Risk factors with advice on what to do about each

Alcohol 

Intake must be limited to 2 units of alcohol a day. None is the best option

Foot ulcers

These result from friction damage to the foot where there is a loss of sensation. ALL diabetics should protect their feet

	Inspect feet daily, look between the toes and on the soles of the feet for cuts, changes in colour, blisters or any scratches that may not have been felt. A mirror can help see under the feet.
	Wash feet daily and dry between the toes well. Do not use talcum powder as it can cause rubbing.
	Cut toenails straight across and file rough edges. It is easier to do this after a bath or shower when the nails are soft.
	Wear socks or stockings that are clean each day -wool or cotton are better than synthetics.
	Wear well fitting shoes -all shoes should be comfortable, not rub or cause the feet to ache.
	For cold feet at night wear bed socks rather than using hot water bottles or reflector heaters that may burn but not be felt at the time.
	Always wear shoes to protect the feet, eg. thongs for the beach, slippers when getting up at night, heavy shoes for gardening.
	Look and feel inside shoes each day for unnoticed stones, tacks or torn linings that may rub feet.

 

High Cholesterol

If you have diabetes then new treatment guidelines released at the end of 2001 state that cholesterol must be lowered to 4.0 to prevent vascular complications. For a fair proportion of diabetics this will not be achievable by diet and tablets will be needed

High Triglycerides

Many diabetics have an elevation of triglycerides. This is independent of cholesterol level. In diabetics this fatty substance in the blood causes all the damage at the microvascular level - the tiniest blood vessels. What we see is that this problem is a function of, and dependent on, obesity and overeating. There is a genetic type of elevation of triglycerides but this is rarely a problem in diabetics

Hypertension

High blood pressure adds very significantly to the cascade of vascular damage that can occur in diabetes. It is controlled by exercise, losing weight, eating a low salt diet for some, and blood pressure tablets where necessary. The desired treatment target for blood pressure has just been lowered (at the end of 2001) to a figure of 130/80 for diabetics

Obesity

Obesity is the prime cause of Diabetes type 2. Attention to obesity, as we have discussed elsewhere, is critical in controlling diabetes

Smoking

If you had a roaring fire would you throw petrol on it. Consider this explanation. Heart attack, stroke and amputations occur much more in diabetics because of raised cholesterol and triglycerides. These fats penetrate the wall of the artery and that wall thickens over time - just like a rusting water pipe. Certain types of events break the thin cover on the inside of an artery, the fat spills out (there is nothing more damaging in free flowing blood than fat). Bingo the artery clogs up - no blood can get through - heart attack, stroke, lose a foot etc. Certain substances stop this rupture happening for example antioxidants. Only very few substances cause it to happen. ONE OF THESE IS SMOKING - EVEN A SINGLE CIGARETTE - AND YOU DON'T KNOW WHICH ONE IT WILL BE.