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Manage Your Diabetes Well

If you have been diagnosed as diabetic, the first consideration for specific Diabetic Foot Care is, of course, to manage your diabetes well. To consistently attend to the treatment plan provided by your PCP or endocrinologist. There needs to be a lifetime commitment to diet, exercise, and your overall health. When you have a scheduled appointment with your doctor be sure to take off your shoes and socks. Ensure that the PCP checks your feet as well.

WHO IS AT RISK?

There are millions of diabetics out there. Their disease processes are not all the same.

THOSE NOT AT RISK.

Most diabetics have controlled blood glucose levels. They also have adequate circulation to their extremities and demonstrate normal sensations in their feet. This group experiences about the same risk for foot problems as everyone else. To repeat, this group has circulation adequate to heal wounds normally without infections. There is normal protective nerve function in order to perceive the sensations of light touch, distinguish sharp from dull, have a normal sense of vibration, note pressure changes and to be able to differentiate between hot and cold. This is good news, however, remain vigilant!

THOSE AT RISK!

Some diabetics are at real risk of serious health problems. Those at risk have one or more of these medical problems.

1. Poorly controlled blood glucose levels.
2. Poor circulation in their extremities.
3. Altered or poor sensation in their feet.

Although the levels of risk vary among these individuals, many can sustain the following: 1. Unrecognized injuries such as cuts, fractures, blisters, heavy calluses, ulcer formation and burns. 2. More frequent bacterial infections which may be difficult to treat and require long-term antibiotic treatment and hospitalization. 3. Increased complexity of medical problems.

DIABETICS AT RISK should at least be doing the following:

1. Keep regular appointments with their PCP and assigned specialists. Follow the entire treatment plan provided to you. If you have questions or concerns, get them addressed, sooner rather than later.
2. Have an appointment with a podiatrist at least every 10 weeks for a foot exam and nail care. The 10 week interval is established by Medicare. This will be covered by medical insurance.
3. Always wear appropriate shoes and socks. By appropriate I mean clean, breathable, well fitting and shock absorbing. Shoes should be fitted by knowledgeable personnel. Ask your PCP about the Medicare shoe program. This program provides for shoes and inserts to all qualified diabetics once a year. On the other hand, in the house on rugs or on the sofa..i.e. a safe environment,…. Take your shoes off. Your feet need air. Being constantly in shoes all day will probably keep your feet damp. This will make the skin more susceptible to breaking down, especially between the toes.
4. Check your feet daily or if you can’t, get someone to help check your feet. Look for cuts, bruises, or any new and unusual findings.
5. Keep your feet clean. Get help if you can’t reach them. Clean well between you toes.
6. Check water temperature with your hands before immersing your feet.
7. Again, do not cut your own nails…. Don’t have your spouse or neighbor cut your nails either. See a podiatrist every 10 weeks for this, corns, calluses, and poor sensation is a dangerous combination.
8. Modified protective inserts in the correct shoe is essential equipment!
9. DON’T SMOKE. Chemicals found in tobacco diminish circulation in small vessels. The disease process of diabetes can also cause this.
10. Never use medicated “corn” pads. Avoid using strong adhesive bandages on your skin.
11. Protect your feet from extreme heat and extreme cold.

This all gets very complicated, doesn’t it? That’s why it’s good to get help from your medical professionals in a timely fashion.

WHAT DO CHRONICALLY HIGH GLUCOSE LEVELS IN BLOOD DO?
Chronically high blood glucose levels (blood sugar) affect the normal function of nerves permanently and cause changes in blood flow in the small vessels, especially in the toes. Nerve damage results in partial or total loss of feeling in the feet so that, the natural presence of pain, that warns of dangerous conditions, is diminished or, at worst, not functional at all. This means that a patient with profound neuropathy will be unlikely to detect a blister forming on a toe in a tight shoe or….. Will not be aware that they are stepping on something that will penetrate the skin…. or be unaware of being burned by shower water that is too hot…… or sustaining burns from walking barefoot across a hot parking lot or on the hot sand at the beach…… or sustaining a cold-weather injury from standing too long in a frozen parking lot.

Well cushioned shoes and inserts are essential for a person with profound loss of sensation in their feet because patients with this condition tend to impact the ground with greater forces which eventually cause fractures throughout the foot.

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