Diabetes is a serious condition, but it is also one where your daily choices have a direct impact on your long-term outcomes. Careful, consistent management can significantly reduce your risk of the complications that make diabetes most dangerous: heart disease, kidney damage, vision loss, nerve damage, and more.
This guide covers the most important things to watch for across several areas of health, from fatigue and skin changes to eye health and sleep, and what you can do to stay ahead of problems before they become serious.
10 Ways to Avoid Diabetes Complications
Managing diabetes well takes consistent daily effort, but the payoff is a dramatically lower risk of life-threatening complications. Here are the most important habits to build:
- Commit to your treatment plan: Learn everything you can about diabetes. Take your medications as prescribed, monitor your blood sugar regularly, and work with your care team. Your healthcare team can guide you, but the daily execution is yours.
- Do not smoke: Smoking significantly worsens diabetes complications. It reduces blood flow to the legs and feet (increasing infection and amputation risk), raises blood sugar, worsens heart disease risk, damages kidneys, and can cause vision loss. If you smoke, quitting is one of the most impactful changes you can make.
- Manage blood pressure and cholesterol: High blood pressure and high cholesterol each damage blood vessels independently. Combined with diabetes, the three together dramatically increase the risk of heart attack, stroke, and kidney disease. A healthy diet, regular exercise, limited alcohol, and medication if needed are all part of managing these numbers.
- Schedule regular checkups and eye exams: Have 2 to 4 diabetes checkups per year plus a yearly physical. Your provider will screen for kidney damage, nerve damage, heart disease, and foot issues. Schedule a separate annual eye exam with an optometrist or ophthalmologist.
- Stay current on vaccines: Diabetes weakens the immune system. Get a yearly flu shot, stay up to date on COVID-19 boosters, ask about the pneumonia vaccine (especially if you are over 65 or have complications), hepatitis B vaccine (if under 60 and not previously vaccinated), and shingles and RSV vaccines if you are over 50 or 60 respectively.
- Take care of your teeth: Diabetes raises the risk of serious gum infections. Brush at least twice a day with fluoride toothpaste, floss daily, and see a dentist at least twice a year. Contact your dentist promptly if gums bleed or look swollen.
- Check your feet every day: High blood sugar reduces circulation and nerve sensation in the feet. Wash feet daily in lukewarm water, dry gently, moisturize (but not between the toes), and inspect daily for cuts, blisters, calluses, redness, or swelling. Never go barefoot. Any wound that does not begin healing within a few days needs prompt medical attention.
- Use alcohol carefully: Alcohol can raise or lower blood sugar unpredictably. If you drink, do so only in moderation (one drink per day for women, two for men), always with food, and be aware that low blood sugar can occur hours after drinking.
- Ask about daily aspirin: If you have diabetes plus other heart disease risk factors like high blood pressure or smoking, your provider may recommend low-dose aspirin to reduce heart attack and stroke risk. Do not start aspirin therapy without discussing it with your provider first.
- Take stress seriously: Chronic stress makes blood sugar harder to manage. Prioritize sleep, set realistic limits on your commitments, practice relaxation techniques, and seek professional support for anxiety or depression, both of which are significantly more common in people with diabetes.
Why Diabetes Causes Fatigue
Persistent tiredness is one of the most common complaints among people with type 2 diabetes, and it has multiple causes.
The most direct cause is blood sugar dysfunction: when glucose cannot enter cells properly due to insulin resistance, cells are starved of energy even when blood sugar is high. Low blood sugar (hypoglycemia), a side effect of insulin and some oral medications, can also cause sudden fatigue and weakness.
Beyond blood sugar itself, several other factors compound fatigue in diabetes:
– Sleep disruption: Overnight blood sugar swings cause wake-ups, frequent urination can interrupt sleep, and type 2 diabetes is strongly linked to sleep apnea, which fragments rest without the person always realizing it – Mental health: Anxiety and depression are significantly more common in people with diabetes and are major drivers of chronic tiredness – Diabetes management itself is time-consuming and mentally taxing, which adds to everyday exhaustion – Medications: Metformin can cause B12 deficiency (a fatigue cause), GLP-1 agonists and statins can list fatigue as a side effect, and blood pressure medications including beta-blockers often cause tiredness – Complications: Kidney disease, heart problems, anemia (which is more common in people with diabetes), and hypothyroidism (also more common in diabetes) all independently cause fatigue
If you are exhausted, tell your provider specifically how fatigue is limiting your daily function. Do not just say you are tired. Say you are too tired to walk, prepare meals, or follow your treatment plan. That level of detail helps your provider identify the cause and address it.
Note: Keeping a symptom journal tracking nighttime wake-ups, energy patterns, and meal habits can help you and your provider spot patterns and identify what is driving your fatigue.
Diabetes and Your Eyes: Why Annual Exams Are Non-Negotiable
About 90 percent of diabetes-related vision loss can be prevented if eye disease is caught and treated early. Yet only about half of people with diabetes receive the recommended yearly eye screenings.
High blood sugar damages the small blood vessels in the eyes over time, leading to conditions including:
– Diabetic retinopathy: Damage to the blood vessels of the retina, the leading cause of blindness in working-age adults – Diabetic macular edema: Swelling in the central part of the retina – Cataracts: Develop at higher rates in people with diabetes – Glaucoma: Increased pressure in the eye, also more common with diabetes
The critical issue is that early-stage diabetic eye disease has no symptoms. Vision may seem completely normal while significant damage is occurring. By the time symptoms appear, irreversible damage may already have happened.
A yearly dilated eye exam (where drops widen the pupil so the provider can see the back of the eye) is the standard of care. Some primary care offices now offer retinal photography as a convenient alternative that can be reviewed remotely by an ophthalmologist.
Common reasons people skip eye exams and what to do about them:
- Vision seems fine: Eye changes from diabetes develop slowly and silently; normal vision does not mean the eyes are unaffected
- Too many appointments already: Ask whether retinal photography can be done at your primary care visit
- Cost or insurance concerns: Diabetes eye exams are often covered by medical insurance (not just vision insurance) as a medically necessary service; ask your insurer
- Anxiety about the exam: Ask your provider to walk you through each step; treatments for any issues found, including lasers and injections, are not painful
- Limited access: Telehealth eye screening and mobile screening services are increasingly available; ask your provider or local hospital
Note: If you are pregnant and have diabetes, see an eye specialist each trimester and one year postpartum, as diabetic retinopathy can worsen significantly during pregnancy.
Diabetes and Skin: What to Watch For
Skin changes are sometimes the first visible sign of diabetes or worsening blood sugar control. Some are cosmetic; others signal a need for medical attention.
Skin conditions more common in people with diabetes include:
Bacterial infections: Styes, boils, folliculitis, carbuncles, and nail infections. Caused most often by Staphylococcus bacteria. High blood sugar impairs the body’s ability to fight infection. Seek medical care if you notice hot, red, swollen, or painful skin.
Fungal infections: Often caused by Candida albicans. Appear as red, itchy rashes with blisters and scaling in warm, moist areas like skin folds, under the breasts, between fingers, in the armpits, groin, or around the nails. Common forms include athlete’s foot, jock itch, and vaginal yeast infections.
Itching: Can result from dry skin, poor circulation, or yeast infections. If poor circulation is the cause, the legs are often most affected. Limit harsh soaps and bathe less frequently in dry weather.
Acanthosis nigricans: Tan or brown raised patches in skin folds around the neck, armpits, and groin. Often associated with insulin resistance and excess weight. Weight loss is the primary treatment.
Diabetic dermopathy: Light brown, scaly patches on the front of the legs. Harmless and does not require treatment.
