Caring for your feet when you have diabetes

People with diabetes need to get to know their feet like - well, like the back of their hand. That's because the high blood glucose levels common in diabetes can lead to two types of damage that spell trouble for the feet:

  • blood vessel damage: Blood vessel damage can reduce blood flow to the feet, which can make the feet more vulnerable to ulcers and infection and make wounds slower to heal.
  • nerve damage: The nerves that carry messages from the feet to the brain can be compromised by too much glucose in the blood. This nerve damage is called neuropathy. When that circuit is interrupted by nerve damage, your feet might have a burning, numbing, or tingling sensation, or you might not be able to sense pain. That sounds like a good thing until you realize that feeling pain is what signals you that problems are afoot.

So say you wear new shoes, and they rub a blister onto your heel. With nerve damage, you might never know that the blister is there at all. And a simple blister that goes undetected can grow into a deep sore, known as an ulcer. An ulcer that becomes infected is a serious condition. Add reduced blood circulation to the mix, and the healing process slows down. To compound the problem, glucose-rich blood provides plenty of food for germs, making infection even harder to fight off.

Left undetected or untreated, ulcers and other foot injuries can affect mobility, changing a person's weight distribution on their feet and boosting their risk of blisters and calluses. Infections can even advance to the point of gangrene. In fact, people with diabetes are at an elevated risk of foot or leg amputation compared to people without diabetes. Amputation is needed to prevent gangrene from spreading to other parts of the body.

Take steps to better foot care

Foot care actually starts far from your feet. Undoubtedly, the first and best strategy for healthy, happy feet is to manage your blood glucose levels. Keep your levels on target as often as possible, and you will minimize and even prevent the damage to your nerves and to your blood vessels. And smokers with diabetes, be advised: smoking decreases blood flow to your feet and can increase the risk of amputation.

Beyond blood sugar management and stopping smoking, there are several things you can do directly to manage your feet:

Go on a daily feet-scanning mission
Just like brushing your teeth or washing your face, checking your feet should be a part of your everyday routine.

  • Check all sides of your feet - tops, bottoms, the toes, in between the toes, on the heels. You're searching for any sign of potential trouble: ingrown toenails, cuts, cracking or dry skin, calluses, blisters, sores, corns, or warts.
  • Changes in skin temperature could also signal developing sores.
  • You can do your scan in the bath or shower, in bed, wherever it's easiest for you to see your feet well.
  • For those with mobility issues or who cannot reach their feet, you can ask a friend or family member to help out. Some people use mirrors to get a better view of the bottoms of their feet. Mirrored weigh scales are also available.
  • If you notice any changes or troubling marks, consult your physician, primary health care provider, or foot specialist. Do not attempt to self-treat injuries or infections - even something as seemingly minor as an ingrown toenail.

Treat your feet with TLC
When you have diabetes, keeping your feet clean is crucial. But the simple act of washing your feet becomes a little more involved.

  • Wash your feet daily in warm water using a mild soap. This means wash - not soak. Soaking can dry the skin. And warm water - not hot or cold. Nerve damage may make it hard to tell how hot or cold the water is, so test the temperature with your hand or your elbow.
  • Dry your feet well. Be gentle. Use a soft towel to pat dry and don't forget between your toes. Avoid scrubbing or rubbing the skin too briskly.
  • Moisturize your feet - your heels and soles - in the morning and at bedtime. Dry skin can crack and leave you susceptible to infection. Excess moisture also welcomes germs, so don't use too much lotion, and never apply it between the toes. Shake on unmedicated powder to minimize sweating.
  • After a shower, your nails are softer, so that's the perfect time to tidy up your toenails. Trim nails straight across and not too short to prevent ingrowns. If your nails have grown too thick (e.g., due to fungal infection such as athlete's foot), you may need to have someone help you.

Keep them covered
Something as straightforward as putting on your shoes and socks presents potential problems.

