High Blood Pressure: Using the DASH Diet

 Key points

• The DASH diet focuses on foods that are high in calcium, potassium, and magnesium. These nutrients can lower blood pressure.
• Taking calcium, potassium, and magnesium supplements does not have the same effect as eating foods that are high in those nutrients.
• Don't make big changes in your diet all at once. Make small changes, and don't give up. As soon as those changes become habit, add a few more changes.
• You'll have more success if you make a plan that includes long-term and short-term goals as well as ideas for getting past barriers-things that might get in the way of changing your eating habits.
• Support from family and friends can go a long way toward helping you find success in changing your habits. Don't be afraid to let family and friends know what you're trying to do. And ask for their help.

What is DASH?

DASH is an eating plan that can help lower your blood pressure. DASH stands for Dietary Approaches to Stop Hypertension. Hypertension is high blood pressure.
The DASH eating plan focuses on foods that are high in calcium, potassium, and magnesium. These nutrients can lower blood pressure. The foods that are highest in these nutrients are fruits, vegetables, low-fat dairy products, nuts, seeds, and beans. Taking calcium, potassium, and magnesium supplements instead of eating these foods does not have the same effect.

The DASH eating plan

Food	Recommended servings	Examples
Low-fat and fat-free milk and milk products	2 to 3 servings a day	A serving is 8 ounces of milk, 1 cup of yogurt, or 1 1/2 ounces of cheese.
Fruits	4 to 5 servings a day	A serving is 1 medium-sized piece of fruit, 1/2 cup chopped or canned fruit, 1/4 cup dried fruit, or 4 ounces (1/2 cup) of fruit juice. Choose fruit more often than fruit juice.
Vegetables	4 to 5 servings a day	A serving is 1 cup of lettuce or raw leafy vegetables, 1/2 cup of chopped or cooked vegetables, or 4 ounces (1/2 cup) of vegetable juice. Choose vegetables more often than vegetable juice.
Grains	7 to 8 servings a day	A serving is 1 slice of bread, 1 ounce of dry cereal, or 1/2 cup of cooked rice, pasta, or cooked cereal. Try to choose whole-grain products as much as possible.
Meat, poultry, fish	No more than 2 servings a day	A serving is 3 ounces, about the size of a deck of cards
Legumes, nuts, seeds	4 to 5 servings a week	A serving is 1/3 cup of nuts, 2 tablespoons of seeds, or 1/2 cup cooked dried beans or peas.
Fats and oils	2 to 3 servings a day	A serving is 1 teaspoon of soft margarine or vegetable oil, 1 tablespoon of mayonnaise, or 2 tablespoons of salad dressing.
Sweets and added sugars	5 servings a week or less	A serving is 1 tablespoon of sugar or jam, 1/2 ounce of jelly beans (about 20), or 1 cup of lemonade.

The DASH eating plan is one of several lifestyle changes your doctor may recommend. Your doctor may also want you to decrease the amount of salt you eat. Lowering salt while following the DASH plan can lower blood pressure even further than just the DASH plan alone.

Why should you use DASH?

Not eating enough potassium, calcium, and magnesium may help cause high blood pressure. These nutrients come from fruits, vegetables, and dairy products.
Researchers believe that it is the combination of 8 to 10 servings a day of fruits and vegetables and 3 servings of low-fat or nonfat dairy products that causes the DASH eating plan to lower blood pressure. Simply taking calcium, potassium, and magnesium supplements does not lower blood pressure.

Good sources of potassium, calcium, and magnesium

Nutrient	Good sources
Potassium	All fresh fruits and vegetables
Calcium	Low-fat and nonfat dairy products
Magnesium	Legumes (cooked dried beans and peas), seeds, nuts, halibut, milk, yogurt, brown rice, potatoes, tomatoes, bananas, watermelon, leafy green vegetables

How can you make DASH a habit?

Setting goals

You'll have more success in changing your eating habits if you make a plan. The plan should include long-term and short-term goals as well as ideas for getting past barriers-things that might get in the way of changing your eating habits.
What is your long-term goal? A long-term goal is something you want to reach in 6 to 12 months. When you have high blood pressure, the long-term goal is to lower your blood pressure to a specific level. Talk to your doctor about what your specific long-term goal should be.
What are the short-term goals that will help you reach your long-term goal? Short-term goals keep you going day to day. They are usually goals you hope to reach tomorrow or next week.
Look at the DASH eating plan. Come up with a short-term goal that looks pretty easy. For example, you might decide that your first short-term goal will be to eat 4 servings of vegetables every day. As soon as you've made those extra vegetables a habit, you can add another short-term goal.

Eating with DASH

Here are some ideas for eating with the DASH plan:

• Drink fat-free milk. A glass of fat-free milk has only 80 calories and no fat. It's packed with nutrients that lower blood pressure. Have a "skinny" latte (made with fat-free milk) as a way to add milk to your diet. If you don't drink coffee, try a skinny steamed milk or chai drink.
• Make a baked potato bar. Serve baked potatoes with a variety of vegetables, such as broccoli. And use other toppings, such as low-fat shredded cheese, chili, salsa, and refried beans. If you use toppings from a can or jar, be sure to choose low-sodium varieties. Or even better, make them yourself from fresh ingredients. Be creative. You could end up with 4 or 5 servings of vegetables at one meal.
• Eat a variety of cut-up vegetables with a low-fat dip such as hummus. Try some new vegetables. Make a stir-fry with lots of different vegetables.
• Buy a vegetarian cookbook, and try one recipe each month or each week.
• Add garbanzo beans to a salad, use fat-free refried beans, and/or make split pea or black bean soup.
• Combine a ready-made pizza crust with low-fat mozzarella cheese and lots of vegetable toppings. Use tomatoes, zucchini, spinach, carrots, cauliflower, and onions.
• For breakfast, have whole-grain cereal, fruit, and low-fat or fat-free milk.
• Take fruit to work or school as a snack.
• Make a dip for fruit from low-fat or nonfat vanilla yogurt and cinnamon.

Get more tips in the topic Quick Tips: Adding Fruits and Vegetables to Your Diet.
Many people find that it helps to write down everything they eat every day. That way they can easily see how much of each food group they've eaten and where they need to add or cut back tomorrow.
A registered dietitian can work with you to change your eating habits and help you plan menus that follow the DASH eating style. Ask your doctor to recommend someone. See a sample DASH menu.

Where to go from here

Now that you have read these tips on following the DASH eating plan, you are ready to change your eating habits to lower your high blood pressure.
For more sample menus and recipes for the DASH eating plan, contact the National Heart, Lung, and Blood Institute. 

• Go to www.nhlbi.nih.gov and search for DASH.
• Or go to www.nhlbi.nih.gov/health/public/heart/hbp/dash.
• Or write to the NHLBI Health Information Center, P.O. Box 30105, Bethesda, MD 20824-0105, and request information on the DASH diet.

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

© 1995-2011 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

High Blood Pressure: Taking Medicines Properly

Key points

• Make your medicine schedule as simple as you can. Take your medicines when you are doing other things, like eating a meal or getting ready for bed. This will make it easier for you to remember to take them.
• Take a list of your medicines-or bring your medicines with you-when you visit your doctor. Include any medicines that were prescribed by other doctors and all your nonprescription medicines. Review the list with your doctor, and discuss any side effects you are having or need to watch for.
• Talk with your doctor if you are having problems with your medicine schedule. Your doctor may be able to change your medicines or change the times you take them.
• Talk with your doctor if you have any changes in your health that might affect your blood pressure, such as weight gain, side effects of medicines, or another medical problem.
• Consider daily or weekly pill containers. These can help you remember which medicines to take and when to take them.
• Follow healthy lifestyle habits. These include staying at a healthy weight, exercising, not smoking, and following a healthy eating plan. If you do these things, your doctor may be able to reduce the amount of medicine you take. And the medicines may work better.

What do medicines do for high blood pressure?

 

Medicines help lower blood pressure. When blood pressure is high, it starts to damage the blood vessels, heart, and kidneys. This can lead to heart attack, stroke, kidney disease, and other problems.
When you have high blood pressure, you don't usually feel sick. It can be hard to think about taking your pills when you don't feel sick. But taking them exactly as directed helps lower your risk for more serious problems.
Medicines control-but don't cure-most cases of high blood pressure. So you will need to take them for the rest of your life. Many people need to take more than one kind of pill to control their blood pressure. The types of blood pressure medicines include:

• Diuretics . These pills cause the kidneys to remove more sodium and water from the body. As a result, there is less blood circulating through the body. And that lowers blood pressure, especially systolic blood pressure. Diuretics are often combined with other blood pressure medicines.
• ACE inhibitors . These drugs block an enzyme needed to form a substance that causes blood vessels to narrow. As a result, blood vessels relax and widen. This makes it easier for blood to flow through the vessels, which reduces blood pressure. Also, these drugs increase the release of water and sodium to the urine, which also lowers blood pressure.
• ARBs . These block the action of a hormone that causes blood vessels to narrow. These drugs also increase the release of sodium and water into the urine.
• Beta-blockers . These pills lower the heart rate, the amount of blood the heart pumps out with each beat, and the force of the heartbeat, all of which lower blood pressure.
• Calcium channel blockers . These work by reducing the amount of narrowing of the blood vessels caused by high blood pressure. This makes it easier for blood to flow through the vessels and lowers blood pressure.
• Other medicines including alpha-blockers and vasodilators. These work by opening up the blood vessels. This makes it easier for blood to flow and lowers blood pressure.
• Direct renin inhibitors . These block the enzyme renin from starting a process that helps regulate blood pressure. As a result, blood vessels relax and widen.

Why is it important to take medicines properly?

 

If you don't take your medicines properly, your blood pressure may not be controlled. This can lead to:

• Heart attack.
• Stroke.
• Kidney disease.
• Eye damage (retinopathy).
• Peripheral arterial disease.

It can take some time to find the right combination of medicines with the fewest side effects. Take your medicines exactly as your doctor tells you to. And don't be surprised if your doctor decides to change your medicines. Just keep following his or her directions.
Some medicines should not be combined with other prescription or nonprescription medicines. Make sure your doctor knows all of the medicines you are taking

How can you take your blood pressure medicines properly?

 

Medicines work really well to control high blood pressure in most people. But they won't work if you don't take them as directed. Here's how you can get started on taking your medicines properly.

Get organized

It may not be too hard for most people to remember to take just one pill a day. But if you start adding more pills-pills that you need to take at different times and in different doses-it can get confusing.
A key to taking your medicines properly is to stay organized:

• Make a list. Make a written or typed list of every medicine you take, including things like aspirin and vitamins. Keep it up to date. Take a copy with you every time you go to the doctor. Use this form(What is a PDF document?), or make up your own. Include space to write down any side effects you have.
• Make a schedule. Make a written or typed daily schedule of when you should take each of your medicines. Put it where you can easily see it every day-on the door of your medicine cabinet, for example. Use this daily planner(What is a PDF document?), or make up your own. Take it along when you travel.
• Use a pillbox. Pillboxes can really help you keep track of your pills. Some hold a week's worth, with separate compartments for morning, noon, evening, and bedtime.
• Use alarms. Set your computer, wristwatch, or cell phone to beep when it's time to take your pills.
• Simplify. Ask your doctor if you can make your pill schedule simpler. For example, maybe you could take one longer-acting pill every day instead of several shorter-acting ones.
• Control costs. Compare prices between several drugstores, and consider mail-order drugstores. Ask your doctor if there is a generic brand you can take to save money.

Become an expert

The more you know about your medicines, the easier it will be to stay on your schedule and take your pills properly.

• Know your medicines. Have your doctor clearly explain what each medicine does. Write down both the brand and generic names. Have your doctor check the list. You can use this list to verify that the medicines you get from the pharmacy are correct.
• Store medicines properly. Your doctor or pharmacist can tell you how to store your medicines. Don't let your medicines get too hot or too cold. Always store them out of the reach of children.
• Watch for side effects. Ask your doctor or pharmacist about what side effects to expect. Write them down if you don't think you'll be able to remember them. Be sure to tell your doctor if you have side effects.
• Have a plan for missed doses. Talk with your doctor about what you should do if you accidentally miss a dose of a medicine. Discuss what to do for each medicine, because it may be different for each one. Write it down.
• Talk to your doctor before you start taking other medicines. Many medicines can keep blood pressure medicines from working right. This will raise your blood pressure. Medicines that could cause a problem include:
  
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (for example, Advil or Motrin), indomethacin (Indocin), ketoprofen, naproxen (for example, Aleve or Naprosyn), and piroxicam (Feldene).
  • Decongestants, such as pseudoephedrine (for example, Sudafed).
  • Herbal or homeopathic remedies.
  Where to go from here
   
  Now that you have read the information on taking your medicines properly for high blood pressure, you are ready to create your system for taking your medicines properly.
  Talk with your doctor
  If you have questions about this information, print it out and take it with you when you visit your doctor. You may want to use a highlighter to mark areas or make notes in the margins of the pages where you have questions.
  If you don't have a medicine plan already, schedule a time with your doctor to create one.
  
  

  By	Healthwise Staff
  Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
  Specialist Medical Reviewer	Robert A. Kloner, MD, PhD - Cardiology
  Last Revised	April 4, 2011

  
  
  

Complementary and Alternative Medicine (CAM) Overview

When you're sick, you visit a doctor with an MD after his name. And you may leave the office with a prescription. Your doctor -- and the medication he prescribes -- is considered part of conventional medicine.
If you also visit a chiropractor or acupuncturist for treatment, you'd be in the field of complementary and alternative medicine. It's called "CAM" for short.

CAM tries to prevent and treat different conditions with techniques such as:

• healing touch
• energy
• herbal medicines

Many CAM therapies have been around for centuries. But do they really work?

There is research to show that some CAM techniques can help with problems like pain and nausea. But other alternative therapies don't have enough medical evidence to determine if they are effective.
Before you CAM, read this overview. Learn which treatments might actually help you feel better -- and which ones may not be worth the money.

Acupuncture

What it is: This traditional Chinese medicine technique uses thin needles to stimulate various points around the body. Each point corresponds to a specific condition. The aim of acupuncture is to restore a balance of energy and good health to the body.
The evidence: Many of acupuncture's benefits still haven't been confirmed. That's because more studies on acupuncture need to be performed. But evidence suggests that acupuncture holds promise for relieving vomiting caused by cancer chemotherapy. It also may help ease some chronic pain conditions, including:

• headaches
• low back pain
• osteoarthritis of the knee

Chiropractic Medicine

What it is: Chiropractors specialize in adjustments -- manipulating the spine to put the body into better alignment. People typically visit the chiropractor when they have pain in their lower back, shoulders, and neck. But many chiropractors claim adjustments can also improve overall health.
The evidence: Chiropractic medicine does seem to provide some relief for lower back pain. But it may not be any better than other back pain treatments.
Studies have also found the technique effective for:

• migraine and neck-related headaches
• neck pain
• joint conditions
• whiplash

But there isn't much data on the effectiveness of chiropractic medicine for some general medical conditions. For example, there's no solid evidence that it can treat asthma, high blood pressure, menstrual pain, or fibromyalgia.

Energy Therapies

Energy therapies use magnets and therapeutic touch to manipulate the body's energy fields and improve health.
Here's a round-up of some common energy therapies:

Magnetic Field Therapy

What it is: Magnets are thought by some to have healing abilities. Centuries ago, people believed magnets could treat everything from gout to baldness. Today, they're worn inside bracelets, shoes, and other accessories.
The evidence: There's no conclusive evidence that magnets are effective pain relievers.
A small study has shown that a magnet therapy called transcranial magnetic stimulation may aid recovery in certain stroke survivors. The results are preliminary. More study is needed to see if the therapy is effective.
Magnets are generally safe. But they can disrupt the function of pacemakers, defibrillators, and insulin pumps. That makes them potentially dangerous for anyone who uses these devices.

Reiki

What it is: The premise of Reiki is that it accesses the body's natural energy to speed healing. The practitioner hovers his or her hands over the patient's body. Or he or she places them lightly on the person's skin.
The evidence: There is something to be said for the healing touch when it comes to bringing about a state of calm. One study checked the effect of Reiki on people hospitalized with heart disease. It showed that Reiki was effective in bringing about an increase in:

• happiness
• relaxation
• feeling of calm

Therapeutic Touch

What it is: Advocates of this technique suggest that the power of touch may direct energy flow and treat pain and disease.
The evidence: It's hard to tell for sure whether therapeutic touch works. There have been few good studies done on this technique. Researchers have investigated its effects on wound healing, pain, and anxiety. But most studies had mixed results. They did not provide conclusive evidence of effectiveness.

Herbal Medicine

Plants form the foundation of herbal medicine. They're taken in several forms including pills, powders, or extracts to treat a variety of conditions. Herbal medicine can be divided into three types:

• Ayurvedic
• Chinese
• Traditional

Ayurvedic

What it is: Ayurvedic medicine originated in India more than 2,000 years ago. It focuses on balance of the mind, body, and spirit. Hundreds of different herbs are used to:

• protect the body against disease
• relieve pain
• improve general health

The evidence: Most studies performed have been small. They cannot provide conclusive evidence that Ayurvedic herbal medicine works.
There's also a serious caution to using Ayurvedic products. One study found that Ayurvedic herbal medicines from South Asia had dangerously high levels of:

• lead
• mercury
• arsenic

Chinese

What it is: Chinese herbal medicines include gingko and ginseng. They are not used to treat a specific symptom or disease. Instead they are meant to restore balance to the body as a whole. These medicines can be taken in many forms, including pills, powders, and teas.
The evidence: Chinese herbal remedies have been studied for treating conditions such as cancer, heart disease, and diabetes. But the research hasn't been well-designed enough to draw any conclusions on effectiveness.
Regarding safety, there have been reports of heavy metals and other toxins in certain Chinese herbal remedies.

