If you have high blood pressure, you can lower it with small lifestyle changes. Work with your doctor to develop a plan for lowering your blood pressure. Part of the plan may also include taking blood pressure-lowering medicine. However, your lifestyle changes will be just as important.

Path to improved health

How do tobacco products affect blood pressure?

The nicotine in cigarettes and other tobacco products causes your blood vessels to constrict and your heart to beat faster. This temporarily raises your blood pressure. When you quit smoking or using other tobacco products, you can lower your blood pressure. Stopping tobacco significantly lowers your risk of heart disease and stroke.

What about losing weight and exercising?

If you’re overweight, losing weight usually helps lower blood pressure. Regular exercise is a good way to lose weight. It also seems to lower high blood pressure even if you don’t lose weight. And even a 5 pound weight loss can bring down blood pressure significantly if you are overweight.

Is sodium really off limits?

Not everyone is affected by sodium. However, sodium can increase blood pressure in some people. Most Americans who have a healthy blood pressure should limit the sodium in their diet to 2,300 mg per day. African Americans, older adults, and people who have high blood pressure should limit the sodium in their diet to 1,500 mg per day. Your doctor may tell you to limit your sodium even more.

To lower your sodium intake, don’t add salt to your food. Check food labels for sodium. Some foods, such as potato chips, obviously have a lot of sodium. But you may not realize how much sodium is in food like bread, canned vegetables, soups, and cheese. Also be aware that some medicines contain sodium.

Do I need to quit drinking alcohol?

In some people, alcohol causes blood pressure to rise quite a bit. In other people, it doesn’t. If you drink alcohol, limit it to no more than 1 drink per day for women or 2 drinks per day for men. One drink is a can of beer, a glass of wine (4-5 oz.), or 1 shot (jigger) of liquor. If your blood pressure increases when you drink alcohol, it’s best to not drink any alcohol.

Does stress affect my blood pressure?

Stress may affect blood pressure. To combat the effects of stress, try relaxation techniques or biofeedback. These things work best when used at least once a day. Ask your family doctor for advice.

Do other health conditions cause high blood pressure?

A little more than half of people who have diabetes have high blood pressure too. Talk to your doctor about other health conditions that could be causing your high blood pressure.

How can I know if changing my lifestyle is helping?

One of the best ways to know if what you are doing is working is to see for yourself. Consider buying a home blood pressure monitor. Use it to see whether what you are doing is lowering your blood pressure numbers. Ask your doctor to recommend a monitor.

Even if doing the things mentioned in this article don’t decrease your blood pressure, they still will promote your overall health and are worth continuing.

Things to consider

Not lowering your blood pressure puts you at higher risk for certain diseases. These can include:

• Stroke
• Heart attack
• Heart failure
• Kidney disease
• Early death

Questions to ask your doctor

• What are the symptoms of high blood pressure?
• What is considered normal blood pressure?
• Can I lower my blood pressure through lifestyle changes alone?
• What are the side effects of blood pressure medicine?
• Could any medications I am taking raise my blood pressure?

Resources

Centers for Disease Control and Prevention: Manage High Blood Pressure

National Institutes of Health, MedlinePlus: Controlling Your High Blood Pressure

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Vitamin D is an important nutrient. It helps your body build strong bones and teeth. Maintaining an adequate level of vitamin D is important for all stages of life. It is especially important for children while their bones and teeth are developing. Vitamin D has other health benefits, as well. Vitamin D may protect against various health conditions, such as some cancers, muscle weakness, mood disorders, diabetes, kidney disease, heart disease, and high blood pressure.

Path to improved health

You can get Vitamin D from certain foods, sunlight, and dietary supplements.

Vitamin D is sometimes called the “sunshine vitamin.” That’s because your body creates its own vitamin D when you are exposed to sunlight. Depending on where you live, you might only need 10 minutes of sunshine 3 to 4 times a week to help your body create the vitamin D it needs. This can happen while you’re taking your dog for a walk or your children to the park. During certain times of the year, especially in northern states, there may not be enough of the right sunlight to make vitamin D. This is true even if you are outside all day.

Most people get very little vitamin D from the foods they eat. That’s because there are very few foods that contain vitamin D. Foods that naturally contain vitamin D include fatty fish, fish oil, eggs, cheese, and butter. There are also foods and drinks that have been fortified with vitamin D. These include milk, milk alternatives, some brands of orange juice, and some vitamin-fortified breakfast cereals. Read the food nutrition labels to learn if the products you choose are sources of vitamin D.

Vitamin D is available over the counter and by prescription. If you are concerned that you are not getting enough vitamin D, talk to your doctor. They will ask you about your diet and your exposure to sunlight. Your doctor also will consider other risk factors you may have.

Your doctor may want to test your level of vitamin D. This can be done through a blood test (inserting a small needle into your vein and taking a sample of blood to send to a lab). This will help determine if you need a supplement and, if so, how much. If you are a senior, a vegetarian or vegan, a nursing mother, or a pregnant woman, talk to your doctor about whether you should take a vitamin D supplement.

Things to consider

A low level of vitamin D in the body is called a vitamin D deficiency. Children who don’t get enough vitamin D are at risk for rickets. Rickets is a disorder that affects the bones. It causes bones to soften and break easily. Vitamin D deficiency can delay a child’s growth. And it can lead to cavities and problems with teeth structure. Adults who do not get enough vitamin D are at risk for osteomalacia (weak bones), osteoporosis (thin bones), and muscle weakness. This can increase the risk of bone fractures and falls.

The amount of vitamin D your body needs can vary depending on several factors, including:

• Weight
• Genetics
• Skin color
• Chronic conditions
• Where you live
• Sun exposure

Adults 70 years old and younger need 600 international units (IU) of vitamin D a day. Adults over the age of 70 need 800 IUs of vitamin D a day. For children between the ages of 1 and 18, the recommended daily dose is 600 IU. For children from birth to 12 months of age, the recommended daily dose is 400 IU.

If you breastfeed your baby, your doctor may prescribe a vitamin D supplement. Breast milk only has a small amount of vitamin D. Talk to your family doctor before giving older children vitamin supplements.

Vitamin D deficiency risk factors:

Some people are at higher risk for vitamin D deficiency than others, including:

• Infants who are only breastfed
• Babies and toddlers who are given non-milk food products or foods that are not fortified with vitamin D
• Seniors or older adults
• Darker-skinned people
• Those with limited exposure to sunlight (this includes people who are homebound)
• People who have difficulty absorbing dietary fat (because of conditions such as colitis, inflammatory bowel disease, and cystic fibrosis)
• Vegans, ovo-vegetarians, and those with other dietary restrictions such as milk-allergies and lactose-intolerance
• Obese people with a body mass index (BMI) greater than 30
• People with kidney disease, including kidney transplant recipients
• Those on medicines called glucocorticoids

People who live in northern states can also be at high risk. This is especially true during winter months. The farther south you live, the easier it is to get your vitamin D from sun exposure all year round.

Questions to ask your doctor

• Can a vitamin D deficiency make you feel overly tired?
• Can too much vitamin D be bad for your health?
• Are there any side effects to vitamin D dietary supplements?
• Can you get adequate sunlight by sitting near a window?

Resources

National Cancer Institute: Vitamin D and Cancer Prevention

National Institutes of Health, Office of Dietary Supplements: Vitamin D

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People used to think they had to suffer through pain after surgery. But it’s normal to need medicine to control your pain. Different types of pain medicine are available, and your doctor can help you pick the right one. Some medicines, such as local anesthetics, are given before surgery to prevent pain. Other types, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, are given after surgery to relieve pain. Opioids can be highly addictive and should be used following your doctor’s instructions.

Why is it important?

Treatment of pain can help you in the following ways:

• It can make you feel more comfortable. This reduces stress and tension, which helps your body heal.
• It can help you move better. If you feel less pain, you can start moving around or walking. This helps avoid problems such as bedsores, blood clots, and urinary infections.
• It can lead to fewer complications. People whose pain is well controlled do better after surgery. You can take deep breaths and be active sooner. You are less likely to get sick with conditions such as pneumonia.

Path to improved health

Before surgery: Local anesthetics

What are local anesthetics, and when are they used?
Local anesthetics block the nerves that send pain signals to your brain. You may get them in a shot near your incision, through a small tube, or as a cream applied to your skin. A doctor (anesthesiologist) or nurse (nurse anesthetist) will give you this medicine before surgery.

What are the benefits of local anesthetics?
Local anesthetics only block pain in a specific part of your body. This means there are fewer side effects and risks. You may remain awake or be sedated. You are able to go home and return to your normal routine. Local anesthetics reduce your need for opioids.

What are the risks of local anesthetics?
You may be dizzy, weak, or confused after surgery. Local anesthetics often require several shots to make pain relief last. Too much of a local anesthetic can cause problems.

After surgery: Pain medicines

Many types of medicines can help with pain after surgery. Pills and liquids (oral medicines) are taken by mouth. Other types of medicines are given in your rectum (anal or suppository). Injections into your skin, muscle, or vein are another form.

What are the benefits of oral medicines?
There are many benefits to oral medicines. Pills and liquids work as well as shots and cause less discomfort. Plus, they’re often less expensive. Also, they’re easy to take when you go home after surgery.

What are the risks of oral medicines?
There’s a delay in pain relief with oral medicines. That’s because you have to wait for your body to absorb the medicine. It can be hard to take them if you’re nauseous or vomiting. (Some medicines come in rectal form so you can still take them.)

What are the benefits of injected medicines?
Pain medicine in injection form works even if you’re nauseous or vomiting. The medicine gets into your bloodstream quickly.

What are the risks of injected medicines?
The injection site often hurts for a short time. Side effects may include dizziness, headache, breathing problems, or seizures.

There are different types of injections.

• Intravenous (IV) catheter.Medicine is injected into your vein through a small tube. The tip of the tube stays in your vein during recovery at the hospital. This method of pain relief works well for short-term pain.
• Patient-controlled analgesia (PCA) pump.This is used in combination with an IV. A PCA pump lets you control when you receive pain medicine. If you feel pain, you push a button to inject medicine into your vein. Your doctor or nurse will show you how and when to use the pump. They program the pump so can’t overdose.
• Epidural catheter.Pain medicine is injected into your back through a small tube. The doctor may inject medicine all at once or in small doses. This method works well for surgery on your chest or stomach. It is more complex and requires close monitoring to prevent problems.

NSAIDs

What are NSAIDs, and when are they used?
NSAIDs are used to treat mild pain after surgery. They reduce swelling and soreness. Examples of NSAIDs are aspirin, ibuprofen, and naproxen.

What are the benefits of NSAIDs?
Depending on your pain level, NSAIDs can stop or lessen pain. They prevent you from using stronger medicine, such as morphine. You can’t get addicted to NSAIDs.

What are the risks of NSAIDs?
NSAIDs may cause nausea, stomach bleeding, or kidney problems. Most NSAIDs thin your blood and can prevent blood clotting. They can increase your blood pressure and make your blood pressure medicine not work properly.

If your pain is too strong, your doctor may prescribe an opioid.

Opioids

What are opioids, and when are they used?
Opioids are stronger pain medicines. They most often are used for severe pain after surgery. Examples of opioids are morphine and codeine.

What are the benefits of opioids?
Opioids work well for severe pain. They do not cause bleeding in your stomach or other parts of your body. Your doctor will prescribe opioids only for extreme pain and only short-term.

What are the risks of opioids?
Opioids can cause drowsiness, nausea, constipation, or itching. They can affect urination and breathing. Many people become addicted to opioids with repeated usage. They can cause serious harm, including overdose and even death. It’s important to use them as prescribed by your doctor and to avoid depending on them indefinitely.

Things to consider

Your doctor will help you decide how to control pain after surgery. The type and amount of pain medicine you need varies. It will depend on your overall health and what kind of surgery you have. Some pain medicines may interact with other medicines. Talk to your doctor about what medicines you take regularly before starting a new pain medicine.

Talk to your doctor about ways to manage chronic pain. They can help you create a plan to manage your pain, limiting the use of pain medications. The plan may include applying ice and/or heat to the area, acupuncture, and relaxation techniques.

Questions to ask your doctor

• Do I need pain medicine before my surgery? If so, what kind?
• What kind of pain medicine will I need after my surgery?
• How long will I need to take pain medicine?
• What should I do if I still have pain after finishing my medicine?

Resources

National Institutes of Health, MedlinePlus: Post Surgical Pain Treatment – Adults

U.S. Food and Drug Administration: Opioid Medications

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A total contact cast is a cast used to treat ulcers (serious, deep sores) on a person’s foot. It consists of a fiberglass or plaster shell with a bar on the bottom. The shell fits around your leg and foot very closely. It follows the shape of your whole foot. That’s why it is called a total contact cast. It is designed to distribute weight along the entire sole of the foot.

The cast helps to protect the skin on your foot. Where the cast sits under the ulcer, there is a layer of soft foam. This makes a space so that no pressure is put on the sore. This allows it to heal more quickly. The cast has only a small amount of padding around the rest of the foot. The bar on the bottom helps keep weight off of the sore when you are standing or walking.

Who needs a total contact cast?

Total contact casts are commonly used by people who have diabetes with foot ulcers that are not healing. Diabetes can cause problems with the feet. A complication called neuropathy can cause a loss of feeling in the feet. This can make it hard to tell if you have a blister or sore on your foot. Small sores can turn into big sores fast. If small sores aren’t taken care of, they can get worse and turn into ulcers.

Path to improved health

The total contact cast takes pressure off the ulcer. This will help your ulcer heal. If you keep walking without the cast, the ulcer won’t heal.

Wearing a total contact cast helps most ulcers heal in 6 to 8 weeks. Your doctor will probably change your cast 1 to 2 days after it is put on. After that, you’ll probably get a new cast every week until you are ready to wear shoes.

What do I need to know about my cast?

Depending on the type of cast you have, the cast will take either 30 minutes or 24 hours to dry after it is first fitted. Your doctor will tell you what kind of cast you have. It is important that you don’t put any weight on the cast while it’s drying.

You should do as little walking as possible after the cast dries, for these reasons:

• The ulcer will heal faster if you put less pressure on it.
• Your leg with the cast is longer than your other leg. This can cause pain in your hip or back if you walk too much.
• You’re less stable when you’re wearing a cast. Your chances of falling and hurting yourself are increased. The less you walk, the less likely you are to fall. Be very careful on slippery or uneven ground. Use a cane for added stability, even if you usually don’t use a cane. If you were already unsteady before wearing the cast, it is a good idea to use a walker.

Can I get my cast wet?

No, the cast needs to stay dry. You won’t be able to take regular baths or showers. Take sponge baths instead.

Try not to go outside when the weather is wet. If you must go outside when it’s wet, wrap your cast in a plastic bag.

Is there anything else I should know?

Here are a few other tips that may help you.

• You may have some itching under the cast. Don’t slide anything down the cast to scratch the itch. You could easily damage the skin underneath.
• When you’re sitting down, put your leg up on a chair or pillow whenever possible.
• While you’re sleeping, you might kick or rub your other leg with the cast. This could cause skin damage on your other leg. It is a good idea to put a thick, soft, knee-high sock over your other leg before you go to bed. Or put a pillow between your legs.

If you would like more information on how diabetes affects your feet, ask your doctor.

Things to consider

Remember that if you have diabetic neuropathy, you don’t have good pain sensation (ability to feel pain) in your leg or foot. So you might not be able to feel if something is wrong. You must check your cast (or have someone else check it) every day. Call your doctor if you notice any of the following.

• The cast is loose. The cast should fit your leg securely. If it becomes loose, it could rub against your leg or foot and cause a new sore. A space of more than 1/4 inch between your cast and your leg is too much.
• Dents, cracks, and other damage to the cast. A dent or other damage can apply dangerous levels of pressure to your leg that you might not be able to feel.
• A smell coming from the cast. This could be a sign of a wound infection that started after your doctor put the cast on.
• Fever (temperature of 100°F or higher) or a sudden, unexplained increase in your blood sugar levels. These also could be signs of infection.

