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Diabetes Preventive Care

Diabetes Preventive Care

Prevention of diabetes related complications

Education and prevention are the most important factors in reducing the risk of diabetes related complication.

Take charge of your own health! Choose the best health care team for yourself!

Effective preventive care typically includes lifestyle modifications such as careful and frequent self-examinations, watchful control of blood glucose and blood pressure, firm weight management and diet, and increased daily activities.

Should secondary complications arise despite preventive care then early detection and prompt effective response by a professional health care team is essential.

The most effective health care is preventive care!

Watch for the early signs and symptoms of diabetes related complications and act upon them ! Quick and correct response to the early warning sings could prevent more serious complications.

The following paragraphs will guide you on how to recognize early warning signs or symptoms and it will list some preventive measures for the most common diabetes complications.

If these symptoms remain untreated minor complications can lead to severe problems such as:

  1. eye – retinopathy and blindness
  2. skin – serious dermatological complications and infections
  3. teeth and gums – parodonthosis and loss of teeth
  4. kidney and bladder problems – kidney failure
  5. feet problems – gangrene and amputations
  6. cardiovascular problems – heart attack, cerebral stroke
1. Eye

Hyperbaric oxygen therapy has been recognized as an effective treatment method for various eye complications associated with diabetes, infections, intoxications, injuries, degenerative diseases or radiation therapy.


  • Maintaining blood glucose level under control may prevent damage to the small blood vessel supplying the eyes.
  • Regularly check your blood pressure and try to keep it within the normal values.
  • Avoid activities that can raise the blood pressure. Also, birth control pills can increase the blood pressure
  • If eye problems develop then early intervention such as laser treatment for retinopathy can decrease the risk of blindness by 90%

Yearly visit to ophthalmologist can confirm some of the following early signs of diabetes:

  • Trouble reading books or traffic signs
  • Problems distinguishing familiar objects
  • Other visual problem such as spots, “floaters” or cobwebs in your field of vision, blurring or distortion, detection of blind spots, eye pain or persistent redness
  • Increased pressure inside the eye may be the warning sign of glaucoma
  • Sudden blindness or partial blindness (one eye) can be caused by the rupture of the vessels supplying the retina

Hyperbaric Oxygen Therapy (HBO) used in eye complications:

  • Hyperbaric oxygen improves visual sharpness (acuity) and reduces the incidence of blindness caused by lack of oxygen.
  • Hyperbaric oxygen improves retinal blood flow and circulation. It its also effective in reducing swelling and thereby the risk of developing glaucoma and cataract.
  • Hyperbaric oxygen reduces scar formation after surgery
  • Hyperbaric oxygen speeds up the healing after surgery and reduces the complications
  • Hyperbaric oxygen suppresses infection either directly by destroying bacteria or assisting white blood cells in phagocytosis.
  • Hyperbaric oxygen improves the immune system response.
  • Hyperbaric oxygen enhances the effect of some antibiotics.


2. Skin

Learn to love your body! Carefully and regularly inspect skin all over your body for any changes.


  • Keep your skin clean and hydrated.
  • Use non-aggressive soaps and do not rub your skin too hard.
  • After washing, dry off skin well especially between toes, under armpits, in the groin, breasts areas and other skin folds where fungal infections can develop.
  • Do not rub dry skin. Breaks or scratches could lead to infections and possibly hard to heal ulcers.
  • If your skin is dry, use moisturizers. Do not use moisturizers between the toes or where the skin folds are. For those areas and other skin folds use baby powder.
  • All minor skin problems such as cuts and scratches should be treated immediately by cleaning off the injured area and putting on bandages.
  • Seek professional help if you discover more serious problems.

Early warning signs:

  • Infection, bacterial (redness, swelling, pus or pain) or fungal (athlete’s foot, vaginal itching).
  • Insulin injection sites covered with rashes or bumps.
  • Blisters or bumps on the extremities which are signs of poor glucose control.

