Though blood vessel disease affects many patients with diabetes, there are strategies to help prevent and control it. These include:  

• Controlling glucose (blood sugar). Keeping glucose close to a normal level can prevent the onset of or minimize angiopathy. A glycohemoglobin test (A1C test) measures a person’s average glucose level for the past few months. Along with regular glucose monitoring, having a glycohemoglobin test at least twice a year is a good way to determine if glucose levels are under control.
  

  

• Controlling high blood pressure (hypertension). Keeping blood pressure under control can help minimize or prevent complications of diabetes. The target blood pressure for most people is below 120/80. High blood pressure can be controlled through self-monitoring, eating a heart-healthy low-salt diet, getting regular exercise and taking blood pressure drugs (antihypertensives) if prescribed.
  
  
• Controlling cholesterol levels. A person’s total cholesterol level should be no more than 200 milligrams a deciliter (mg/dL) and no more than five times the HDL level. Diabetes can upset the balance of “good” HDL and “bad” LDL cholesterol.

People with diabetes tend to have LDL particles that stick to arterial walls and damage them more easily. When glucose latches onto LDL, it remains in the bloodstream longer and may lead to plaque. People with diabetes also tend to have low HDL and high triglyceride levels, which increase the risk of heart and artery disease. High triglycerides lead to increased production of LDL and deplete the production of HDL.

Regular exercise and a heart-healthy diet can reduce levels of total cholesterol, LDL cholesterol and triglycerides. If these strategies are unsuccessful, a physician may prescribe cholesterol-reducing drugs. Levels of HDL cholesterol may be increased by eating monounsaturated fat in moderation, decreasing the amount of saturated fat, limiting alcohol use and starting an exercise program. Adult patients should have a lipid profile completed annually to monitor cholesterol levels.

• Quitting smoking or not starting to smoke. Along with its many other hazards to health, smoking raises blood pressure and damages the heart and circulatory system by gradually narrowing blood vessels. It is a major risk factor for peripheral arterial disease (PAD).
  
  
• Monitoring protein levels in urine. In the early stages of kidney disease (nephropathy) small amounts of protein leak into urine (microalbuminuria). As time goes by, more protein is leaked into the urine (proteinuria), leading to an increased risk of end-stage renal disease (ESRD), or chronic kidney failure. In patients with diabetes for more than five years, the American Diabetes Association recommends microalbuminuria testing every year.
  
  
• Eye exams. The retina and other structures of the eye can be severely damaged before a patient notices a change in vision or has any other symptoms. To detect diabetic retinopathy, glaucoma, cataracts and other diseases, it is important to have a dilated pupil examination at least once a year by an ophthalmologist.

• Foot care. PAD occurs when blood vessels in the legs become narrowed or blocked by fatty deposits. Decreased blood flow can lead to sores and infections on the legs and feet. When ulcers do not heal, amputation may become necessary. Proper foot care can help prevent complications and amputation. Ways to care for feet include:
  
  
• • Schedule a complete foot examination at least annually.
    
    
  • Inspect feet daily for red spots, cuts, swelling and blisters. A physician should be contacted for these foot problems, as well as for ingrown toenails and changes in foot color, shape or sensitivity.
    
    
  • Corns and calluses should be trimmed by a physician.
    
    
  • Wash feet daily and dry them carefully.
    
    
  • Rub a thin coat of lotion on the top and bottom of feet, but not between the toes.
    
    
  • Wear comfortable shoes and socks and never walk barefoot.
    
    
  • Protect the feet from extreme heat and cold.
    
    
  • Keep the blood flowing to the feet. Elevate them when sitting. Wiggle the toes and move the ankles up and down for five minutes two or three times a day. Do not cross your legs.

• Regular exercise. Exercise is an excellent tool to keep blood pressure down and reduce cholesterol levels. Physical activity can help delay or prevent cardiovascular disease. During exercise, muscles use glucose for energy, lowering sugar levels in the body. Emotionally, it can reduce levels of stress and depression.
  

• Eating nutritious foods. For most people, a healthy diet is high in fruits, vegetables, fiber and whole grains and low in saturated fat, trans fat, salt and sugar.
  
  
• Achieving and maintaining a healthy weight. Being overweight or obese is a major risk factor for a host of serious health conditions, including diabetes, coronary artery disease, high blood pressure, heart attack and stroke. Losing weight also lowers insulin resistance.

• Watching intake of alcohol. Alcohol affects the clearance of fat from the liver, increases the risks of low blood glucose (hypoglycemia), high blood pressure, neuropathy and retinopathy. It also raises levels of triglycerides in the blood. However, modest consumption of alcohol can benefit the heart and may reduce the risk of diabetes. Patients are advised to ask their physician about how much alcohol they should drink, if any.
  
  
• Taking aspirin. Studies have shown that taking a low-dose aspirin every day improves blood flow and lowers the risk of heart attack and stroke. However, aspirin can also damage the kidneys and stomach and cause other problems. A physician should be consulted before starting aspirin therapy.