Have a yearly physical

Beyond their regular checkups to monitor diabetes treatment, people with diabetes should have a physical examination once a year. If, when administering the examination, the doctor knows the patient has diabetes, he or she will be looking for emerging problems caused by the disease.

An annual exam also is an opportunity to screen for other conditions, such as kidney and heart disease, which may not be part of regular checkups. In addition, those with diabetes might be so focused on their disease that they don't notice symptoms associated with other conditions or complete other aspects of preventive care — mammograms, for example. During a physical exam, these issues may come to light.

Get a yearly eye exam

Going to an eye specialist (ophthalmologist or optometrist) annually will help detect diabetes-related vision problems and catch them early when they are treatable. People with poorly controlled diabetes, high blood pressure, kidney disease or elevated cholesterol may want to see their eye specialist more than once a year.

A thorough eye exam includes the following tests and procedures:

• Visual acuity test — This test establishes a baseline measurement for future exams and determines the need for corrective lenses.
• External eye exam — This procedure measures eye movements, pupil size and their ability to respond to light.
• Retinal exam — A doctor places medicated eye drops into the eyes to dilate the pupils, then checks for damage to the retinas and the tiny blood vessels that nourish them. This test is especially important because retinal damage is the most common eye complication of diabetes.
• Glaucoma test (tonometry) — Diabetes increases the risk of developing glaucoma, a disease that can gradually narrow the field of vision and produce tunnel vision and blindness. This test helps detect glaucoma by measuring pressure in the eyes.
• Slit-lamp exam — During this procedure, the doctor evaluates the structures of the eyes, such as the cornea and iris. A check also is made for cataracts, which can cloud lenses and make vision blurry so objects look as if they're being seen through wax paper. Diabetes can spur cataracts to develop sooner than they otherwise might.
• Eye photography — If there is eye damage or suspected damage, photos may be taken with specially designed cameras to document the status of vision and establish a baseline for further exams.

 See the dentist

High blood sugar impairs the immune system from fighting off bacteria and viruses that cause infection. Because your mouth is loaded with bacteria, the gums are one common site of infection. If germs settle there, teeth may loosen and fall out.

To help prevent damage to your gums and teeth:

• See a dentist twice a year, and make sure he or she knows you have diabetes.
• Brush your teeth twice a day.
• Floss every day.
• Look for early signs of gum disease, such as bleeding gums, redness and swelling.

Keep vaccinations up to date

Because high blood sugar can weaken the immune system, people with diabetes are more prone to getting influenza and pneumonia than people who don't have diabetes. Those with heart or kidney disease are at an even higher risk.

Annual flu shot

An annual flu vaccination is the best way to avoid influenza or reduce its symptoms. Get the shot before each influenza season, which starts around October in the Northern Hemisphere and April in the Southern Hemisphere. In the tropics, the flu virus is present year-round.

In the United States, flu shots are modified annually to protect against those influenza strains most likely to circulate during the coming season. The vaccine contains only noninfectious viruses and can't cause the flu. The most common side effect is a little soreness at the spot where the shot is given.

Pneumonia vaccine

Most doctors recommend a one-time pneumonia vaccination. Those with complications from diabetes (such as kidney or heart disease) or who are 65 years of age or older may need a 5-year booster shot.

The pneumonia vaccine contains antigens — substances that activate the immune system — that protect against 85 to 90 percent of all forms of pneumonia found in the United States. Some people who receive the vaccine develop side effects similar to the flu. However, they generally last no more than 2 days.

Others

It's important to be up to date with other important immunizations, such as a tetanus shot and its 10-year boosters. Ask a doctor about getting vaccinated for protection against hepatitis B if you haven't received the vaccine already.

 Foot care

Diabetes is potentially dangerous to feet in two ways —

• Diabetes can damage the network of nerves in the feet, reducing the sensation of pain. A person with diabetes could develop a sore or blister without realizing it.
• Diabetes can narrow the arteries, reducing blood flow to the feet. With less blood to nourish tissues in the feet, it's harder for sores to heal.

An unnoticed cut or sore hidden beneath socks and shoes can quickly develop into a larger problem.

"Diabetes is the most common cause for non-traumatic limb amputation," says Dr. Collazo-Clavell. "This has a dramatic impact in the way an individual lives his or her life and can be easily prevented."

Here are some tips —

Check your feet every day

Examine feet thoroughly, looking for the following:

• Blisters, cuts and bruises
• Cracking, peeling, wrinkling
• Redness, red streaks, swelling
• Feet that are pinker, paler, darker or redder than usual, possibly due to pressure from tight shoes

If a wound isn't healing, looks like it may be infected, or is getting bigger, see a doctor.

Keep feet clean and dry

Wash feet every day with lukewarm water. To avoid burning them, test the water temperature with a thermometer — it should be no warmer than 90 F. Or touch a dampened washcloth to a sensitive area of your body, such as your face, neck or wrist.

Wash with a gentle massage-like motion, using a soft washcloth or sponge and a mild soap. Dry the skin by blotting or patting, but don't rub — rubbing may damage the skin. Dry carefully between toes to prevent fungal infection.

Moisturize the skin

People with diabetes sweat less than people who don't have the disease, leaving the skin dry -especially the feet. Dry skin can itch and crack, increasing the risk of an infection. Use a moisturizer regularly, but never between toes because the extra moisture may increase the risk of fungal infection.

Wear clean, dry socks

Wear socks made of fibers such as wool or polypropylene, which pull sweat away from the skin. Avoid those with tight elastic bands that reduce circulation or that are thick or bulky. Bulky socks often fit poorly, and a poor fit can irritate the skin. It's also a good idea to avoid mended socks with thick seams that can rub and irritate the skin. Indentations from the seams in socks aren't a problem for most people, but among people with diabetes they can cause pressure sores.

Trim toenails carefully

Bathe feet in warm water and clean toenails carefully using a soft toothbrush and mild soap. Cut the nails straight across, so they are even with the end of the toe. File rough edges so there aren't any sharp areas that could cut neighboring toes. Be especially careful not to injure the surrounding skin. If there is redness around the nails, report this to your doctor or a podiatrist (a doctor who specializes in foot care). A podiatrist also can provide this kind of preventive foot care.

Use foot products cautiously

Don't use a file or scissors on calluses, corns or bunions. Also, don't put chemicals on your feet, such as wart removers. See your regular doctor or podiatrist for problem calluses, corns, bunions or warts.

Shoes

To help prevent injury to your feet and toes, always wear shoes. Check them periodically for tears or rough edges, and shake them out before putting them on to make sure there is nothing inside (such as a pebble).

Select a comfortable and safe style of shoe with:

• Soft leather tops
• Closed-toe design
• Low-heels
• Flexible soles made from crepe or foam rubber

 Don't smoke

Those with diabetes who smoke are three times more likely to die of heart disease or stroke than nonsmokers with diabetes.

• Smoking narrows arteries, reducing blood flow to the legs (making it more difficult for wounds to heal) and increasing the risk of heart attack and stroke.
• Smoking increases the risk of nerve damage and kidney disease.
• Smoking impairs the immune system, producing more colds and respiratory infections.

Approximately 1 in 4 Americans with diabetes smokes. There are many ways to quit smoking. Check out the MayoClinic.com Stop Smoking Planner to help get you started.

Take a daily aspirin

The American Diabetes Association (ADA) recommends that most people with diabetes take an aspirin every day because studies show that daily aspirin can reduce the risk of heart attack by up to 60 percent. The recommended dose is anywhere from 81 milligrams (mg) a day, the amount found in a "baby" aspirin, to 325 mg a day, the amount in an adult tablet.

People with diabetes produce more "sticky" platelets that attach themselves to the inside walls of arteries, clogging them and causing blood clots to form. Clogged arteries and blood clots can lead to a heart attack or stroke. Aspirin decreases the stickiness of platelets, reducing the risk of blood clots.

It's best to take aspirin with food and take coated aspirin tablets that dissolve in the small intestine instead of the stomach. A serious side effect of regular aspirin usage is that it can cause stomach irritation, bleeding or an ulcer. Once taking aspirin, some people bruise more easily and the bruises last longer. That's because aspirin reduces the ability of blood platelets to seal up and heal wounds.

Aspirin therapy isn't for everyone. Those who should avoid aspirin include:

• People who have had an allergic reaction to aspirin in the past
• People who have a stomach ulcer
• People who have liver disease
• People who are taking some other drug that reduces clotting, such as warfarin
• Children — aspirin can produce an extremely dangerous condition in children called Reye's syndrome

Consult with your doctor to see if taking aspirin is right for you

 Monitor blood pressure

People with diabetes are twice as likely to develop high blood pressure than those without diabetes. Black people are twice as likely and Hispanic people are three times more likely than white people to have both diabetes and high blood pressure.

Whatever the ethnic group, having both diabetes and high blood pressure is serious. Like diabetes, high blood pressure can damage blood vessels. When these two conditions team up, they can undermine health and lead to a heart attack, a stroke or any number of life-threatening conditions. Between 35 percent and 75 percent of all complications associated with diabetes can be attributed to having high blood pressure.

The ADA recommends that adults with diabetes keep their blood pressure below 130/85 millimeters of mercury (mm Hg). The same healthy habits that can improve blood sugar (a balanced diet and regular exercise) also can help reduce blood pressure. However, if blood pressure can't be controlled with diet and exercise alone, a doctor may prescribe blood pressure-lowering medication.

Drugs called ACE inhibitors or angiotensin II receptor blockers have been preferred in individuals with diabetes. These medications have a low rate of side effects and they help protect the kidneys, which are at high risk from both diseases. Other high blood pressure medications prescribed to people with diabetes include diuretics, beta-blockers, calcium antagonists and alpha-blockers.

 Manage stress

People under a lot of stress have more difficulties taking good care of themselves and their diabetes — they may not eat right, exercise or take medication as it was prescribed. Excessive or prolonged stress also can increase hormones that block the effect of insulin, causing blood sugar to rise.

To find out if stress is affecting your blood sugar level, try keeping a chart for a few weeks. Rate your stress level on a scale of 1 to 10, then take a blood sugar reading and write the number beside the stress rating. After a few weeks, look for a pattern. Does an increase in your stress level tend to produce an increase in your blood sugar level?

If stress is a problem for you, stop and think about what causes you stress. Then ask yourself if there is anything you can do to change the situation. If a hectic day of running from one event to another stresses you out, reduce your daily commitments. If certain friends, neighbors or family members cause you stress, limit the time you spend with them. If your job is stressful, look for ways to lighten the load, such as handing off some of your responsibilities to others.