Type 1 Diabetes: Living With Complications: Treatment Overview

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Treatment Overview

Treatment for your complication from type 1 diabetes depends on the stage of the disease.

For eye disease (diabetic retinopathy)

Keep all appointments with your eye specialist, and call if you notice any changes in your vision. Vision changes may mean your diabetic retinopathy is getting worse. Early detection and treatment of any changes can help prevent vision loss.

• If you have diabetic retinopathy in an early stage (nonproliferative stage), you need no treatment unless it is affecting the macula, the part of the retina that provides central vision. If the macula is damaged by swelling (macular edema), you may have laser treatment to seal leaking blood vessels, surgical removal (vitrectomy) of the fluid within the eye (vitreous gel), or steroid injections into the fluid of the eye.
• If the eye disease is advanced (proliferative stage), you may have either laser treatment or vitrectomy.

If you have severe vision loss, vision aids can help. Your local or state organization for the visually impaired can help you find these aids.

For more information, see the topic Diabetic Retinopathy.

For kidney disease (diabetic nephropathy)

Keep all appointments with your doctor, because the blood and urine tests done during these visits will monitor any kidney damage. Also, follow your doctor's instructions on taking your medicines (if you take any), because this can help slow damage.

If you have small amounts of protein in your urine (microalbuminuria), which is an early sign of kidney damage, you may be given an angiotensin-converting enzyme (ACE) inhibitor. Angiotensin II receptor blockers (ARBs) also treat kidney disease. These medicines are usually the first choice for people with type 1 diabetes who have microalbuminuria. Treatment for high blood pressure and high cholesterol may also help your kidneys work better.³ If you develop kidney failure, you may need dialysis, a kidney transplant, or possibly a pancreas-kidney transplant.⁸

You can also:

• Limit your intake of protein. This may help you preserve kidney function. Talk to your doctor or dietician about how much protein is best for you.
• Limit salt in your diet because it makes your body retain fluid and can increase your blood pressure.

For more information, see the topics Diabetic Nephropathy and Chronic Kidney Disease.

For heart and large blood vessel disease (macrovascular disease)

You can treat heart and large blood vessel disease by:

• Controlling high blood pressure. You may try some lifestyle or behavioral therapy for 3 months before starting medicine 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.⁵ Angiotensin-converting enzyme (ACE) inhibitors or other medicines can keep your blood pressure consistently below 130/80 mm Hg. Angiotensin II receptor blockers (ARBs) also help treat high blood pressure and kidney disease in people with diabetes. ARBs are used alone or along with an ACE inhibitor. For more information, see the topic High Blood Pressure (Hypertension).
• Controlling high cholesterol. Cholesterol-reducing medicines can keep your LDL cholesterol level less than 100 mg/dL. Or you can aim for keeping your LDL at 70 mg/dL, your triglyceride level less than 150 mg/dL, and if possible, your HDL cholesterol level more than 40 mg/dL in men. Women may want to keep their HDL higher than 50 mg/dL. For more information, see the topic High Cholesterol.
• Taking aspirin. Consider taking aspirin if you've had a heart attack or stroke or are age 40 or older and at risk for heart attack or stroke.⁵ For more information, see the topics Coronary Artery Disease, Heart Attack and Unstable Angina, Peripheral Arterial Disease of the Legs, and Stroke.
• Not smoking. Smoking increases your risk for heart attack and stroke and makes many health problems worse. Quitting can lower your risk.⁹
• Exercising. Try to get at least 30 minutes of exercise on most, preferably all, days of the week. Take steps to exercise safely.

For nerve disease (diabetic neuropathy)

Keeping your blood sugar levels as close to normal as possible (hemoglobin A1c of 7% or less) is the only treatment that can stop or slow the progression of neuropathy.

If you have peripheral neuropathy, your doctor may suggest medicines (such as nonprescription pain relievers, creams, or prescription oral or injected medicines). Physical therapy or acupuncture may relieve pain and stiffness and/or improve your mood and mental well-being.

To help prevent injuries:

• Turn your water heater down, and use a bath thermometer or have someone test your bath water to make sure that it is not too hot. Don't use an electric blanket.
• Arrange your furniture so that the walkways through your house are free of clutter, preventing falls.

If you have focal neuropathy (affecting one nerve), your doctor may suggest a joint splint.

If you have autonomic neuropathy (affecting internal functioning), your doctor may suggest the following:

• For digestive problems: Eat smaller, more frequent meals that contain less fat and fiber. You can also take medicine for gastroparesis, such as metoclopramide (Reglan) and erythromycin. If gastroparesis becomes severe, you may need surgery to place a feeding tube in the small intestine .
• For urinary problems: Drink more fluids each day to prevent urinary tract infections.
• For profuse sweating: Drink more fluids when you are outside in hot weather to prevent dehydration.
• For sexual problems: Try a device for erection problems or a lubricating cream for vaginal dryness. Medicines for erection problems include sildenafil citrate (Viagra), tadalafil (Cialis), and vardenafil (Levitra). But all of these medicines can make heart problems worse. Do not take them if you take nitrate medicines (such as nitroglycerin). Talk to your doctor about which medicine would work best for you.
• For hypoglycemia unawareness: Check your blood sugar level more often to prevent very low blood sugar levels.

Your doctor may refer you to a specialist for treatment of specific complications.

For more information, see the topic Diabetic Neuropathy.

For foot problems

Have your doctor do a thorough foot exam yearly. If you develop serious infections or bone and joint deformities, you may need surgery (possibly amputation). You can prevent many foot problems by inspecting your feet daily and protecting them from injury.

Diabetes: Taking care of your feet

What To Think About

The most important thing you can do is to keep your blood sugar level as close to normal as possible. This slows the progression of your complication from diabetes and lowers your risk for developing others. Continue eating a diet that spreads carbohydrate throughout the day, get regular exercise, and take your prescribed insulin. You can take insulin by injection or through an insulin pump. For more information, see the Home Treatment section of the topic Type 1 Diabetes: Living With the Disease.

Last updated:	November 18, 2008
Author:	Caroline Rea, RN, BS, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Matthew I. Kim, MD - Endocrinology & Metabolism
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC