If you have diabetes watch for these warning signs that something is amiss – and make sure you know how to respond

#1. Blurry vision.

Vision changes may mean your blood sugar is high, says endocrinologist Alan L. Rubin, MD, author of Diabetes for Dummies, Type 1 Diabetes for Dummies and other health books in the “Dummies” series. “High blood sugar draws more fluid into the lens of the eye, so your vision is less sharp,” he explains. “The first thing to do is to check your blood sugar more frequently and bring it under better control.” Temporary blurriness may also occur when starting insulin.
What to do: If problems persist despite good glucose numbers, tell your doctor. Eyesight changes may be caused by an easy-to-fix problem like dry eyes, be a side effect of some medications or even computer eye strain. But it can also be a warning sign of diabetic retinopathy – when tiny blood vessels at the back of the eye swell and leak. It could also be a sign of other vision issues like glaucoma or age-related macular degeneration. All can be treated to prevent further problems.

#2. Unusual thirst and feeling extra-tired.

High blood sugar is usually the culprit, according to the American Diabetes Association. But don’t shrug it off —letting your numbers drift beyond the healthy range sets you up for complications and could be a sign of a serious condition that needs immediate medical attention.

What to do: Check your glucose level now and recheck frequently; make sure you’re following your eating and exercise plan and taking your medication as directed. If you’ve been sick, follow your sick-day plan; illness can make blood sugar rise.

Extremely high blood sugar – over 600 mg/dL – can lead to seizures, coma and even death, the ADA warns. This condition, called Hyperosmolar Hyperglycemic Nonketotic Syndrome, is more common in older adults with type 2 and may be triggered by an illness or infection. Other symptoms include a high fever, warm skin without perspiration, confusion, vision problems and even hallucinations. Call 9-1-1 or have someone drive you to the emergency room now.

#3. Sores on your feet

Reduced blood circulation and nerve damage, both caused by diabetes, are a double whammy for your feet. You may not notice small blisters, bug bites or chafing right away if you’ve lost sensation in your feet, so you may not take care of these problems quickly. Poor blood flow reduces healing time, setting the stage for tough-to-treat infections that can require amputation.  It’s a worst-case scenario that may happen more often than you think. Each year, doctors perform about 73,000 toe, foot and leg amputations on people with diabetes, according to the Centers for Disease Control and Prevention.

What to do: Contact your doctor immediately if you have a sore or ulcer on the top, side or bottom of your foot. Daily foot checks will help you spot problems early. “You cannot ignore skin problems on your feet if you have diabetes,” Rubin says. “They must be treated promptly by your doctor. Don’t delay or think you can deal with it yourself.”

#4. Feeling shaky, clammy or light-headed.

Don’t ignore these classic signs of low blood sugar, especially if you have type 1 or are a type 2 who uses insulin. Hypoglycemia can lead to seizures, unconsciousness and even death. It’s crucial to know your own low blood sugar symptoms (some people have mood swings, others feel hungry or sleepy or get a headache) so you can act fast, Rubin says.
What to do: Check your blood sugar and have 15 grams of a simple carb to raise your level quickly. This could be glucose tablets (follow instructions on the package), a half-cup of juice or regular soda (not diet), a tablespoon of table sugar, honey or corn syrup or some hard candy or jelly beans (read the label to figure out how many you need to get 15 grams of sugar or carbohydrates). “It’s also important to tell others around you, in advance, about your diabetes and symptoms of low blood sugar so they can help you,” Rubin says. “You may not notice what’s happening but your family, co-workers or friends will.
If you have had severe insulin reactions with extremely low blood sugar that lead to unconsciousness, your doctor may prescribe injectable glucagon for you to carry. Show the people around you how to administer it in a low blood sugar emergency. Tell them to call 9-1-1 if you pass out or if they’re not sure what to do. #5: Leg pain, especially when you walk.

You may have peripheral arterial disease (PAD). Narrowed or clogged blood vessels in your legs and feet that pinch blood flow, leading to pain from oxygen-deprived muscles when you move around. One in three people with diabetes over age 50 has PAD, according to the National Institutes of Health. But many don’t get help.  Your legs may also feel numb, tingling or cold.

What to do: Make an appointment with your doctor. “It’s not an emergency, but PAD increases risk for heart attack and stroke in people with diabetes and should be treated as soon as possible,” Rubin says. “Medications, lifestyle changes and, if needed, surgery can ease the pain so you stay mobile. And your doctor can also help you control your cholesterol and blood pressure levels to protect your heart and brain.”

#6: A fruity mouth odor

A rare yet life-threatening problem, diabetic ketoacidosis (DKA) develops when you don’t have enough insulin in your bloodstream to draw glucose into cells. Your body burns fat for energy instead, producing byproducts called ketones that make your breath smell fruity. You may also feel extremely thirsty, urinate frequently, be less alert than usual, have a headache and even have nausea and vomiting.
What to do: DKA is a medical emergency. Call 9-1-1 or have someone drive you to the emergency room. DKA is more common in type 1s, especially if you miss insulin doses, are seriously ill or have had surgery. Without fast treatment, DKA can cause heart attacks, kidney damage and a build-up of fluid in the brain according to the National Institutes of Health.

#7: You just don’t care anymore

The daily challenges of diabetes – juggling glucose tests, medications, healthy eating, exercise, doctor appointments and all that vigilance– can leave you feeling burned-out…or even depressed. They’re not the same thing, but both are common experiences and should be taken seriously. In a pair of University of California San Francisco studies involving 898 type 2s, researchers found that one-third to one-half felt burned-out during an 18-month period.   And people with diabetes are twice as likely to experience depression, according to the National Institute of Mental Health.
What to do: Get help. Tell your doctor right away if you’ve got signs of depression, like feeling sad, empty or hopeless or not enjoying activities you once loved.   Medication and counseling can help. If you’re feeling burned-out, try looking for practical ways to make self-care easier – like buying an affordable piece of exercise equipment so you can stay active without driving to the gym. Forgive yourself for being less than perfect and ask for support from friends and family, too.

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