  • Before slipping your feet into your shoes, look into each shoe and use your hand to feel around inside. You never know when a stray pebble, thumbtack, or paperclip could be awaiting your foot.
  • Buying new shoes? Since feet swell through the day, it's best to shop for shoes late in the afternoon.
  • Choose shoes that fit properly, that don't rub blisters, that provide cushioning, and that encourage even distribution of weight across the foot. Flip-flops, sandals, or peep-toe, pointy-toed, high-heeled, or worn-out shoes are not recommended.
  • Once you have a new pair of shoes, allow time to break them in. During the first few weeks, wear them for only 1 to 2 hours at a time.
  • Socks rock. Always wear socks or stockings to keep feet from sweating too much or rubbing blisters. Switch your socks daily, and opt for looser-fitting ones that are not tight around the ankles.
  • During colder weather, wear loosely-fitted wool socks to protect your feet from moisture and frostbite.
  • Never go barefoot! Wear slippers or shoes at all times when you will be walking around, even indoors.
  • Put your feet up when sitting. Don't cross your legs for long periods of time.

Have your health care provider perform periodic foot check-ups
Most physicians and primary health care providers know that foot care is a priority for people with diabetes, but you can advocate for your own two feet, too.

  • Remove your shoes and socks when you're waiting for your health care provider. This way, neither of you can forget about your feet.
  • Don't be foot-shy. If you have a question or concern, speak up.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Diabetes-Self-Care

Diabetes and your skin

At some point in their lives, about 1 in 3 people with diabetes will develop a skin disorder related to their condition. Just a few factors take the blame for most diabetes-related skin problems, including nerve damage, poor circulation due to damaged blood vessels, high blood glucose levels, and reactions to the pokes and jabs from insulin injections or home blood glucose testing.

Nerve damage interrupts the messages your skin sends when it's in danger from infection, injury, or excessive dryness. It also decreases your body's sweat output, which can leave skin overly dry. Damaged blood vessels causing poor circulation deprives the skin of oxygen and can lead to ulcers, infections, and wounds that heal slowly. Changes in blood flow can also cause a condition called necrobiosis lipoidica diabeticorum, leading to yellow, waxy, and raised skin that is often lined with a purple border.

When blood glucose levels are high, the body tries to flush out some of the glucose through the urine. In this way, your skin loses precious fluids that it needs to keep the skin healthy and moisturized. Skin that becomes very dry can crack and peel and leave a person vulnerable to bacterial and fungal infections that may be severe and slow to heal. Germs can also enter through cracks in the skin and feed off glucose-rich blood, making infection more likely to occur.

Life with diabetes can be filled with many pokes and injections. Daily blood glucose tests require tiny pin-pricks to the skin, and the skin can become irritated. Rarely, insulin injections spark allergic reactions with pain, burning, redness, itchiness, and swelling around the injection site. Some people are even allergic to the adhesives, tapes, and wipes that are used to prepare skin for injections or to hold insulin pumps in place. More common are the fatty deposits (lipohypertrophy) that can develop beneath the skin on the spots where insulin is repeatedly injected, making the skin appear lumpy or indented. To avoid these deposits, switch up injection sites from day to day.

Tips for skin care

  • Control your blood glucose level. It is not always easy, but maintaining a healthy balance in your blood glucose could work wonders for your skin.
  • Wash and dry. Keep your skin clean by washing in warm water and using mild soap. Gently pat-dry your skin, paying extra attention to places where water can hide - under arms, under breasts, between legs, or between toes. Make quick "skin scans" a part of your shower routine. Limit bathing and using hot water, as they strip the skin of oils and make skin even drier. Check your feet every day for small cuts or scrapes that can often go unnoticed. Take care when clipping toenails.
  • Moisturize. Massage lotion or moisturizer into your skin after washing. Don't skimp on dry-patch-prone spots like elbows, knees, and heels.
  • Chafe-proof your skin. Pat non-medicated talcum powder onto any areas where skin touches skin, such as between the thighs.
  • Stay hydrated. This is good skin care advice for everyone! Drink lots of fluids to keep your skin supple.
  • Dress the part. Wear breathable materials, especially on areas prone to moisture.
  • Humidify your home. During the winter months, use a humidifier to moisten the air dried out by radiators and forced heating.
  • Protect your skin from the sun. While this is true for everyone, wearing sunscreen will protect your skin from the burning and blistering that can lead to dangerous infections..