Traditional

A number of different herbs are grown right here in the U.S. or in Europe that are considered "Western" or "traditional" herbal remedies. Most studies on these herbs have been small. So it's hard to know for sure whether they work. A few herbs that have shown possible benefit include:

• Chamomile for relieving stomach upset.
• Cranberry for preventing urinary tract infections.
• Flaxseed, garlic, and soy for lowering cholesterol.
• Peppermint oil for preventing heartburn.
• St. John's wort for relieving mild to moderate depression.

Although herbal remedies are considered "natural," they can cause side effects. They may also interact with drugs you're taking for other conditions. Talk to your doctor before taking any herbal medicine.

© 2011 WebMD, LLC. All rights reserved.

Taking care of diabetes during holidays

More than 20 million Americans are living with diabetes, and another 40 million are in the early stages of the disease. Managing diabetes can be a challenge all year long, but the holidays can pose special problems. All those extra treats, meals and drinks can add up to extra pounds and higher glucose levels. But a little planning, and will power, can keep diabetes in check, according to Susan Steinweg, a registered nurse and a certified diabetes educator. She's also the coordinator of Carroll Hospital Center's Diabetes Center.

Why are the holidays a particularly perilous time for those with diabetes?

Typically, the holidays are a time for traditions, family and food, and nurturing through food is a common theme. Individuals with diabetes often feel obligated to partake of these tempting delicacies, and once they do, like all of us, they often overindulge. This overindulgence can lead to weight gain and blood glucose level elevations.

What is a good strategy for handling the season?

Do not go to any holiday gatherings "starving." Have a healthy snack before attending. Bring a platter of fresh-cut vegetables with low-fat dip to share and to nibble on. Choose only the food items that are "worth it" and sample them. Do not feel obligated to try everything or to eat everything once you have put it on your plate.

When not at parties or gatherings, continue to be careful with your food choices and increase your activity level. Walking is a great way of burning calories that otherwise would be stored as fat, resulting in weight gain.

What happens if you do overindulge at a party? Do drinks count?

Strive not to overindulge at a party. You will feel sluggish and tired as a result, and you will lack energy to participate in holiday activities. Most folks regret overeating mentally and physically. However, if you should overindulge, exercise more and cut back on portion sizes throughout your day.

Alcoholic beverages do count. Your body recognizes alcohol as a toxin and immediately tells the liver to "detoxify" the alcohol. The calories are immediately stored as fat. People living with diabetes must be especially careful when consuming alcohol, as their blood glucose could drop suddenly, causing safety issues, including loss of consciousness, falls and accidents.

People with diabetes should always include a light snack when consuming alcohol to prevent sudden drops in their blood glucose. Many alcoholic beverages contain sugary mixes and fruit juices, which also will affect a person's blood glucose in a negative way. So stick to one light beer or a glass of wine, and avoid mixed drinks unless they are mixed with diet tonic. One mixed drink (with diet tonic) should be the "limit."

What about pre-diabetes?

Like all of us, people with "pre-diabetes" need to also pay particular attention to their intake over the holidays. Pre-diabetes is the state that occurs when a person's blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. In other words, it is the very early stages of diabetes. Most people with "pre-diabetes" have an opportunity to slow their progression to diabetes by eating well, exercising and losing 5 percent of their body weight. Though it may not be realistic to lose weight during the holidays, certainly focusing on making healthy choices, cutting portion sizes and getting plenty of exercise can be steps in the right direction.

What are the long-term repercussions for those who don't manage their disease well?

Diabetes is a sneaky disease. Early on in their diagnosis, most folks do not notice any symptoms of diabetes. They spend some time in denial doubting that they even have it. It is hard to believe that you have diabetes if you don't feel any different, and that makes it easy to ignore.

However, diabetes that is not well controlled can lead to serious complications. These very debilitating complications can include heart and circulatory issues, kidney disease, eye disease, neuropathy ("pins and needle" sensations, pain, burning in the hands and feet) and erectile dysfunction.

Early diagnosis, education and support from certified diabetes educators are essential. We help people understand their diabetes — how to monitor their blood glucose levels using a meter and how to care for themselves, for example —and we're here to answer any diabetes health-related questions they may have.

Diabetes is hereditary, so if you have diabetes, make sure your loved ones are screened regularly

By Meredith Cohn, The Baltimore Sun

December 15, 2011

 

12 Tips to Avoid Diabetes Complications

1. Choose Carbs Carefully

Diabetes doesn't mean you have to cut carbs completely. Choose carbohydrates that break down in the body slowly, providing steady energy. Reach for whole grains, beans, nuts, and fresh vegetables and fruits. Yes, you can eat fruit even though it's sweet. It's about eating the right amounts of carbohydrates at each meal. A registered dietitian can help you learn how much is right for you.

2. Lose Weight If You Need To

Start small. If you are overweight, shedding just a few pounds can improve the body's ability to use insulin. It'll help lower your blood sugar and improve your blood pressure and blood fats. You'll also have more energy. Ready? Aim to burn more calories than you eat. To start, try cutting fat and calories from your diet, such as chips or fries.

Choose Carbs Carefully

Diabetes doesn't mean you have to cut carbs completely. Choose carbohydrates that break down in the body slowly, providing steady energy. Reach for whole grains, beans, nuts, and fresh vegetables and fruits. Yes, you can eat fruit even though it's sweet. It's about eating the right amounts of carbohydrates at each meal. A registered dietitian can help you learn how much is right for you.

Lose Weight If You Need To

Start small. If you are overweight, shedding just a few pounds can improve the body's ability to use insulin. It'll help lower your blood sugar and improve your blood pressure and blood fats. You'll also have more energy. Ready? Aim to burn more calories than you eat. To start, try cutting fat and calories from your diet, such as chips or fries.

3. Get Enough Sleep

Getting too much or too little sleep can increase your appetite and cravings for high-carb foods. That can lead to weight gain, increasing your risk for complications such as heart disease. So shoot for seven or eight hours of sleep a night. If you have sleep apnea, treating it can improve your sleep and lower your blood sugar levels.

4. Be Active: Exercise and Diabetes

Pick something you like -- walking, dancing, biking, or just marching in place while you're on the phone. Do it a half-hour a day; work up to that if you need to. Exercise can help you lower your cardiovascular risks, cholesterol, and blood pressure levels, and keep your weight down. Exercise also relieves stress and may help you cut back on diabetes medication.

5. Monitor Your Blood Sugar Daily

You know you're supposed to check it. And actually checking your blood glucose levels can help you avoid diabetes complications, like nerve pain, or keep them from getting worse. Checking it can also help you see how foods and activities affect you, and if your treatment plan is working. Your doctor can help you set a target glucose level range. The closer you get to your target, the better you'll feel.

6. Manage Stress

When you have diabetes, stress can cause your blood glucose levels to rise. Get rid of whatever physical or mental stresses you can. Learn coping techniques to deal with others. Relaxation techniques such as breathing exercises, yoga, and meditation may be especially effective if you have type 2 diabetes.

7. Say No to Salt

Reduce the salt in your diet. It may help lower blood pressure and protect your kidneys. Not salting the food on your plate may not be enough. Most of the salt in Americans' diets comes from processed foods. Avoid convenience foods and use fresh ingredients when you can. Season with herbs and spices instead of salt when you cook.
Adults age 51 and older, and individuals with high blood pressure, diabetes, or chronic kidney disease should reduce their sodium intake to 1,500 mg a day -- that's less than half a teaspoon of salt.

8. Heart Disease Risk and Diabetes

Heart disease can be a serious diabetes complication. Keep an eye on your risk by getting these ABCs checked:
A1C level. This is a measure of your average blood sugar control for the last 2-3 months. You may need it checked two or more times a year. Talk to your doctor about setting a goal.
Blood pressure. Goal: below 130/80 mm Hg.
Cholesterol. Goal: LDL below 100 mg/dl; HDL above 40 mg/dl; and triglycerides below 150 mg/dl.

9. Take Care of Bumps and Bruises

Diabetes raises your risk of infection and slows healing, so treat even simple cuts and scrapes quickly. Properly clean your wound and use an antibiotic cream and sterile bandage. See a doctor if it's not better in a few days. Check your feet every day for blisters, cuts, sores, redness, or swelling. Moisturize them to prevent cracks.

Choose Carbs Carefully

Diabetes doesn't mean you have to cut carbs completely. Choose carbohydrates that break down in the body slowly, providing steady energy. Reach for whole grains, beans, nuts, and fresh vegetables and fruits. Yes, you can eat fruit even though it's sweet. It's about eating the right amounts of carbohydrates at each meal. A registered dietitian can help you learn how much is right for you.

Lose Weight If You Need To

Start small. If you are overweight, shedding just a few pounds can improve the body's ability to use insulin. It'll help lower your blood sugar and improve your blood pressure and blood fats. You'll also have more energy. Ready? Aim to burn more calories than you eat. To start, try cutting fat and calories from your diet, such as chips or fries.

Get Enough Sleep

Getting too much or too little sleep can increase your appetite and cravings for high-carb foods. That can lead to weight gain, increasing your risk for complications such as heart disease. So shoot for seven or eight hours of sleep a night. If you have sleep apnea, treating it can improve your sleep and lower your blood sugar levels.

Be Active: Exercise and Diabetes

Pick something you like -- walking, dancing, biking, or just marching in place while you're on the phone. Do it a half-hour a day; work up to that if you need to. Exercise can help you lower your cardiovascular risks, cholesterol, and blood pressure levels, and keep your weight down. Exercise also relieves stress and may help you cut back on diabetes medication.

Monitor Your Blood Sugar Daily

You know you're supposed to check it. And actually checking your blood glucose levels can help you avoid diabetes complications, like nerve pain, or keep them from getting worse. Checking it can also help you see how foods and activities affect you, and if your treatment plan is working. Your doctor can help you set a target glucose level range. The closer you get to your target, the better you'll feel.

Manage Stress

When you have diabetes, stress can cause your blood glucose levels to rise. Get rid of whatever physical or mental stresses you can. Learn coping techniques to deal with others. Relaxation techniques such as breathing exercises, yoga, and meditation may be especially effective if you have type 2 diabetes.

Say No to Salt

Reduce the salt in your diet. It may help lower blood pressure and protect your kidneys. Not salting the food on your plate may not be enough. Most of the salt in Americans' diets comes from processed foods. Avoid convenience foods and use fresh ingredients when you can. Season with herbs and spices instead of salt when you cook.
Adults age 51 and older, and individuals with high blood pressure, diabetes, or chronic kidney disease should reduce their sodium intake to 1,500 mg a day -- that's less than half a teaspoon of salt.

Heart Disease Risk and Diabetes

Heart disease can be a serious diabetes complication. Keep an eye on your risk by getting these ABCs checked:

A1C level. This is a measure of your average blood sugar control for the last 2-3 months. You may need it checked two or more times a year. Talk to your doctor about setting a goal.

Blood pressure. Goal: below 130/80 mm Hg.

Cholesterol. Goal: LDL below 100 mg/dl; HDL above 40 mg/dl; and triglycerides below 150 mg/dl.

Take Care of Bumps and Bruises

Diabetes raises your risk of infection and slows healing, so treat even simple cuts and scrapes quickly. Properly clean your wound and use an antibiotic cream and sterile bandage. See a doctor if it's not better in a few days. Check your feet every day for blisters, cuts, sores, redness, or swelling. Moisturize them to prevent cracks.

10. Break Your Smoking Habit

People with diabetes who smoke are two times more likely to die prematurely than those who don't. Quitting helps your heart and lungs. It lowers your blood pressure and risk of stroke, heart attack, nerve damage, and kidney disease. Ask your doctor about help for quitting tobacco.

Choose Carbs Carefully

Diabetes doesn't mean you have to cut carbs completely. Choose carbohydrates that break down in the body slowly, providing steady energy. Reach for whole grains, beans, nuts, and fresh vegetables and fruits. Yes, you can eat fruit even though it's sweet. It's about eating the right amounts of carbohydrates at each meal. A registered dietitian can help you learn how much is right for you.

Lose Weight If You Need To

Start small. If you are overweight, shedding just a few pounds can improve the body's ability to use insulin. It'll help lower your blood sugar and improve your blood pressure and blood fats. You'll also have more energy. Ready? Aim to burn more calories than you eat. To start, try cutting fat and calories from your diet, such as chips or fries.

Get Enough Sleep

Getting too much or too little sleep can increase your appetite and cravings for high-carb foods. That can lead to weight gain, increasing your risk for complications such as heart disease. So shoot for seven or eight hours of sleep a night. If you have sleep apnea, treating it can improve your sleep and lower your blood sugar levels.

Be Active: Exercise and Diabetes

Pick something you like -- walking, dancing, biking, or just marching in place while you're on the phone. Do it a half-hour a day; work up to that if you need to. Exercise can help you lower your cardiovascular risks, cholesterol, and blood pressure levels, and keep your weight down. Exercise also relieves stress and may help you cut back on diabetes medication.

Monitor Your Blood Sugar Daily

You know you're supposed to check it. And actually checking your blood glucose levels can help you avoid diabetes complications, like nerve pain, or keep them from getting worse. Checking it can also help you see how foods and activities affect you, and if your treatment plan is working. Your doctor can help you set a target glucose level range. The closer you get to your target, the better you'll feel.

Manage Stress

When you have diabetes, stress can cause your blood glucose levels to rise. Get rid of whatever physical or mental stresses you can. Learn coping techniques to deal with others. Relaxation techniques such as breathing exercises, yoga, and meditation may be especially effective if you have type 2 diabetes.

Say No to Salt

Reduce the salt in your diet. It may help lower blood pressure and protect your kidneys. Not salting the food on your plate may not be enough. Most of the salt in Americans' diets comes from processed foods. Avoid convenience foods and use fresh ingredients when you can. Season with herbs and spices instead of salt when you cook.
Adults age 51 and older, and individuals with high blood pressure, diabetes, or chronic kidney disease should reduce their sodium intake to 1,500 mg a day -- that's less than half a teaspoon of salt.

Heart Disease Risk and Diabetes

Heart disease can be a serious diabetes complication. Keep an eye on your risk by getting these ABCs checked:

A1C level. This is a measure of your average blood sugar control for the last 2-3 months. You may need it checked two or more times a year. Talk to your doctor about setting a goal.

Blood pressure. Goal: below 130/80 mm Hg.

Cholesterol. Goal: LDL below 100 mg/dl; HDL above 40 mg/dl; and triglycerides below 150 mg/dl.

Take Care of Bumps and Bruises

Diabetes raises your risk of infection and slows healing, so treat even simple cuts and scrapes quickly. Properly clean your wound and use an antibiotic cream and sterile bandage. See a doctor if it's not better in a few days. Check your feet every day for blisters, cuts, sores, redness, or swelling. Moisturize them to prevent cracks.

Break Your Smoking Habit

People with diabetes who smoke are two times more likely to die prematurely than those who don't. Quitting helps your heart and lungs. It lowers your blood pressure and risk of stroke, heart attack, nerve damage, and kidney disease. Ask your doctor about help for quitting tobacco.

11. Pick Super Foods, Don't Supersize

There's no single diabetes diet. But here are basics to keep in mind: Enjoy super foods like berries, sweet potatoes, fish with omega-3 fatty acids, and dark green, leafy vegetables. Look at food labels and avoid saturated fat and trans fats. Instead, opt for mono and polyunsaturated fats like olive oil. A registered dietitian can give you personalized advice.

Choose Carbs Carefully

Diabetes doesn't mean you have to cut carbs completely. Choose carbohydrates that break down in the body slowly, providing steady energy. Reach for whole grains, beans, nuts, and fresh vegetables and fruits. Yes, you can eat fruit even though it's sweet. It's about eating the right amounts of carbohydrates at each meal. A registered dietitian can help you learn how much is right for you.

Lose Weight If You Need To

Start small. If you are overweight, shedding just a few pounds can improve the body's ability to use insulin. It'll help lower your blood sugar and improve your blood pressure and blood fats. You'll also have more energy. Ready? Aim to burn more calories than you eat. To start, try cutting fat and calories from your diet, such as chips or fries.

Get Enough Sleep

Getting too much or too little sleep can increase your appetite and cravings for high-carb foods. That can lead to weight gain, increasing your risk for complications such as heart disease. So shoot for seven or eight hours of sleep a night. If you have sleep apnea, treating it can improve your sleep and lower your blood sugar levels.

Be Active: Exercise and Diabetes

Pick something you like -- walking, dancing, biking, or just marching in place while you're on the phone. Do it a half-hour a day; work up to that if you need to. Exercise can help you lower your cardiovascular risks, cholesterol, and blood pressure levels, and keep your weight down. Exercise also relieves stress and may help you cut back on diabetes medication.

Monitor Your Blood Sugar Daily

You know you're supposed to check it. And actually checking your blood glucose levels can help you avoid diabetes complications, like nerve pain, or keep them from getting worse. Checking it can also help you see how foods and activities affect you, and if your treatment plan is working. Your doctor can help you set a target glucose level range. The closer you get to your target, the better you'll feel.

Manage Stress

When you have diabetes, stress can cause your blood glucose levels to rise. Get rid of whatever physical or mental stresses you can. Learn coping techniques to deal with others. Relaxation techniques such as breathing exercises, yoga, and meditation may be especially effective if you have type 2 diabetes.

Say No to Salt

Reduce the salt in your diet. It may help lower blood pressure and protect your kidneys. Not salting the food on your plate may not be enough. Most of the salt in Americans' diets comes from processed foods. Avoid convenience foods and use fresh ingredients when you can. Season with herbs and spices instead of salt when you cook.
Adults age 51 and older, and individuals with high blood pressure, diabetes, or chronic kidney disease should reduce their sodium intake to 1,500 mg a day -- that's less than half a teaspoon of salt.

Heart Disease Risk and Diabetes

Heart disease can be a serious diabetes complication. Keep an eye on your risk by getting these ABCs checked:

A1C level. This is a measure of your average blood sugar control for the last 2-3 months. You may need it checked two or more times a year. Talk to your doctor about setting a goal.

Blood pressure. Goal: below 130/80 mm Hg.

Cholesterol. Goal: LDL below 100 mg/dl; HDL above 40 mg/dl; and triglycerides below 150 mg/dl.

Take Care of Bumps and Bruises

Diabetes raises your risk of infection and slows healing, so treat even simple cuts and scrapes quickly. Properly clean your wound and use an antibiotic cream and sterile bandage. See a doctor if it's not better in a few days. Check your feet every day for blisters, cuts, sores, redness, or swelling. Moisturize them to prevent cracks.

Break Your Smoking Habit

People with diabetes who smoke are two times more likely to die prematurely than those who don't. Quitting helps your heart and lungs. It lowers your blood pressure and risk of stroke, heart attack, nerve damage, and kidney disease. Ask your doctor about help for quitting tobacco.

Pick Super Foods, Don't Supersize

There's no single diabetes diet. But here are basics to keep in mind: Enjoy super foods like berries, sweet potatoes, fish with omega-3 fatty acids, and dark green, leafy vegetables. Look at food labels and avoid saturated fat and trans fats. Instead, opt for mono and polyunsaturated fats like olive oil. A registered dietitian can give you personalized advice.

12. Set Up Doctor Visits

Expect to see your doctor two to four times a year. If you take insulin or need help balancing your blood sugar levels, you may need to visit more often. Also get a yearly physical and eye exam. You should be screened for eye, nerve, and kidney damage, and other complications. See a dentist twice a year. And be sure to tell all health care providers that you have diabetes.

Reviewed by Brunilda Nazario, MD on September 09, 2011
© 2011 WebMD, LLC. All rights reserved.

Diabetes: Treating Wounds and Injuries

No matter how small or superficial a wound is, you should not ignore it if you have diabetes, says Daniel Cohen, DPM, a podiatrist with Medical Associates of Brevard in Brevard County, Fla. If you stub your toe, get a blister from tight shoes, or nick your chin while shaving, you probably give it little thought. But if you have diabetes, you should seek proper treatment.
Knowing how to treat minor wounds will help you avoid infection and speed healing.

Why Diabetic Wounds Can Cause Problems

Diabetes is a chronic disease where your body can't use glucose, or sugar, the way it should. It can cause a number of complications, including some that make it harder for wounds to heal. These include:

• Nerve damage (neuropathy). When you have neuropathy, you may not feel the pain of a cut or blister until it has grown worse or become infected.
• Weakened immune system. When the body's natural defenses are down, even a minor wound may become infected.
• Narrow arteries. People with clogged arteries in their legs are more likely to develop wounds, have severe wound infections, and have problems healing. Narrowed arteries makes it harder for blood to get to the wound. Blood flow promotes healing, so anything that blocks it can make wounds more likely to become infected.

How to Treat a Diabetic Wound

If you have a wound, no matter how small, take the following steps to avoid infection and promote healing:

• Take care of the wound immediately. Even a minor wound can become infected if bacteria are allowed to build up after injury.
• Clean the wound. Rinse the wound under running water to remove dirt. Don't use soap, hydrogen peroxide, or iodine, which can irritate the injury. Then apply antibiotic ointment to prevent infection, and cover the wound with a sterile bandage. Change the bandage daily, and use soap to clean the skin around the wound. Inspect your wound daily for any signs of infection.
• See your doctor. Don't take any chances -- have your doctor check minor skin problems or areas of redness before they turn into larger problems. Err on the side of caution, says podiatrist and wound specialist Robert Snyder, DPM, medical director of the Wound Healing Center at University Hospital in Tamarac, Fla., and incoming president of the American Academy of Wound Management in Washington, D.C. "It's far easier to treat a minor skin problem before it becomes serious," he says.
• Keep pressure off the wound as it heals. For example, if your wound is on the bottom of the foot -- a common place for diabetic people to develop calluses and blisters -- stay off it as much as possible so it will have a better chance to heal, says Snyder.

Foot Wounds Are Dangerous

Feet and ankles are particularly vulnerable to diabetic wound problems, according to Cohen. "Wound healing below the knee is a different dynamic than in other parts of the body," he says. "These areas are prone to swelling, which can inhibit healing. Also, if you have a wound on your arm, you can immobilize it. This is much harder with a foot wound."
But it's not easy for people with diabetes to avoid foot wounds because they are more likely than other people to have calluses, dry skin and nerve damage. All of these combined  can lead to an increased risk of ulcers (open sores) and can lead to infections. Along with loss of  feeling in their feet, many people with diabetes also have vision problems. So they may neither feel nor see a small wound until it becomes serious, says Snyder.  
A wound that becomes serious may do more than cause pain and inconvenience. It may cause so much damage to tissue and bone that amputation becomes the only option.
Research shows that an ulcer precedes most lower limb amputations in people with diabetes. That's why it's so important to care for a wound before it becomes serious -- or, if at all possible, prevent wounds in the first place.

How to Prevent Wounds

The best way to avoid wound problems is to prevent wounds in the first place:  

• Check your feet daily. Look for blisters, calluses, chafing, and redness. "This is the single most important thing you can do to avoid diabetic foot problems," says Cohen. If you have trouble seeing, have someone else check your feet every day.
• Pay attention to your skin. Check for small, seemingly minor skin problems like infected hair follicles or inflamed areas around the fingernails. If you notice a problem, speak with your doctor.
• Moisturize your feet. Use moisturizer to keep the skin on your feet soft and supple. But don't use lotions between your toes because this can lead to an fungal infection. To treat athlete's foot, Cohen recommends using a gel rather than a cream antifungal product because gels don't leave a moisture residue between the toes.
• Wear proper footwear. Wearing well-fitting shoes can help you avoid blisters. Closed-toe shoes reduce the risk of foot injury. "We advise our patients to wear close-toed shoes, even around the house, " says Cohen. If you have trouble finding shoes that fit properly, speak to your doctor. You may need a custom-made shoe.
• Inspect your shoes every day. People with diabetic neuropathy may walk around with a pebble or other object in their shoe without knowing it is there, says Snyder.  You should also check for tears or rough areas on the inside of the shoe.
• Choose the right socks. Buy socks that wick moisture away from skin.  Avoid socks with seams. Socks made specifically for people with diabetes are available in many specialty stores and online.
• Wash your feet daily. After washing, dry them carefully, including between the toes.
• Smooth away calluses. After your bath or shower, use an emery board or pumice stone to gradually remove calluses. Never cut calluses with  scissors or a nail clipper.
• Keep toenails clipped and even. Ingrown toenails can lead to foot problems. Have your doctor check your feet regularly.
• Manage your diabetes. Preventing serious foot wounds also means keeping your diabetes under control. This includes monitoring blood sugar, blood pressure, and cholesterol levels; eating healthfully; taking the medications your doctor prescribes; exercising regularly; not smoking; and having regular medical checkups.

Snyder emphasizes the importance of consistent preventive care for people with diabetes. "If you have diabetes, you should have a team of specialists who you see for regular medical checkups, including a podiatrist and an ophthalmologist, as well as your primary care doctor," he says.

By Constance Matthiessen
© 2010-2011 WebMD, LLC. All rights reserved.

The Dangers of Prehypertension

It's Not High Blood Pressure, Yet, but You Still Need to Address It

Is your blood pressure creeping up? ... Not quite in the high blood pressure range, but not normal, either?
That's prehypertension. And though it's not high blood pressure -- yet -- it may not be as harmless as you thought.
Here's what you need to know about prehypertension, and why you need to nip it in the bud.
First, the numbers:

• Normal blood pressure is below 120/80.
• Prehypertension is blood pressure that ranges from 120-139 for the top number or 80-89 for the bottom number.
• High blood pressure (hypertension) is 140 or higher for the top number, or 90 or higher for the bottom number, or you are taking a blood pressure medication.

The top number is your systolic pressure, which is the force of blood against your arteries as your heart beats. The bottom number is diastolic pressure, which is the pressure on your arteries when your heart relaxes between beats.

Stroke Risk

Having prehypertension may make you more likely to have a stroke, especially in people younger than 65, a recent study shows.

"If you have prehypertension, and you're under 65, it really matters," says researcher and neurosciences professor Bruce Ovbiagele, MD, of the University of California, San Diego. "Most people who get to 65 already have hypertension."

Ovbiagele's team also found that stroke was more likely for people at the upper end of the prehypertensive range. But even if your blood pressure is not that high, it's wise to take action if your blood pressure is heading in the wrong direction.

"No matter what you consider your break point, any increase in blood pressure is generally a bad thing," says Richard Stein, MD, who directs the exercise, nutrition, and cardiovascular program at New York University's Center for Prevention of Cardiovascular Disease.

"It's causing the heart muscle to beat against a higher pressure, so [the heart] is becoming thicker," Stein says, adding that high blood pressure is also stressful for the kidneys.

Becoming More Common

More than a quarter of U.S. adults -- 28% -- have prehypertension, according to CDC estimates. About 20% of people who have prehypertension will go on to develop hypertension, Ovbiagele says. High blood pressure is the leading cause of stroke and also a major risk factor for heart disease and kidney damage.

Prehypertension and hypertension are on the rise. They've become more common as the U.S. becomes more obese and sedentary, Stein says. You're also more likely to get prehypertension if you have diabetes, high cholesterol, or a family history of high blood pressure, Stein says.

Prehypertension is a particular problem among African-Americans. Researchers have reported that African-Americans with prehypertension develop high blood pressure a year sooner than Caucasians. Although the reasons why are unclear, experts do know that "blood pressure is very difficult to control in African-Americans," Ovbiagele says.

Stealth Threat

Prehypertension, like hypertension, doesn't show signs or symptoms. Many people don't know they have it, and doctors often overlook it, Ovbiagele says.

How do you know if you have it? The only way to know is to check your blood pressure, Stein says. In otherwise healthy people, elevated systolic and/or diastolic blood pressure on two separate occasions -- taken two or three days apart -- is enough to be diagnosed with high blood pressure. You can take your blood pressure at home with a blood pressure monitor, or use the machine at your local pharmacy or grocery store, if it has one.

If it's consistently within the prehypertension range, tell your doctor so that you can get it under control before it becomes hypertension.

Taking Charge of Your Blood Pressure

The good news is, you can slow the progression to hypertension. Here's what experts recommend:

• Eat healthfully. Consider following the DASH diet, which focuses on eating more fruits, vegetables and whole grains, and less saturated fat, total fat, and cholesterol. It also restricts sodium, which can raise blood pressure, and emphasizes foods rich in calcium, potassium, and magnesium, minerals that help lower blood pressure. 
• Watch the salt. Although a recent study showed that lowering your salt intake may raise cholesterol and triglycerides, most experts still recommend cutting back on salt. Be on the lookout for sodium in canned, prepared, and processed foods. Avoid sprinkling too much salt on foods. The American Heart Association recommends limiting your intake to 1,500 mg a day.
• Move more. Get at least 30 minutes of moderate activity every day, most days of the week.
• Get to a healthy weight. Extra pounds make prehypertension more likely. Physical activity and healthy eating can help you shed extra weight.
• Limit alcohol. Try to drink no more than two drinks a day if you're a man or no more than one if you're a woman. If you don't drink, don't start.
• Curb stress. It's unclear whether chronic stress, by itself, can raise your blood pressure in the long run. But it can make you more likely to overeat and to skip exercise, Stein says. So try to change your circumstances, or at least how you deal with them, by practicing stress reduction techniques such as meditation.
• Check your blood pressure. If you can, buy a home monitor, and take your blood pressure twice day: once in the morning and once at night, Stein says. "One very high reading is concerning, but one alone isn't enough," he says. "You want to see how it changes over time."

By Winnie Yu
WebMD Feature
© 2011 WebMD, LLC. All rights reserved.

Controlling Diabetes: When Pills Aren't Enough

You Don't Check Your Blood Sugar

People with type 2 diabetes can often keep their blood sugar levels under control with diet, exercise, and medicine. But unless you check your blood sugar level every day with a meter, you won't have the most accurate results. Any person with diabetes can benefit from checking their blood sugar. And when you track your results in a log, your doctor can tell how well you're responding to your treatment plan over time.


You're Thirsty, and You Have to Go 


Thirst and frequent urination are two classic diabetes signs caused by too much sugar in your blood. As your kidneys work harder to filter out the sugar, they also pull more fluids from your tissues, which is why you have to go to the bathroom more often than usual. Thirst is your body's way of telling you it needs to replenish the liquids it's losing. If you don't drink more fluids, you can dehydrate.

You're Wiped Out

Fatigue is another signal that your blood sugar isn't under control. When sugar is staying in your bloodstream instead of being diverted to your body's cells, your muscles don't get enough fuel to use for energy. You might feel only a little tired, or your fatigue might be so bad that you need a nap. Sometimes people with diabetes feel especially tired after eating a big meal.

The Room Is Spinning

Feeling dizzy or shaky can be a sign of low blood sugar or hypoglycemia. Because your brain needs glucose to function, a drop in blood sugar can be dangerous -- even life-threatening -- if you don't address it. A glass of fruit juice can bring up your blood sugar in the short term. But if you're regularly feeling shaky, talk to your doctor. You may need to adjust your medications or diet.

Your Hands and Feet Swell

If you have high blood pressure as well as diabetes, the two conditions can damage the kidneys' ability to filter wastes and fluid over time. As water builds up in your body, your hands and feet may swell -- a warning sign that you may have kidney disease. You can preserve the kidney function you have by taking your diabetes and blood pressure medicines as prescribed, and watching the protein in your diet.

You Have Numbness or Tingling

Nerve damage (called peripheral neuropathy) can be another sign of chronically elevated blood sugars. It results in numbness or tingling in your hands and feet, or inability to feel pain or temperature changes. See your podiatrist for regular foot exams. People with neuropathy may not realize they have been injured from a cut or that a wound is becoming infected. Or they may be oversensitive to pain. They might experience severe and constant pain from otherwise painless stimulation.

You Have Stomach Trouble

Diabetes also damages the nerve that helps your stomach empty and move food smoothly through your digestive tract. When your stomach can't empty quickly enough, a condition called gastroparesis, you may deal with unpleasant abdominal problems like diarrhea, constipation, or incontinence. Many people also have problems eating or swallowing. Gastroparesis also can make it harder to control your diabetes.

You Don't Check Your Blood Sugar

People with type 2 diabetes can often keep their blood sugar levels under control with diet, exercise, and medicine. But unless you check your blood sugar level every day with a meter, you won't have the most accurate results. Any person with diabetes can benefit from checking their blood sugar. And when you track your results in a log, your doctor can tell how well you're responding to your treatment plan over time.

You're Thirsty, and You Have to Go

Thirst and frequent urination are two classic diabetes signs caused by too much sugar in your blood. As your kidneys work harder to filter out the sugar, they also pull more fluids from your tissues, which is why you have to go to the bathroom more often than usual. Thirst is your body's way of telling you it needs to replenish the liquids it's losing. If you don't drink more fluids, you can dehydrate.

You're Wiped Out

Fatigue is another signal that your blood sugar isn't under control. When sugar is staying in your bloodstream instead of being diverted to your body's cells, your muscles don't get enough fuel to use for energy. You might feel only a little tired, or your fatigue might be so bad that you need a nap. Sometimes people with diabetes feel especially tired after eating a big meal.

The Room Is Spinning

Feeling dizzy or shaky can be a sign of low blood sugar or hypoglycemia. Because your brain needs glucose to function, a drop in blood sugar can be dangerous -- even life-threatening -- if you don't address it. A glass of fruit juice can bring up your blood sugar in the short term. But if you're regularly feeling shaky, talk to your doctor. You may need to adjust your medications or diet.

Your Hands and Feet Swell

If you have high blood pressure as well as diabetes, the two conditions can damage the kidneys' ability to filter wastes and fluid over time. As water builds up in your body, your hands and feet may swell -- a warning sign that you may have kidney disease. You can preserve the kidney function you have by taking your diabetes and blood pressure medicines as prescribed, and watching the protein in your diet.