Hyperbaric Oxygen therapy (HBO) in treatment of skin disorders and infections:

  • Hyperbaric oxygen increases the tissue oxygen tension and provides adequate oxygen supply to low oxygen supplied area
  • Hyperbaric oxygen arrests infection and prevents sepsis development
  • Hyperbaric oxygen enhances some antibiotics and anti-fungal activity
  • Hyperbaric oxygen acts as an antibiotic (bactericidal and bacteriostatic), therefore impairs metabolism of microorganisms
  • Hyperbaric oxygen produces free oxygen radicals that are toxic to bacteria (inhibition of alpha-toxin production in gas gangrene)
  • Hyperbaric oxygen assists leukocyte in bacteria elimination (phagocytosis)
  • Hyperbaric oxygen speeds up wound healing
  • Hyperbaric oxygen in bone infections helps in removal of necrotic bone (osteoclastic function) and speeds up new bone formation (osteogenesis) 
3. Teeth and gums


  • Take special care of your teeth and gums.
  • Have regular dentist check up every six months. Brush at least twice a day, also cleaning gums and your tongue.
  • Use dental floss, but take care not to provoke bleeding. Gum disease could lead to parodonthosis.

Warning signs of diabetes could be the following:

  • Gum disease (tenderness, swelling, frequent bleeding, pus appearing at touch, retraction of the gum line from teeth)
  • Persistent bad breath and taste in the mouth
  • Changes in the alignment of the upper and lower jaw when biting
  • Change in the fit of dentures
  • Parodontosis


4. Kidney problems – Nephropathy

High blood pressure and diabetes can interfere with normal kidney functions disturbing the process of filtering waste products from the blood. It can also causing excess secretion of proteins in the urine. Fortunately, a normal kidney will have significant excess filtration capacity effectively delaying the onset of more serious symptoms. Noticeable problems of the kidney will not appear until 80% of the kidney is damaged. Kidney damage appears more frequently in type I diabetes, however it is common in type II diabetes in association with hypertension.


  • Maintain blood glucose levels under control
  • Maintain blood pressure under control
  • Maintain normal body weight and reduce the amount of salt intake
  • Maintain a low protein diet

Early warning signs:

  • Fluid buildup and swelling
  • Sleeplessness and tiredness
  • Vomiting
  • Weakness
  • Excess of proteins in urine

Prolonged kidney complications can lead to kidney failure, requiring dialysis and possible kidney transplant.

Hyperbaric Oxygen therapy in kidney and bladder problem:

  • Hyperbaric oxygen helps to reduce urinary urgency and frequency
  • Hyperbaric oxygen helps in preventing and reducing kidney and bladder infection
5. Feet


  • Be kind to your feet! Check and pamper them daily! Do not try to save money when buying shoes. Good fitted shoes of good quality will pay back many times.
  • Custom made shoes for feet with partial amputation with good fit and appropriately balanced shoe for non-amputated foot. People with already amputated or partial amputated foot are at greater risk of developing wounds on other healthy foot.
  • If blisters or wounds are developed make sure that the pressure is taken away from the wounded areas either by wearing pressure relieve bandages or cutting holes in the shoes.
  • Never walk bare feet. Use cotton socks as cotton allows the proper circulation of the air around the toes.
  • Wash your feet daily in the warm water with mild soap and dry well after washing, especially between the toes where fungus can develop. Limit soaking your feet to 10-15 minutes.
  • Use the moisturizing lotions or creams for the dry skin but avoid applying between the toes where you can use baby powder.
  • Dry skin on the feet and the calluses rub off gently with the fine file. Do not apply any force since the dry skin can break easily and make pathway for infection. For deep cracks in skin (fissures) use a special cream for cracked skin for diabetics.
  • Avoid having your feet too close to the fireplace or soaking them in hot water as well as exposing them to too cold environment because the sensitivity in diabetic people is impaired which can cause burns or frostbites without a person noticing it.
  • Check your feet with the mirror every day and watch for any redness, calluses, blisters, fungus, cuts or wounds. For painful pressure points use pressure-relieving bandages. Minor cuts or wounds clean with the cleaning solutions, first and apply the bandage. Treat funguses with anti-fungal cream. If the problem persist seek professional help
  • Cut your toenails once a week, preferably after washing when nails are soft. Do not cut nails too deep, avoid cutting into the corners, because you may cut the skin. File the nail edges carefully, since the sharp edges can make a sore that can get infected. If you cannot reach your toes or you cannot see well, see a pedicure that is knowledgeable in handing diabetic feet.
  • Wear comfortable shoes that have enough room for toes. Avoid pointy shoes, if you have any foot problem, such as partial amputation, developed wound, bunion, hammertoe or flatfeet wear a shoe adapted (customized) for this condition.
  • If you haven’t done it already, quit smoking!
  • On thick, hypertrophic nails reduce thickness with file
  • If necessary, use orthotics such as insoles, arch supports, toe dividers, that can be customized
  • Avoid wearing tight socks as they may limit the blood circulation to your feet.
  • Wear socks in bed if you easily get cold feet.
  • To reduce swelling elevate legs during rest
  • Avoiding positions with cross legs and prolonged standing would provide good circulation
  • Take care of regular intake of prescribed medications
  • Inspect and shake out shoes before putting them on. Due to insensitivity in your feet you may not feel small stones that could be trapped inside the shoe, causing the wound.


Hyperglycemia in diabetic people can cause 2 main problems to your feet:

1. Nerve damage or so called neuropathy which basically the lack of feeling or sensation. With damage nerves you may not feel pain, heat or cold in your legs or feet, you might let a wound or a cut on your foot get worse because you do not feel it is there. This can lead to infection and quickly develop into a gangrene that may require amputation

2. Poor blood flow or so called peripheral vascular disease is the problem when not enough blood is coming into your feet, making smaller skin problems such as cuts or small wounds quickly developing into larger and more serious wounds resistant to heal

Guidelines for buying shoes

When buying shoes keep in mind that a fit is the primary concern and fashion secondary. Do not try to save money when buying shoes. Good fitted shoes of good quality will pay back many times.

  • Avoid the shoes that are larger or smaller than your feet.
  • With your fingers check your shoe for the proper feet because the sensitivity in your feet could be reduced
  • Shoes should bend where the toes bend. Best is to buy shoes made of soft lather and have the heal height not more than one and a half inches.
  • Make sure that shoes are brought and deep in the toe area.
  • Seams and straps on shoes should be placed to avoid pressure areas
  • Do not use dress shoes for long walks
  • If your feet tend to swell in the afternoon, take an extra pair with you if you are away from home
  • Avoid slippers, sandals and loafers if going for a walk, because these type of shoes provides very little support
6. Cardiovascular problems

Most of the cardiovascular complications related to diabetes are due to a slower blood flow or a blockage of the blood vessels throughout the body. Slowing of the blood flow in diabetes is generally due to increased blood viscosity (thicker blood), whereas clotting of the blood vessels could be due to increased amount of lipids (fats) in the blood, that more readily stick to the blood vessels wall when there is increased glucose in the blood. Reducing the fats and cholesterol in your diet would decrease the blood lipids, like cholesterol and triglycerides.

When blood vessels are narrowed or clogged, the blood supply to the heart is reduced, causing chest pain or so called angina. When a blood vessel in or near the heart becomes blocked, this can lead to heart attack People with diabetes are 2 to 4 times more likely to get heart disease. More than half of the death in older people with diabetes is due to cardiovascular disease.


The goal is to increase the amount of oxygen going to the heart!

  • Keep under control your blood sugar levels and blood pressure
  • Stop smoking!
  • Keep blood cholesterol and other blood fats as close to normal by eating a healthy high-fiber and low-fat diet
  • If prescribed, the pills for blood and blood pressure and diabetes they have to be taken regularly, and preferably at the same time every day
  • Some doctors may tell you to take an aspirin every day to help protect your heart
  • Find the physical activity you like and stay active

Signs and symptoms:

  • Shortness of breath
  • Pain in the chest, arms, shoulder or back
  • Tiredness
  • Weakness, sweating
  • Nausea
  • Indigestion
  • Swollen ankles or feet

If you are at risk of developing diabetes or currently living with it, you need to pay close attention to your circulation and how well it delivers oxygen.

Oxygen deficiency is typically caused by poor microcirculation. Lack of oxygen is the basis for serious illnesses where tissue and organs start to break down.

  1. Diabetes is the leading cause of leg amputation (50%)
  2. chronic kidney failure (50%)
  3. blindness (12%)
  4. stroke and heart attack

ref: Canadian Diabetes Association

Early warning signs of numbness and pain can easily escalate to chronic wounds, gangrene, amputation or worse.

Diagnosis of poor oxygen supply is important and can be done with a micro-circulation assessment. 

Further reading:
  1. Adams KR, Mader JT: Aminoglycoside potentiation with adjunctive hyperbaric oxygen therapy in experimental Pseudomonas Aeruginosa osteomyelitis. Undersea Biomed Res; 14 (suppl):37, 1987.
  2. Ackerman NB, Brinkley FB: Oxygen tensions in normal and ischemic tissues during Hyperbaric therapy. JAMA 198:142-145, 1966
  3. Bakker DJ: Hyperbaric oxygen therapy and the diabetic foot. Diabetes Metab Res Rev; 16 Suppl 1: S55-8. Review, Sep-Oct; 2000
  4. Baroni G, Porro T, Fuglia E et al.: Hyperbaric oxygen in diabetic gangrene treatment. Diabetes Care 10:81-86, 1987
  5. Bird AD, Telfer A: Effect of hyperbaric oxygen on limb circulation. Lancet 13:355-356, 1965
  6. Brakora MJ, Sheffield PJ: Hyperbaric oxygen therapy for diabetic wounds. Clin Podiatr Med Surg; 12 (1): 105-17. Review, Jan 1995
  7. Boykin JV: Hyperbaric oxygen therapy: a physiological approach to selected problem wound healing. Wounds; 8(6): 183-198, 1996
  8. Boykin JV: Wound healing management: enhancing patient outcomes and reducing costs. J Healthc Resour Manag; 15: 4:22, 24-6, May 1997
  9. Cavanagh PR, Buse JB, Frykberg RG, et al: Consensus Development Conference on Diabetic Foot Wound Care. Diabetes Care;22(8):1354-1360, 1999
  10. Chantelau E: Hyperbaric oxygen therapy for diabetic foot ulcers. Diabetes Care; 20(7):1207-8 Jul 1997
  11. Chen-Yin Chen, et al: Adjuvant Hyperbaric Oxygen Therapy in the Treatment of Hemodialysis Patients with Chronic Osteomyelitis. Renal Failure, 30:233–237, 2008
  12. Cianci P, Hunt TK: Adjunctive hyperbaric oxygen therapy in treatment of diabetic foot wounds. The Diabetic Foot. Fifth Edition; Chpt 14:306-319, 1993
  13. Cianci P: Adjunctive Hyperbaric oxygen therapy in the treatment of the diabetic foot. J Am Podiatr Med Assoc; 84(9): 448-55. Review, Sep 1994
  14. Cianci P, Hunt TK: Long-term results of aggressive management of diabetic foot ulcers suggest significant cost effectiveness. Wound Repair and Regeneration; 5 (2): 141-146,1997.
  15. Ciaravino ME, Friedell ML, Kammerlocher TC: Hyperbaric oxygen in treatment of nonhealing wounds. Annals of vascular surgery; 10 (6): 558-62, Nov 1996
  16. Davis JC, Hunt TK: The Role of Oxygen. Problem Wounds Elsevier Science, New York 1988.
  17. Demello F.J., Hashimoto T., Hitchcock C.R., and Haglin J.J. The effect of hyperbaric oxygen on the germination and toxin production of Clostridium perfringens spores. In Wada J. and Iwa J.T. (eds): Proceedings of the Fourth International Congress Hyperbaric Medicine. Baltimore: The Williams & Wilkins Cop; 276, 1970,
  18. Ehrlich HP, Grislis G, Hunt: Metabolic and circulatory contributions to oxygen gradients in Wounds. Surgery; 72:578-583,1972
  19. Faglia E, Favales F, Aldeghi A, Calia P, Quarantiello A, Oriani G, Michael M, Campagnoli P, Morabito A: Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. Diabetes Care; 19(12): 1338-1343,1996.