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Diabetes-Self-Care

Diabetes: caring for your eyes

Diabetes can wreak havoc on the body in surprising ways. A person with diabetes may see changes to their energy levels, their weight, or their skin. One change they may not see coming is the way diabetes can affect their vision.

People with diabetes often develop cataracts at a younger age. They experience glaucoma more than others, and 40% to 45% of people with diabetes will face diabetic retinopathy (damage to the tissue at the back of the eye called the retina). It is the most common cause of blindness in people under the age of 65.

The retina senses light as it enters the eye, and it is a vital component of good vision. In diabetic retinopathy, elevated blood glucose levels can damage the vessels that feed and nourish the retina. People with diabetes who also have high blood pressure are at a much higher risk for diabetic retinopathy because high blood pressure can also damage the retina.

The early stage of retina damage is called nonproliferative retinopathy. Weakened vessel walls can leak blood into the retina. Bulges in the vessels may develop. The leaking vessels often lead to swelling in the retina and cause a decrease in vision. A person with eye damage at this point may have normal vision or slightly blurred vision.

Over time, the damaged vessels can no longer provide enough oxygen to the retina, causing parts of the retina to die. At advanced stages of retinopathy, called proliferative retinopathy, the body may trigger the production of new blood vessels to supply the retina. But these new blood vessels are often weak, leading to even more bleeding into the retina. This, in turn, can block light from reaching the back of the eye, obscuring vision with floating spots along with decreased vision. Eventually, the damaged vessels may form scar tissue and tear away from the eye. An untreated detached retina can lead to vision loss or full blindness.

The loss of vision may be due to macular edema (swelling of the macula). The macula is the part of the eye where the most detailed and clear vision occurs. When fluid leaks into the centre of the macula, the swelling causes blurred vision. Macular edema can occur at any time, but it is more likely to happen as the retinopathy progresses.

Some patients with type 2 diabetes may have retinopathy at the time of diagnosis, as many of these patients have had undiagnosed high blood sugars for many years. Eye surgery may be necessary to remove blood from the eye to improve vision. Laser surgery may also be an option to help shrink the abnormal new blood vessels forming in the retina.

Tips for preventing eye damage and vision loss:

  • Monitor and control blood glucose levels.
  • Monitor and control blood pressure.
  • Monitor and control blood cholesterol.
  • Don't smoke. Smoking causes more blood vessel damage.
  • Have a thorough eye examination every year, more often if necessary or if advised by your physician or primary health care provider. The exam should include pupil dilation, which will allow an eye specialist or other qualified health care provider to check for signs of retinal damage, cataracts, and glaucoma.

If you notice changes in your vision, visit your physician or primary health care provider as soon as possible.

If vision loss occurs, talk to your eye specialist or health care provider about low vision services or devices that could help you optimize the vision you still have. You can still continue to do most, if not all, of your daily activities, including caring for your diabetes. Many adaptive vision tools are available. You don't have to let poor eyesight affect your diabetes management. Here are some tips to help you with low vision:

Diabetes care tips:

  • Use home blood glucose monitors with a large result display.
  • Label your medication vials using large print written on larger paper or stock cards and tape it to the vials.
  • Use felt-tip pens to record your blood glucose readings.
  • Take advantage of blood glucose monitors that have memory and allow you to view and print your results on the computer. When it comes time to look and print the results, use a larger font size.
  • Use vision aids that make taking insulin easier, such as devices that help align the insulin bottle and syringe for correct needle insertion, or tactile measuring devices.
  • Try a tape or digital recorder to record your blood glucose results and other information.
  • See a vision specialist and seek out resources or agencies in your community to find out more about adaptations for day-to-day tasks to make life with vision loss easier.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Diabetes-Self-Care

Diabetes: when to call my health care provider

Monitoring your blood sugar, maintaining a healthy diet, getting physical activity, following your treatment plan, and checking your feet are all important steps in taking care of your diabetes. But did you know that taking care of your diabetes also includes knowing when to call your physician or primary health care provider or seek medical help?

You should contact your health care team if these 2 situations occur frequently:

1. When you experience low blood sugar

Symptoms of low blood sugar include:

  • blood sugar less than 4.0 mmol/L
  • hunger
  • shakiness
  • nervousness
  • sweating
  • dizziness or lightheadedness
  • sleepiness
  • difficulty speaking
  • anxiety
  • weakness
  • inability to concentrate

Be sure that you, your family, friends, and coworkers learn to recognize these symptoms and spot the signs of hypoglycemia. If you begin to experience these symptoms, follow your diabetes management plan as recommended by your physician or primary health care provider (e.g., some people are told to eat something that contains a certain amount of sugar). Hypoglycemia can be treated, so be sure to ask your health care provider what you should do when your blood sugar goes too low.

It's important to seek immediate medical attention if you experience any of the following:

  • confusion and disorientation
  • seizures
  • severe changes in behaviour
  • unconsciousness or coma

Be sure that your family, friends, and coworkers learn to spot the signs of hypoglycemia... it just might save your life!

2. When you experience high blood sugar

Symptoms of high blood sugar can include:

  • being very thirsty
  • blurred vision
  • weakness
  • needing to urinate often
  • sleepiness

Be sure that you, your family, friends, and coworkers learn to recognize these symptoms and spot the signs of hyperglycemia. If you begin to experience these symptoms, follow your diabetes management plan as recommended by your physician or primary health care provider (e.g., some people are told to increase their insulin dose or make adjustments to their medications). Hyperglycemia can be treated, so be sure to ask your health care provider what you should do when your blood sugar goes too high.

Untreated hyperglycemia may lead to a condition called diabetic ketoacidosis, which develops when your body doesn't have enough insulin. Not having enough insulin means your body can't use the sugar in your blood for energy. Instead, your body begins to break down fat for energy.

Breaking down fat produces ketones. Large amounts of ketones are not good for your body as they are acidic. A buildup of ketones in your blood leads to ketoacidosis and can be life-threatening. You should test for ketones in your urine if your blood sugar levels go above 13.3 mmol/L.

It's important to seek immediate medical attention if you experience any of the following:

  • fruity-smelling breath
  • nausea and vomiting
  • severe dry mouth
  • confusion
  • shortness of breath
  • coma

Be sure that your family, friends, and coworkers learn to spot the signs of hyperglycemia... it just might save your life!

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Diabetes-Self-Care

How to take care of yourself when you're sick

People with diabetes need to take special care during times of illness. When you are sick, it is very important to keep a watchful eye on your blood glucose levels, as they may be very unpredictable.

Many illnesses raise blood glucose. This is especially true for those associated with fever. This is caused by the release of stress hormones that cause more glucose to be produced and make it more difficult for the body to use it. On the other hand, illnesses that are associated with vomiting and diarrhea may cause low blood sugar (hypoglycemia). It is important to test your blood glucose levels at least every 2 to 4 hours, day and night, during times of illness.

If you are sick, continue to take your diabetes medications unless otherwise advised by a health care professional. If you take insulin, be sure to check with your health professional about guidelines for insulin adjustment during times of illness. Depending on the type of illness you have, and based on your blood glucose readings, you may have to adjust your insulin up or down. If your blood sugars are elevated, you may need to test your urine or blood for ketones. Develop a "sick day" plan with your diabetes team to help you keep your blood sugars in check during times of illness.

Try to consume 15 g of carbohydrates every hour to maintain your nutrition and avoid hypoglycemia. Avoid caffeinated coffee, tea, and pop since they may cause you to lose extra fluids from your body. If you can't eat according to your normal meal plan, solid foods should be replaced with fluids that contain glucose and electrolytes such as sports drinks and electrolyte mixtures.

You should call your doctor if you have:

  • blood sugar levels that stay above 10 mmol/L or below 4.0 mmol/L
  • trouble keeping liquids or solids down
  • a fever above 38.3°C (101°F)
  • diarrhea or are vomiting

Get plenty of rest. If you need to use a cough or cold medication, be sure to ask your pharmacist to help you make the best choice.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Diabetes-Self-Care