Diabetic blisters: Painless blisters on the hands, feet, or legs that resemble burn blisters. Occur in people with neuropathy. Heal on their own in about three weeks when blood sugar is controlled.
Eruptive xanthomatosis: Firm, yellow, pea-sized bumps with a red halo, most common on the hands, feet, arms, and legs. Indicates poorly controlled diabetes with high blood fat levels. Resolves when diabetes is better managed.
Note: Good skin care starts with good blood sugar control. Keep skin clean and dry, moisturize regularly, treat minor cuts immediately with soap and water, and never ignore a wound that is not healing. See a provider promptly for any skin problem that does not improve on its own.
Sleep, Diabetes, and Blood Sugar: A Two-Way Relationship
Sleep and blood sugar are deeply interconnected. Poor sleep makes diabetes harder to manage; poorly managed diabetes makes sleep harder to get. Both directions of this cycle matter.
How poor sleep worsens diabetes:
– Increases insulin resistance – Raises appetite and cravings for high-calorie foods – Makes weight management harder – Weakens the immune system – Increases the risk of anxiety and depression
How diabetes disrupts sleep:
– Overnight blood sugar swings (both high and low) can cause waking – Frequent urination from high blood sugar interrupts sleep – CGM alarms can cause fragmented rest – Type 2 diabetes is strongly linked to obstructive sleep apnea, which causes repeated micro-awakenings that leave the person unrefreshed even after a full night in bed
Practical habits to improve sleep quality:
– Set a caffeine cutoff at least 6 hours before bedtime – Keep the bedroom cool (around 65 degrees Fahrenheit) – Turn on night mode on devices in the evening to reduce blue light exposure – Take a warm bath or shower about an hour before bed, which helps the body temperature drop and promotes sleep onset – Do gentle stretching before bed to relieve muscle tension – Review your evening blood sugar before bed and treat any low readings with a small protein and complex carbohydrate snack to reduce overnight drops
Note: If you snore or wake up unrefreshed despite adequate sleep time, ask your provider about a sleep apnea evaluation. Sleep apnea is both common and highly treatable in people with diabetes, and addressing it can make a meaningful difference in blood sugar control.
Inflammation, Obesity, and Diabetes: Breaking the Cycle
Obesity, chronic inflammation, and type 2 diabetes are interconnected in a self-reinforcing cycle. Excess body fat, particularly belly fat, triggers the release of inflammatory chemicals (cytokines) that disrupt insulin function. This inflammation increases insulin resistance, worsening blood sugar control. High blood sugar creates more inflammation, making it harder to lose weight. And the cycle continues.
Chronic inflammation can also damage blood vessels, contributing to heart disease, kidney disease, neuropathy, and retinopathy. It may even increase cancer risk (breast, lung, liver) and is linked to gut imbalances associated with asthma, liver disease, and Alzheimer’s disease.
The good news is that the same habits that manage diabetes also reduce inflammation:
– Anti-inflammatory diet: A Mediterranean-style eating pattern centered on fruits, vegetables, whole grains, lean protein, beans, nuts, olive oil, and seafood has been shown to reduce inflammatory markers and improve insulin sensitivity. Limit red and processed meat, fried foods, white flour products, and sugary drinks. – Regular exercise: Both aerobic and strength training lower blood levels of inflammatory markers. Results can persist for 24 hours or more after a workout. – Weight loss: Losing as little as 5 percent of body weight reduces the fat tissue that drives inflammatory signaling. Losing 15 percent or more produces more substantial risk reduction. – Medications: GLP-1 agonists (semaglutide), metformin, and SGLT2 inhibitors all have documented anti-inflammatory effects in addition to their primary blood sugar lowering roles.
Note: Steroids (corticosteroids), while powerful anti-inflammatories, can significantly raise blood sugar and make diabetes harder to control. If you are prescribed steroids for any reason, let your diabetes provider know and monitor your blood sugar more closely during that period.