You Have Numbness or Tingling

Nerve damage (called peripheral neuropathy) can be another sign of chronically elevated blood sugars. It results in numbness or tingling in your hands and feet, or inability to feel pain or temperature changes. See your podiatrist for regular foot exams. People with neuropathy may not realize they have been injured from a cut or that a wound is becoming infected. Or they may be oversensitive to pain. They might experience severe and constant pain from otherwise painless stimulation.

You Have Stomach Trouble

Diabetes also damages the nerve that helps your stomach empty and move food smoothly through your digestive tract. When your stomach can't empty quickly enough, a condition called gastroparesis, you may deal with unpleasant abdominal problems like diarrhea, constipation, or incontinence. Many people also have problems eating or swallowing. Gastroparesis also can make it harder to control your diabetes.

You're Losing Your Sight

High blood sugar and high blood pressure both can damage the sensitive structures in your eyes and threaten your vision. Diabetic retinopathy -- caused by damage to the blood vessels in the eye -- is the biggest cause of blindness in adults. Blurred vision, spots, lines, or flashing lights are signs that it's time to see your eye doctor. Get your eyes checked now, before your vision has a chance to deteriorate.

You're Losing Weight

Losing unwanted pounds is always a good idea to manage type 2 diabetes. But if you're losing weight quickly, without trying, or without doing anything different, it may be a sign that your blood sugar is too high. When your glucose is high, it gets flushed out of the body in urine, taking the calories and fluids you consume with it.

You Don't Check Your Blood Sugar

People with type 2 diabetes can often keep their blood sugar levels under control with diet, exercise, and medicine. But unless you check your blood sugar level every day with a meter, you won't have the most accurate results. Any person with diabetes can benefit from checking their blood sugar. And when you track your results in a log, your doctor can tell how well you're responding to your treatment plan over time.

You're Thirsty, and You Have to Go

Thirst and frequent urination are two classic diabetes signs caused by too much sugar in your blood. As your kidneys work harder to filter out the sugar, they also pull more fluids from your tissues, which is why you have to go to the bathroom more often than usual. Thirst is your body's way of telling you it needs to replenish the liquids it's losing. If you don't drink more fluids, you can dehydrate.

You're Wiped Out

Fatigue is another signal that your blood sugar isn't under control. When sugar is staying in your bloodstream instead of being diverted to your body's cells, your muscles don't get enough fuel to use for energy. You might feel only a little tired, or your fatigue might be so bad that you need a nap. Sometimes people with diabetes feel especially tired after eating a big meal.

The Room Is Spinning

Feeling dizzy or shaky can be a sign of low blood sugar or hypoglycemia. Because your brain needs glucose to function, a drop in blood sugar can be dangerous -- even life-threatening -- if you don't address it. A glass of fruit juice can bring up your blood sugar in the short term. But if you're regularly feeling shaky, talk to your doctor. You may need to adjust your medications or diet.

Your Hands and Feet Swell

If you have high blood pressure as well as diabetes, the two conditions can damage the kidneys' ability to filter wastes and fluid over time. As water builds up in your body, your hands and feet may swell -- a warning sign that you may have kidney disease. You can preserve the kidney function you have by taking your diabetes and blood pressure medicines as prescribed, and watching the protein in your diet.

You Have Numbness or Tingling

Nerve damage (called peripheral neuropathy) can be another sign of chronically elevated blood sugars. It results in numbness or tingling in your hands and feet, or inability to feel pain or temperature changes. See your podiatrist for regular foot exams. People with neuropathy may not realize they have been injured from a cut or that a wound is becoming infected. Or they may be oversensitive to pain. They might experience severe and constant pain from otherwise painless stimulation.

You Have Stomach Trouble

Diabetes also damages the nerve that helps your stomach empty and move food smoothly through your digestive tract. When your stomach can't empty quickly enough, a condition called gastroparesis, you may deal with unpleasant abdominal problems like diarrhea, constipation, or incontinence. Many people also have problems eating or swallowing. Gastroparesis also can make it harder to control your diabetes.

You're Losing Your Sight

High blood sugar and high blood pressure both can damage the sensitive structures in your eyes and threaten your vision. Diabetic retinopathy -- caused by damage to the blood vessels in the eye -- is the biggest cause of blindness in adults. Blurred vision, spots, lines, or flashing lights are signs that it's time to see your eye doctor. Get your eyes checked now, before your vision has a chance to deteriorate.

You're Losing Weight

Losing unwanted pounds is always a good idea to manage type 2 diabetes. But if you're losing weight quickly, without trying, or without doing anything different, it may be a sign that your blood sugar is too high. When your glucose is high, it gets flushed out of the body in urine, taking the calories and fluids you consume with it.

You Have Recurring Infections

Frequent or recurring infections are sometimes a sign of high blood sugar. You might experience gum disease, urinary tract infections, bacterial or fungal infections of the skin, or, if you're a woman, yeast infections. Other infections might include pneumonia and respiratory infections, kidney and gallbladder infections, and severe bacterial middle ear and fungal sinus infection

You Don't Check Your Blood Sugar

People with type 2 diabetes can often keep their blood sugar levels under control with diet, exercise, and medicine. But unless you check your blood sugar level every day with a meter, you won't have the most accurate results. Any person with diabetes can benefit from checking their blood sugar. And when you track your results in a log, your doctor can tell how well you're responding to your treatment plan over time.

You're Thirsty, and You Have to Go

Thirst and frequent urination are two classic diabetes signs caused by too much sugar in your blood. As your kidneys work harder to filter out the sugar, they also pull more fluids from your tissues, which is why you have to go to the bathroom more often than usual. Thirst is your body's way of telling you it needs to replenish the liquids it's losing. If you don't drink more fluids, you can dehydrate.

You're Wiped Out

Fatigue is another signal that your blood sugar isn't under control. When sugar is staying in your bloodstream instead of being diverted to your body's cells, your muscles don't get enough fuel to use for energy. You might feel only a little tired, or your fatigue might be so bad that you need a nap. Sometimes people with diabetes feel especially tired after eating a big meal.

The Room Is Spinning

Feeling dizzy or shaky can be a sign of low blood sugar or hypoglycemia. Because your brain needs glucose to function, a drop in blood sugar can be dangerous -- even life-threatening -- if you don't address it. A glass of fruit juice can bring up your blood sugar in the short term. But if you're regularly feeling shaky, talk to your doctor. You may need to adjust your medications or diet.

Your Hands and Feet Swell

If you have high blood pressure as well as diabetes, the two conditions can damage the kidneys' ability to filter wastes and fluid over time. As water builds up in your body, your hands and feet may swell -- a warning sign that you may have kidney disease. You can preserve the kidney function you have by taking your diabetes and blood pressure medicines as prescribed, and watching the protein in your diet.

You Have Numbness or Tingling

Nerve damage (called peripheral neuropathy) can be another sign of chronically elevated blood sugars. It results in numbness or tingling in your hands and feet, or inability to feel pain or temperature changes. See your podiatrist for regular foot exams. People with neuropathy may not realize they have been injured from a cut or that a wound is becoming infected. Or they may be oversensitive to pain. They might experience severe and constant pain from otherwise painless stimulation.

You Have Stomach Trouble

Diabetes also damages the nerve that helps your stomach empty and move food smoothly through your digestive tract. When your stomach can't empty quickly enough, a condition called gastroparesis, you may deal with unpleasant abdominal problems like diarrhea, constipation, or incontinence. Many people also have problems eating or swallowing. Gastroparesis also can make it harder to control your diabetes.

You're Losing Your Sight

High blood sugar and high blood pressure both can damage the sensitive structures in your eyes and threaten your vision. Diabetic retinopathy -- caused by damage to the blood vessels in the eye -- is the biggest cause of blindness in adults. Blurred vision, spots, lines, or flashing lights are signs that it's time to see your eye doctor. Get your eyes checked now, before your vision has a chance to deteriorate.

You're Losing Weight

Losing unwanted pounds is always a good idea to manage type 2 diabetes. But if you're losing weight quickly, without trying, or without doing anything different, it may be a sign that your blood sugar is too high. When your glucose is high, it gets flushed out of the body in urine, taking the calories and fluids you consume with it.

You Have Recurring Infections

Frequent or recurring infections are sometimes a sign of high blood sugar. You might experience gum disease, urinary tract infections, bacterial or fungal infections of the skin, or, if you're a woman, yeast infections. Other infections might include pneumonia and respiratory infections, kidney and gallbladder infections, and severe bacterial middle ear and fungal sinus infections.

