Diabetics know what they will hear whenever they see their doctor: another exhortation to eat right and exercise, because that's how to keep blood sugar low and under control. It's proven advice, but not enough to prevent a long list of diabetic complications from sending you to the emergency room, say diabetes experts.
Diabetes-related complications, in fact, are among the most common reasons for hospitalization, according to a recent study in the Journal of Women's Health. Researchers found that in 2006, for example, diabetics hospitalized because of congestive heart failure accounted for more than 1 in every 16 discharges; diabetics with pneumonia made up another 1 in 26. Moreover, the overall rate of hospital admissions for diabetics is rising—up more than 65 percent between 1993 and 2006. And it will climb even faster if the Centers for Disease Control and Prevention's recent estimate that as many as 1 in 3 Americans, up from 1 in 10 now, will have type 1 or type 2 diabetes by 2050 holds up.
For those who already have the disease, though, there is hope. Some of these tips may help keep you healthy—and out of the hospital:
Do a daily foot check. "Keeping good watch over your feet is an important aspect of good diabetes care," says Joyce Lee, a coauthor of the Women's Health study and assistant professor in the department of pediatrics and communicable diseases at the University of Michigan Hospitals and Health Centers. A high blood glucose level can cause nerve damage in the feet, and you might not feel a cut, scrape, or blister that could be the start of a deep skin infection. Data from the study indicates that young men are especially prone to such ulcerations. Applying lotion regularly and drinking lots of water can keep skin on the feet—and the rest of the body—from becoming dry and cracked, advises the National Diabetes Information Clearinghouse.
Coddle teeth and gums. Diabetics run an increased risk of tooth decay, inflamed gums, and gum disease because the condition increases vulnerability to bacterial infections and hampers the ability to fight them. Periodontitis, an especially severe infection that destroys gum tissue and the bone that holds teeth in place, also complicates a diabetic's life by raising blood sugar levels when hormones are released by the immune system to battle the infection, warns the American Diabetes Association. Brushing after every meal, or at least twice a day, and flossing once a day is crucial, according to the NDIC.
Go easy on salt. Sodium and high blood pressure go hand in hand, and high blood pressure multiplies a diabetic's already elevated risk of cardiovascular and kidney diseases, says Om Ganda, director of the lipid clinic at the Joslin Diabetes Center in Boston. The landmark DASH study by researchers at the National Heart, Lung, and Blood Institute of the National Institutes of Health, published in 2001 in the New England Journal of Medicine, showed that cutting down on salt dramatically reduced blood pressure even in those on a healthy diet rich in veggies, fruit, and low-fat dairy. The American Heart Association says that 1,500 milligrams of salt—about two-thirds of a teaspoon—should be the daily limit; the average American consumes two to three times as much. Cutting back on salt isn't just a matter of reaching for the shaker less often, unfortunately. Prepared foods tend to be salt-heavy: One large fast-food taco or egg-and-sausage biscuit has close to the AHA's recommended limit. Even unlikely suspects such as a half cup of low-fat cottage cheese or a smallish cinnamon-raisin bagel will kick in almost a third of the recommended total. For diabetics, zeroing in on the number next to sodium on nutritional labels is a survival skill.
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Ditch the butter—go for olive oil. Switching can make a marked impact on cholesterol, especially for those who have trouble reducing overall fat intake, says Ganda. The saturated fat in butter raises blood cholesterol and the risk of cardiovascular problems; olive oil is a monounsaturated fat that can reduce bad cholesterol. A diet heavy in olive oil may even bring down the chance of developing diabetes. A study published this month in Diabetes Care tracked 418 non-diabetic Spanish adults over four years who ate either a traditional Mediterranean diet rich in olive oil, their normal Mediterranean diet supplemented with fat from nuts, or a low-fat diet. By the end, between 10 and 11 percent of those in the two Mediterranean groups had developed diabetes compared with 18 percent in the low-fat group.
Kick the habit. Smoking is a major factor in atherosclerosis, which frequently puts diabetics in the hospital when an artery becomes blocked and causes a heart attack, stroke, or other vascular problem. Smoking also raises blood pressure and cholesterol. And a diabetic who smokes has a greater risk of pneumonia and of having a worse case.
Fend off depression. "This is a chronic illness where patients are reminded daily they have diabetes," says Tom Donner, acting director of the Johns Hopkins Diabetes Center. "That's a taxing burden." Depression is dangerous for diabetics because it can make them feel as if they have no control over their illness, says Robert Rizza, executive dean of research and a diabetes specialist at the Mayo Clinic in Rochester, Minn. That may make them feel so helpless they might not stick to their medications or show up for doctor visits. Yoga or meditation can reduce the stress, and a special interest or activity—a book club, fantasy football, birdwatching—can let you again take pleasure from life, making your disease more manageable.
Most complications stemming from diabetes are preventable; the key is to understand and manage the illness from Day 1 to keep minor complications from becoming major. Diabetes is a time bomb, says Rizza. "It's ticking," he says, "and unless you're taking care of it...you'll end up in the hospital."