  20. Faglia E, Favales F, Aldeghi A, et al: Change in major amputation rate in a center dedicated to diabetic foot care during the 1980s: prognostic determinants for major amputation. J Diabetic Complications; 12:96-102. 1998;
  21. Farrell H.: Hyperbaric oxygen in the management of foot lesions in diabetic patients. Fourth Consensus Conference of the European Committee on Hyperbaric Medicine. London, December 4-5, 1998. Diabetes Nutr Metab; 12 (1): 47-8. Review, Feb 1999
  22. Hammarlund C, Sundberg T: Hyperbaric oxygen reduced size of chronic leg ulcers: a randomized double blind. Plastic Reconstructive Surgery; 93:829-834,1994.
  23. Hart GB, Lamb RC, Strauss MB: Gas gangrene I. A collective review. II. A 15-year experience hyperbaric oxygen. J Trauma; 23:991-1000, 1983
  24. Hart GB, Strauss MB: Gas gangrene–clostridial myonecrosis: a review. Journal of Hyperbaric Medicine;5(2):125-144,1990
  25. Hehenberger K, Brismar K, Lind F, et al.: Dose Dependent Hyperbaric Oxygen Stimulation of Human Fibroblast Proliferation. Wound Repair and Regeneration; 5:147-150,1997
  26. Hirn M, Niinikoski J, Lehtonen OP: Effect of hyperbaric oxygen and surgery on experimental multimicrobial gas gangrene. Eur Surg Res;25:265-269,199
  27. Hirn M: Hyperbaric oxygen in the treatment of gas gangrene and perineal necrotizing fasciitis. European Journal of Surgery; Supplement (570):1-36, 1993
  28. Hunt TK, Conolly WB, Aronson SB, Goldstein P: Anaerobic metabolism and wound healing: A hypothesis of the initiation and cessation collagen synthesis in wounds. The American Journal of Surgery; 135: 328-332, Mar 1978
  29. Hunt TK,Zederfeld B, Goldstick TK: Oxygen and healing. The American Journal of Surgery; 118: 521-525, 1969
  30. Jain KK: Hyperbaric Oxygen Therapy in Infections. Textbook of hyperbaric medicine: Ch 13, Hogrefe & Huber Publishers, Inc., 3rd Ed.13: 189 –211, 1999.
  31. Jain KK: Hyperbaric Oxygen Therapy in Wound Healing. Textbook of hyperbaric medicine: Ch 14, Plastic Surgery, and Dermatology, Hogrefe & Huber Publishers, Inc., 3rd Ed.14: 213–241, 1999
  32. Jones H.P. The role of oxygen and its derivatives in bacterial killing and inflammation. In Gottlieb S.F., Longmuir I.S., and Totter J.R. (eds): Oxygen: An In-Depth Study of its Pathophysiology. Bethesda, Maryland: Undersea Medical Society, pp. 493-516, 1984
  33. Kindwall EP: Effects of Hyperbaric Oxygen Therapy in Infections Disease: Basic Mechanisms, Hyperbaric Medicine Practice: Ch 10, Best Publishing Company, 2nd Ed.10: 205-244,1999
  34. Kindwall EP: Wound Management: Best Chronic Wound Care Practices for The Hyperbaric Practitioners, Hyperbaric Medicine Practice: Ch 17, Best Publishing Company, 2nd Ed: Ch 17:395-429,1999
  35. Kindwall EP: Enhancement of Healing in Selected Problem Wounds, Hyperbaric Medicine Practice: Ch 33, Best Publishing Company, 2nd Ed: Ch 33:813-850,1999
  36. Kivisaari J, Niinikoski J: Effects of hyperbaric oxygenation and prolonged hypoxia on the healing of open wounds. Acta Chir Scand; 141(1): 14-9, 1975
  37. Knighton DR, Silver IA, Hunt TK: Regulation of wound healing angiogenesis- Effect of oxygen gradients and inspired oxygen concentration. Surgery; 90(2): 262-270, Aug 1981