Cuts and Bruises Won't Heal

If your blood sugar isn't well controlled, you might find that cuts and bruises are slow to heal. Tending to injuries, however small, is important because it reduces the risk of infections in people with diabetes. Infections themselves can also worsen blood sugars, which makes it even harder for your immune system to fight off the infection

You Don't Check Your Blood Sugar

People with type 2 diabetes can often keep their blood sugar levels under control with diet, exercise, and medicine. But unless you check your blood sugar level every day with a meter, you won't have the most accurate results. Any person with diabetes can benefit from checking their blood sugar. And when you track your results in a log, your doctor can tell how well you're responding to your treatment plan over time.

You're Thirsty, and You Have to Go

Thirst and frequent urination are two classic diabetes signs caused by too much sugar in your blood. As your kidneys work harder to filter out the sugar, they also pull more fluids from your tissues, which is why you have to go to the bathroom more often than usual. Thirst is your body's way of telling you it needs to replenish the liquids it's losing. If you don't drink more fluids, you can dehydrate.

You're Wiped Out

Fatigue is another signal that your blood sugar isn't under control. When sugar is staying in your bloodstream instead of being diverted to your body's cells, your muscles don't get enough fuel to use for energy. You might feel only a little tired, or your fatigue might be so bad that you need a nap. Sometimes people with diabetes feel especially tired after eating a big meal.

The Room Is Spinning

Feeling dizzy or shaky can be a sign of low blood sugar or hypoglycemia. Because your brain needs glucose to function, a drop in blood sugar can be dangerous -- even life-threatening -- if you don't address it. A glass of fruit juice can bring up your blood sugar in the short term. But if you're regularly feeling shaky, talk to your doctor. You may need to adjust your medications or diet.

Your Hands and Feet Swell

If you have high blood pressure as well as diabetes, the two conditions can damage the kidneys' ability to filter wastes and fluid over time. As water builds up in your body, your hands and feet may swell -- a warning sign that you may have kidney disease. You can preserve the kidney function you have by taking your diabetes and blood pressure medicines as prescribed, and watching the protein in your diet.

You Have Numbness or Tingling

Nerve damage (called peripheral neuropathy) can be another sign of chronically elevated blood sugars. It results in numbness or tingling in your hands and feet, or inability to feel pain or temperature changes. See your podiatrist for regular foot exams. People with neuropathy may not realize they have been injured from a cut or that a wound is becoming infected. Or they may be oversensitive to pain. They might experience severe and constant pain from otherwise painless stimulation.

You Have Stomach Trouble

Diabetes also damages the nerve that helps your stomach empty and move food smoothly through your digestive tract. When your stomach can't empty quickly enough, a condition called gastroparesis, you may deal with unpleasant abdominal problems like diarrhea, constipation, or incontinence. Many people also have problems eating or swallowing. Gastroparesis also can make it harder to control your diabetes.

You're Losing Your Sight

High blood sugar and high blood pressure both can damage the sensitive structures in your eyes and threaten your vision. Diabetic retinopathy -- caused by damage to the blood vessels in the eye -- is the biggest cause of blindness in adults. Blurred vision, spots, lines, or flashing lights are signs that it's time to see your eye doctor. Get your eyes checked now, before your vision has a chance to deteriorate.

You're Losing Weight

Losing unwanted pounds is always a good idea to manage type 2 diabetes. But if you're losing weight quickly, without trying, or without doing anything different, it may be a sign that your blood sugar is too high. When your glucose is high, it gets flushed out of the body in urine, taking the calories and fluids you consume with it.

You Have Recurring Infections

Frequent or recurring infections are sometimes a sign of high blood sugar. You might experience gum disease, urinary tract infections, bacterial or fungal infections of the skin, or, if you're a woman, yeast infections. Other infections might include pneumonia and respiratory infections, kidney and gallbladder infections, and severe bacterial middle ear and fungal sinus infections.

Cuts and Bruises Won't Heal

If your blood sugar isn't well controlled, you might find that cuts and bruises are slow to heal. Tending to injuries, however small, is important because it reduces the risk of infections in people with diabetes. Infections themselves can also worsen blood sugars, which makes it even harder for your immune system to fight off the infection.

Keep Control

Don't panic about diabetes complications -- try to avoid them by carefully following your doctor's treatment plan. Take your medicine, eat a healthy diet, and exercise to keep your blood sugar levels in check. Use your meter to test your blood sugar so you know that it's staying in the recommended range. An A1C test at least twice a year will give you a good snapshot of your blood sugar control over time.

You Don't Check Your Blood Sugar

People with type 2 diabetes can often keep their blood sugar levels under control with diet, exercise, and medicine. But unless you check your blood sugar level every day with a meter, you won't have the most accurate results. Any person with diabetes can benefit from checking their blood sugar. And when you track your results in a log, your doctor can tell how well you're responding to your treatment plan over time.

You're Thirsty, and You Have to Go

Thirst and frequent urination are two classic diabetes signs caused by too much sugar in your blood. As your kidneys work harder to filter out the sugar, they also pull more fluids from your tissues, which is why you have to go to the bathroom more often than usual. Thirst is your body's way of telling you it needs to replenish the liquids it's losing. If you don't drink more fluids, you can dehydrate.

You're Wiped Out

Fatigue is another signal that your blood sugar isn't under control. When sugar is staying in your bloodstream instead of being diverted to your body's cells, your muscles don't get enough fuel to use for energy. You might feel only a little tired, or your fatigue might be so bad that you need a nap. Sometimes people with diabetes feel especially tired after eating a big meal.

The Room Is Spinning

Feeling dizzy or shaky can be a sign of low blood sugar or hypoglycemia. Because your brain needs glucose to function, a drop in blood sugar can be dangerous -- even life-threatening -- if you don't address it. A glass of fruit juice can bring up your blood sugar in the short term. But if you're regularly feeling shaky, talk to your doctor. You may need to adjust your medications or diet.

Your Hands and Feet Swell

If you have high blood pressure as well as diabetes, the two conditions can damage the kidneys' ability to filter wastes and fluid over time. As water builds up in your body, your hands and feet may swell -- a warning sign that you may have kidney disease. You can preserve the kidney function you have by taking your diabetes and blood pressure medicines as prescribed, and watching the protein in your diet.

You Have Numbness or Tingling

Nerve damage (called peripheral neuropathy) can be another sign of chronically elevated blood sugars. It results in numbness or tingling in your hands and feet, or inability to feel pain or temperature changes. See your podiatrist for regular foot exams. People with neuropathy may not realize they have been injured from a cut or that a wound is becoming infected. Or they may be oversensitive to pain. They might experience severe and constant pain from otherwise painless stimulation.

You Have Stomach Trouble

Diabetes also damages the nerve that helps your stomach empty and move food smoothly through your digestive tract. When your stomach can't empty quickly enough, a condition called gastroparesis, you may deal with unpleasant abdominal problems like diarrhea, constipation, or incontinence. Many people also have problems eating or swallowing. Gastroparesis also can make it harder to control your diabetes.

You're Losing Your Sight

High blood sugar and high blood pressure both can damage the sensitive structures in your eyes and threaten your vision. Diabetic retinopathy -- caused by damage to the blood vessels in the eye -- is the biggest cause of blindness in adults. Blurred vision, spots, lines, or flashing lights are signs that it's time to see your eye doctor. Get your eyes checked now, before your vision has a chance to deteriorate.

You're Losing Weight

Losing unwanted pounds is always a good idea to manage type 2 diabetes. But if you're losing weight quickly, without trying, or without doing anything different, it may be a sign that your blood sugar is too high. When your glucose is high, it gets flushed out of the body in urine, taking the calories and fluids you consume with it.

You Have Recurring Infections

Frequent or recurring infections are sometimes a sign of high blood sugar. You might experience gum disease, urinary tract infections, bacterial or fungal infections of the skin, or, if you're a woman, yeast infections. Other infections might include pneumonia and respiratory infections, kidney and gallbladder infections, and severe bacterial middle ear and fungal sinus infections.

Cuts and Bruises Won't Heal

If your blood sugar isn't well controlled, you might find that cuts and bruises are slow to heal. Tending to injuries, however small, is important because it reduces the risk of infections in people with diabetes. Infections themselves can also worsen blood sugars, which makes it even harder for your immune system to fight off the infection.

Keep Control

Don't panic about diabetes complications -- try to avoid them by carefully following your doctor's treatment plan. Take your medicine, eat a healthy diet, and exercise to keep your blood sugar levels in check. Use your meter to test your blood sugar so you know that it's staying in the recommended range. An A1C test at least twice a year will give you a good snapshot of your blood sugar control over time.

When to Call Your Doctor

Any new or unusual symptoms are worth making a call to your doctor. Call if you feel dizzy or your blood sugar drops, or if you have severe symptoms like uncontrolled vomiting, dizziness, numbness or tingling, or blurred or double vision that doesn't go away. Also call if you're having trouble controlling your blood pressure on your own.

brought to you by Novo Nordisk.
© 2011 WebMD, LLC. All rights reserved.