You should also call your doctor if:

• You are having a lot of pain in your back or hip
• You get the cast wet
• You are having problems with your balance

Questions to ask your doctor

• What caused my ulcer?
• How will the total contact cast help?
• How long will I need to wear it?
• Why do you need to change the cast?
• How can I avoid getting ulcers in the future?

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Exercise can make a real difference for people who have diabetes. Exercise can help control your weight and lower your blood sugar level. It also lowers your risk of heart disease. Heart disease is a condition that is common in people who have diabetes. Exercise can also help you feel better about yourself and improve your overall health.

Path to improved health

Talk to your doctor about what kind of exercise is right for you. The type of exercise you can do will mainly depend on whether you have any other health problems. Most doctors recommend aerobic exercise. This type of exercise makes you breathe deeply and makes your heart work harder. Examples of aerobic exercise include walking, jogging, aerobic dance, or bicycling. If you have problems with the nerves in your feet or legs, you may need to choose other exercises. Your doctor may want you to do a type of exercise that won’t put too much stress on your feet. These exercises include swimming, bicycling, rowing, or chair exercises.

No matter what kind of exercise you do, you should warm up before you start and cool down when you’re done. To warm up, spend 5 to 10 minutes doing a low-intensity exercise such as walking. Then gently stretch for another 5 to 10 minutes. Repeat these steps after exercising to cool down.

When you start an exercise program, go slowly. Gradually increase the intensity and length of your workout as you get more fit. Talk to your doctor for specific advice.

Should I drink more fluids during exercise?

Yes. When you’re exercising, your body uses more fluid to keep you cool. By the time you feel thirsty, you may already be getting dehydrated. Dehydration (not enough fluid in your body) can affect your blood sugar level. Drink plenty of fluid before, during, and after exercise. Make sure you are drinking water or sugar-free drinks so you aren’t raising your sugar levels.

Exercise checklist for people who have diabetes

• Talk to your doctor about the right exercise for you.
• Check your blood sugar level before and after exercising.
• Check your feet for blisters or sores before and after exercising.
• Wear the proper shoes and socks.
• Drink plenty of fluid before, during, and after exercising.
• Warm up before exercising and cool down afterward.
• Have a snack handy in case your blood sugar level drops too low.

Things to consider

There are risks to exercising for people who have diabetes, but the benefits far outweigh the risks. Exercise changes the way your body reacts to insulin. Regular exercise makes your body more sensitive to insulin. This could cause your blood sugar level to get too low (called hypoglycemia) after exercising.

Your doctor may tell you to check your blood sugar level before and after exercising. There are two ways you can monitor your blood sugar level each day. It can be done through a blood glucose monitor or a continuous glucose monitoring system. Talk with your doctor about which method is best for you.

If your blood sugar level is too low or too high just before you plan to exercise, wait. It’s better to wait until the level improves. Also, be sure to watch your blood sugar level if you exercise in really hot or cold conditions. Temperature changes how your body absorbs insulin.

When to see a doctor

Your blood sugar may be normal when you begin exercising but quickly drop during your workout. Be sensitive to this. Hypoglycemia usually occurs gradually, so you need to pay attention to how you’re feeling during exercise. If you have any of these symptoms, stop exercising:

• A change in your heartbeat
• If you feel shaky or anxious
• If you suddenly begin to sweat more than normal

Follow your doctor’s advice about how to treat hypoglycemia. If you begin to feel worse, call your doctor immediately.

Questions for your doctor

• Am I healthy enough to begin an exercise program?
• What kinds of exercises should I do?
• Are there any exercises I should avoid?
• Do I have any other health conditions that would affect my ability to exercise?
• Am I taking any medication that would interfere with exercise?
• How does exercise affect my blood glucose?
• How does exercise affect my diabetes?

Resources

American Diabetes Association

Centers for Disease Control and Prevention: Get Active!