  38. Milington JT, Norris TW. Effective treatment strategies for diabetic foot wounds. J Fam Pract 2000 Nov;49(11 Suppl):S40-8.
  39. Niinkoski J, Hunt TK, Dunphy JE: Oxygen supply in healing tissue. Am J Surg; 123: 247-252, March 1972
  40. Niinikoski J. Effect of oxygen supply on wound healing and formation of experimental granulation tissue. Acta Physiol Scand; 334:1-72, 1969.
  41. Oriani G: Chronic Hyperbaric Oxygen Therapy Indications. Handbook on Hyperbaric Medicine, Springer; 110-124,1996
  42. Oriani G, Meazza D, Favales F, et al: Hyperbaric oxygen therapy in diabetic gangrene. Journal of Hyperbaric Medicine; 5(3): 171-175, 1990
  43. Reiber GE, Pecoraro RE, Koepsell TD: Risk factors for amputation in patients with diabetes mellitus. Annals of Internal Medicine; 117: 97-105, 1992.
  44. Stephens MB: Gas gangrene: potential for hyperbaric oxygen therapy. Postgrad Med; 99(4): 217-20, 224. Apr 1996
  45. Stone JA, Cianci P: The adjunctive role of hyperbaric oxygen therapy in the treatment of lower extremity wounds in patients with diabetes. Diabetes;10(2): 118-123, 1997
  46. Zamboni WA, Wong HP, Stephenson LL, Pfeifer MA: Evaluation of hyperbaric oxygen for diabetic wounds: prospective study. Undersea Hyper Med;24(3): 175-179, 1997
  47. Weisz G, Ramon Y, Waisman D, Melamed Y: Treatment of necrobiosis lipoidica diabeticorum by hyperbaric oxygen. Acta Derm Venereol; 73(6): 447-8, Dec1993
  48. Williams RL: Hyperbaric oxygen therapy and the diabetic foot. J Am Podiatr Med Assoc; 87(6): 279-92. Review, Jun 1997;
  49. Staples J, Clement D.Hyperbaric oxygen chambers and the treatment of sports injuries. Sports Med. 1996 Oct;22(4):219-27. Review.
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  51. K.K. Jain, “Hyperbaric Oxygen as an Adjuvant in Rehabilitation and Sport Medicine” Hyperbaric Medicine 1999; 31: 440-445
  52. K.K. Jain, “Hyperbaric Oxygenation in Traumatology and Orthopedics” Hyperbaric Medicine 1999; 26: 390 –403
  53. “Canadian Diabetes Association Technical Review: The Diabetic Foot and Hyperbaric Oxygen Therapy”, Canadian Journal of Diabetes, 2006, 30(4):411-421
  54. “Adjunctive Hyperbaric Oxygen Therapy for Diabetic Foot Ulcer: An Economic Analysis”, Canadian Agency for Drugs and Technologies in health, March 2007
  55. “Medical Progress: Hyperbaric-Oxygen Therapy”, Review Articles, The New England Journal of Medicine, 334(25):1642-1648, June 1996

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Diabetes Neuropathy
P K - Vancouver

“I love to dance but had to stop because of numbness in my feet that caused me to slip and rip my Achilles tendon. After intense oxygen therapy the feeling is back in my feet and I’m back dancing again.” 

 ..Dr. Sosiak says, "the evidence is there" -- not only that HBOT works "about 75 per cent of the time," but also that it's cost-effective. "Amputation in Canada, using the CDA's own figures, costs about $74,000," he said, while an average course of HBOT treatment -- 30 or 40 are usually needed to fully heal a diabetic ulcer -- costs between $8,000 and $12,000.

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 Information contained on this site is intended for general consumer understanding and education. It should not be used as a substitute for any medical professional opinion, advice or prescribed medication nor should it serve as diagnosis or treatment of health problems.