Instructions
Take Another Course
With the diabetic patient, keeping blood glucose under control is the key to maintaining one’s health. With regard to their feet, blood glucose fluctuations can lead to neuropathy and vascular insufficiency. Nueropathy can make it difficult for your patients to know when their feet are at risk or being damaged. The better your patients are at controlling their blood sugar, the healthier their feet will be over the long term. And, of course, high blood sugar levels can make it hard for the body to fight infections.
It’s important for people with diabetes to wear appropriate footwear. Shoes should be made of natural, preferably breathable materials that offer more depth in the toe box, and have good coverage on the top and bottom. Shoes should also be free from seams that can rub the foot, as should socks, as well as being made from cotton or other natural materials. And diabetics should never go barefoot, indoors or out. And orthotics can be a great help in alleviating pressure points and offering an additional protective measure to the feet.
Before putting on shoes, instruct the patient to check to make sure they are free from any foreign objects which could cause injury to the foot. The loss of nerve sensation common in diabetics can make it difficult for the patient to feel something in the shoe, allowing injuries to occur. It’s important to keep the feet dry, especially between the toes. This area is prone to retaining moisture, and once moist, skin tends to break down which can lead to infection. Moisturizers can still be used, just not between the toes. Have patients attend to bunions, calluses, corns, hammertoes, and other aggravations promptly, so they don’t lead to infection due to pressure sores and uneven rubbing.
Toenails that are too long can rub or dig into neighboring skin causing blisters, cuts and ingrown toenails. Regular trimming can avoid this, and should only be done by the patient if they can demonstrate this skill properly to their healthcare professional. Avoiding burns sounds pretty obvious, but neuropathy can cause enough lack of sensation in the feet that heating pads and bath water represent potential risks. Hot sand and pavement can also burn skin, while some antiseptic solutions can burn skin as well.
And while we mentioned foot self-examination, having the patient’s doctor examine their feet at every visit is a good idea, a regular, thorough, professional podiatric foot exam every year is a must for the diabetic patient.
And with all diabetic teaching, reducing key modifiable risks should always be the focus (non-modifiable risks include family history, race or ethnic background, age, and a history of gestational diabetes). These include physical inactivity, which is a leading factor in developing prediabetes and type 2 diabetes. It is recommended for otherwise healthy individuals to get at least 150 minutes per week of moderate-intensity aerobic physical activity, or 75 minutes per week of vigorous-intensity aerobic physical activity. A combination of the two with muscle-strengthening at least 2 days per week is also acceptable. Overweight patients are at higher risk for developing diabetes, and by losing just 5-7% of their body weight can cut their risk of developing prediabetes by half. Hypertension is another modifiable risk, and one that causes damage to the cardiovascular system, and has been linked to the development of diabetes. Abnormal cholesterol levels can increase the risk for type 2 diabetes and cardiovascular disease. Healthy eating, getting enough aerobic physical activity, and maintaining a healthy weight can all help to improve lipid levels.3
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