National Institutes of Health, MedlinePlus: Diabetes and Exercise

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People who have diabetes have too much sugar in their blood. Managing diabetes means managing your blood sugar level. What you eat is closely connected to the amount of sugar in your blood. The right food choices will help you control your blood sugar level.

Path to improved health

Eating well is one of the primary things you can do to help control diabetes.

Do I have to follow a special diet?

There isn’t one specific “diabetes diet.” Your doctor can work with you to design a meal plan. A meal plan is a guide that tells you what kinds of food to eat at meals and for snacks. The plan also tells you how much food to have. For most people who have diabetes (and those without, too), a healthy diet consists of:

• 40% to 60% of calories from carbohydrates
• 20% calories from protein
• 30% or fewer calories from fat

Your diet should also be low in cholesterol, low in salt, and low in added sugar.

Can I eat any sugar?

Yes. In recent years, doctors have learned that eating some sugar doesn’t usually cause problems for most people who have diabetes—as long as it is part of a balanced diet. Just be careful about how much sugar you eat and try not to add sugar to foods.

What kinds of foods can I eat?

In general, at each meal you may have:

• 2 to 5 choices (or up to 60 grams) of carbohydrates
• 1 choice of protein
• A certain amount of fat

Talk to your doctor or dietitian for specific advice.

• Carbohydrates are found in fruits, vegetables, beans, dairy foods, and starchy foods such as breads. Try to have fresh fruits rather than canned fruits, fruit juices, or dried fruit. You may eat fresh vegetables and frozen or canned vegetables. Condiments such as nonfat mayonnaise, ketchup, and mustard are also carbohydrates.
• Protein is found in meat, poultry, fish, dairy products, beans, and some vegetables. Try to eat poultry and fish more often than red meat. Don’t eat poultry skin. Also, trim extra fat from all meat. Choose nonfat or reduced-fat options when you eat dairy, such as cheeses and yogurts.
• Not all fats are bad. It is important to know the differences between fats. Unsaturated fats are the “good” fats (nuts, fish, olive oil, canola oil, seeds, etc.). Saturated fats are less healthy. You should limit these in your diet. They include red meats, butter, lard, full-fat dairy products, dark-meat poultry, etc. Trans fats are the worst fats for you. These fats can be found in processed foods like crackers, snack foods, and most fast foods. To identify trans fats, check food labels for the words “partially hydrogenated.” Your doctor or dietitian will tell you how many grams of fat you may eat each day. When eating fat-free versions of foods (such as mayonnaise and butter), check the label to see how many grams of carbohydrates they contain. Keep in mind that these products often have added sugar.

What is the exchange list?

The exchange list is a tool to help you plan healthy meals and snacks. To add variety to your diet, you can substitute certain foods for other foods in the same group. Some examples are listed here.

Things to consider

If you don’t manage your diabetes, you are putting yourself at risk for many other health problems. The best way to manage diabetes is through diet, exercise, and sometimes medication. Poor diabetes management over time can lead to kidney disease and heart disease. It also can damage your eyes and nerves. It can cause skin tissue problems, especially on your feet and legs.

An important part of managing your diabetes is monitoring your blood sugar level. It’s easy to do this yourself either through a blood glucose monitor or a continuous glucose monitoring system. Your doctor can help you decide which method is best for you.

When to see a doctor

If you are unable to control your blood sugar through diet and exercise, talk to your doctor. It may mean that you need medication to help in your diabetes management. Some signs of uncontrolled high blood sugar include:

• Blurry vision
• Unquenchable thirst
• Unexplained weight loss
• Dizziness or being light-headed
• Nausea
• You are more emotional than normal for no obvious reasons

Questions to ask your doctor

• If I have type 2 diabetes, can I manage it with diet and exercise alone?
• If I take medicine to control my blood sugar, do I really need to diet and exercise?
• Can I still go out to eat when I have diabetes?
• Am I healthy enough to begin an exercise routine?
• What kinds of exercises should I do?
• If I exercise, can I have more high-fat foods?
• Where can I learn more about eating right?

Resources

American Diabetes Association: Nutrition

American Heart Association: Healthy for Good

Centers for Disease Control and Prevention: National Diabetes Education Program

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