouble keeping your blood sugar in your target range.


Diabetic Foot Ulcer: Care Instructions

Your Care Instructions

Diabetes can damage the nerve endings and blood vessels in your feet. That means you are less likely to notice when your feet are injured. A small skin problem like a callus, blister, or cracked skin can turn into a larger sore, called a foot ulcer. Foot ulcers form most often on the pad (ball) of the foot or the bottom of the big toe. You can also get them on the top and bottom of each toe.

Foot ulcers can get infected. If the infection is severe, then tissue in the foot can die. This is called gangrene. In that case, one or more of the toes, part or all of the foot, and sometimes part of the leg may have to be removed (amputated).

Your doctor may have removed the dead tissue and cleaned the ulcer. Your foot wound may be wrapped in a protective bandage. It is very important to keep your weight off your injured foot. After a foot ulcer has formed, it will not heal as long as you keep putting weight on the area.

Always get early treatment for foot problems. A minor irritation can lead to a major problem if it's not taken care of soon.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Foot Image

How can you care for yourself at home?

Follow your doctor's instructions about keeping pressure off the foot ulcer. You may need to use crutches or a wheelchair. Or you may wear a cast or a walking boot.
Follow your doctor's instructions on how to clean the ulcer and change the bandage.
If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
To prevent foot ulcers
Keep your blood sugar close to normal by watching what and how much you eat. Track your blood sugar, take medicines if prescribed, and get regular exercise.
Do not smoke. Smoking affects blood flow and can make foot problems worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
Do not go barefoot. Protect your feet by wearing shoes that fit well. Choose shoes that are made of materials that are flexible and breathable, such as leather or cloth.
Inspect your feet daily for blisters, cuts, cracks, or sores. If you can't see well, use a mirror or have someone help you.
Have your doctor check your feet during each visit. If you have a foot problem, see your doctor. Do not try to treat your foot problem on your own. Home remedies or treatments that you can buy without a prescription (such as corn removers) can be harmful.

When should you call for help?

Call your doctor now or seek immediate medical care if:
You have symptoms of infection, such as:Increased pain, swelling, warmth, or redness.
Red streaks leading from the area.
Pus draining from the area.
A fever.

Watch closely for changes in your health, and be sure to contact your doctor if:
Your foot ulcer does not get better as expected.
You have a new problem with your feet, such as:A new sore or ulcer.
A break in the skin that is not healing after several days.
Bleeding corns or calluses.
An ingrown toenail.
You need help to do proper foot care.

Collage of People
Care instructions adapted under license by Alliance In Health Diabetes Control Center. This care instruction is for use with your licensed healthcare professional. If you have questions about a medical condition or this instruction, always ask your healthcare professional. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.