Type 2 Diabetes: Living With Complications
Treatment Overview
Treatment of your complications of type 2 diabetes depends on the stage of the disease.
In general, keeping your blood sugar levels in a normal or near-normal range can prevent or slow the worsening of your complication and reduce the risk of developing new ones. Keeping blood sugar under control can help protect your vision and kidney function even before you develop any symptoms of eye or kidney complications.
You should see your health professional regularly to review your treatment and to have screening examinations and tests for complications.
If you are age 21 or older, talk to your health professional about taking a low-dose ASA daily to help prevent heart attack, stroke, or other large blood vessel disease (macrovascular disease). People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases.811
Effective treatment of high blood pressure and high cholesterol can help decrease your risk for worsening of complications. Stopping smoking and limiting alcohol to one drink a day for women and two drinks a day for men also can help.
For eye disease (diabetic retinopathy)
Keep all appointments with your eye specialist, and call if you notice any changes in your vision. Early detection and treatment of any changes can help prevent vision loss.
- Early (non-proliferative) diabetic retinopathy should be closely watched but may not need treatment right away. Laser treatment or surgical removal of the vitreous gel (vitrectomy) may be needed if the macula has been damaged by swelling (macular edema).
- Late-stage (proliferative) diabetic retinopathy may require laser treatment or vitrectomy.
If you have severe vision loss, use vision aids to help you do as much of your diabetes care and remain as active as possible. Your local or provincial organization for the visually impaired can help you find appropriate vision aids.
For more information, see the topic Diabetic Retinopathy.
For heart and large blood vessel disease
Don't smoke. Smoking increases your risk for heart attack.
Control your blood pressure. Keep it at 130/80 millimetres of mercury (mm Hg) or lower. Often, more than one blood pressure medicine will be necessary in addition to lifestyle changes. Blood pressure medicines that can be useful include:
- Diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers, or calcium channel blockers. If you have risk factors for macrovascular disease, your doctor may prescribe an ACE inhibitor to protect your heart and large blood vessels even if your blood pressure is normal. If your systolic blood pressure is between 130 mm Hg and 139 mm Hg or your diastolic blood pressure is between 80 mm Hg and 89 mm Hg, you may try some lifestyle or behavioural therapy for 3 months before starting medicine.12 For more information, see the topic High Blood Pressure (Hypertension).
- Statins to reduce high cholesterol. Strive to keep your LDL cholesterol level less than 2.0 mmol/L (80 mg/dL) and your triglyceride level less than 1.5 mmol/L (130 mg/dL).13 If possible, the HDL cholesterol level should be more than 1.03 mmol/L (40 mg/dL) in men. Women may need an HDL level of more than 1.3 mmol/L (50 mg/dL).14 A low-fat diet, exercise, and weight loss can lower your cholesterol, but you may need to take lipid-lowering medicines, such as statins, to reach your goals. Statins reduce LDL levels and the risk of heart disease in people with diabetes.14 They also have been shown to reduce the risk of heart attack and stroke by one-third in people with diabetes, even those who do not have high LDL levels or existing heart disease.15 For more information, see the topic High Cholesterol.
For nerve disease (diabetic neuropathy)
Keeping your blood sugar levels within a normal or near-normal range is the only way to stop or slow the progression of neuropathy.
If you have peripheral neuropathy, you may take medicines (such as non-prescription pain relievers, creams, or prescription oral or injection medicines) to relieve pain. You also may try physiotherapy or acupuncture to relieve pain and improve your physical functioning, mood, and mental well-being.
You also can make changes in your home to reduce the risk of hurting yourself because of diminished sensation. These include lowering the water temperature in your home, using pot holders to avoid burns, and removing clutter that can cause falls. For more information on making life easier when you have neuropathy, see the Home Treatment section of this topic. Also, see the topic Diabetic Neuropathy for more on this complication.
For kidney disease (diabetic nephropathy)
Early detection and treatment of kidney disease can help prevent worsening of your kidney function. Treatment involves taking medicines that can lower blood pressure (and can protect your kidneys even if you do not have high blood pressure), keeping your blood sugar under control, and possibly limiting the amount of protein in your diet.
- You will probably take an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) to keep your blood pressure at 130/80 millimetres of mercury (mm Hg) or less. You also may take these medicines if you do not have high blood pressure but have small amounts of protein in your urine (microalbuminuria), an early sign of kidney damage.
- Your doctor may ask you to limit the amount of protein in your diet to no more than 10% of your daily calories.3
- You may need to limit salt in your diet, because it makes your body retain fluid and can increase your blood pressure.
- It may be helpful to see a nephrologist before kidney failure develops.
If you develop kidney failure, you will need dialysis or a kidney transplant.
For more information, see the topics Diabetic Nephropathy and Chronic Kidney Disease.
For foot problems
Foot care is important for people with diabetes. You need to inspect your feet every day and protect them from injury. If you have poor eyesight, have someone else check your feet. If you develop serious infections or bone and joint deformities, you may need surgery (even amputation) to treat those problems.
To protect your feet:
- Avoid exercise that could injure your feet. Walking is fine, but jogging may be too rough.
- Make sure bathwater is not too hot.
- Wash and moisturize your feet every day.
- Do not walk barefoot.
- Wear cotton socks, and wear shoes that fit you well.
- Check your shoes for any loose objects or rough edges before you put them on.
- Get early treatment for any foot problem, even a minor one. Call your doctor at the first sign of a problem with your feet. Blisters, small cuts, or other problems that may seem minor can quickly become more serious.
For more information on protecting your feet, see:
What to Think About
Make every effort to keep your blood sugar levels within a normal or near-normal range to slow the progression of your complication and reduce your risk for developing others. Eat a balanced diet with the calories you need to help you stay at a healthy weight. Or if you are overweight, eat a balanced diet and reduce your calories to help you lose some weight. Get regular physical exercise, and take your prescribed oral diabetes medicine or insulin. For more information, see the Home Treatment section of the topic Type 2 Diabetes: Living With the Disease.
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| Author: | Caroline Rea, RN, BS, MS | Last Updated: December 12, 2007 |
| Medical Review: | Caroline S. Rhoads, MD - Internal Medicine Matthew I. Kim, MD - Endocrinology & Metabolism David C.W. Lau, MD, PhD, FRCPC - Endocrinology & Metabolism | |
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