Sometimes my Diabetes diagnosis feels overwhelming
We understand this feeling, and you may even ask yourself, what can I really do to help myself in taking care of my health and my feet? Well, there are several things that I recommend to my diabetic patients to be proactive in their care. There are things that you can do daily, weekly, monthly, and some things you can put off for just every few months. By breaking these up into smaller increments, it may not seem so overwhelming. These tips will help you spend a little time on your health and prevent complications having to do with your feet.
Daily Foot Care for Diabetics
I highly encourage daily foot checks! A daily foot check can occur at any time of the day, some of my patients like to do it first thing in the morning when they wake up, and others like to do it at the end of the day when they are winding down for the evening. If you are not able to do this on your own, recruit a family member to help you, or use a mirror held up to your foot in order to see the parts of your foot that you can't. Whenever you decide to do it, there are a few things to look for:
- Check for any areas of redness or skin build up due to bony prominences. Skin can build up on the tops of curly toes (hammer toes) and can cause corns, and buildup of skin on the bottom of the feet (called calluses). If any of these areas become red, this is an indication that there may be a break in skin coming soon and you should take note of this and watch for changes.
- For corns or calluses, DO NOT use over the counter corn removers. These can come in either bottles (drops) or in the form of a corn pad. The reason you should not use this is because these contain a medication with acid. And acid directly on skin without being monitored is a very dangerous thing! So never try to use over the counter corn removing products. It is better to bring these areas of redness or skin buildup to your podiatrist and she can make suggestions to decrease the irritation, either with padding or shoe alteration.
- Check between your toes. If there is a crack in the skin, or if the skin is peeling, this could indicate an increase of moisture and possibly a fungal infection referred to as tinea pedis. Sometimes if the skin is cracked, bacteria can enter this innerspace between the toes and cause an infection. If this happens, you will see redness and swelling and possibly experience pain and drainage. This condition needs to be seen by a doctor right away. So be sure to prevent moisture buildup by drying thoroughly between your toes after a bath or shower. You can do this with a rolled up piece of gauze or paper towel, or even a Q tip. If you cannot reach your toes, you can even use a hairdryer (on the COOLEST setting, NOT WARM and NOT HOT!) to dry between the toes. But if there is peeling or redness, this is something to show your podiatrist. You may need a topical medication to help get rid of the fungus.
- Check your toenails. Take note if there are any areas near the nail border that are painful or incurvated. Sometimes, you may see the nail growing into the skin and this can even cause a break in the skin. This is an easy entry for bacteria, and this can cause an infected ingrown nail. This condition needs immediate attention and you should call the office as soon as possible to set up an appointment as you may need a procedure to drain the infection and/or an oral antibiotic to help cure the infection. Some patients with diabetic neuropathy don't have very good feeling in their toes, and they may not feel the ingrown nail, but by checking your toes, you can see if you have one.
- Check inside your shoes. It is important to turn each shoe upside down and look into the end of the inside of the shoe to make sure there is no foreign object in there that shouldn't be. Sometimes something as small as a pebble can get caught in the shoe, and for diabetic patients with neuropathy, you may not be able to feel something as small and subtle as a little pebble. This can wreak havoc on your skin as you go about your day without noticing that you are stepping on something in your shoe. It can cause a break in skin and even a sore that could become infected. In fact, I have even seen patients walk in with a sewing needle in their foot that they never even knew was there. They would have known if they did daily foot checks!
- Check your blood sugars daily. Many times your primary care doctor or you endocrinologist (diabetes specialist) may recommend that you keep a log. You don't have to bring in the log to your podiatrist, but your primary care doctor may ask for it. This log allows you to see daily and even hourly trends, and give you and your doctors information you can use to help tweak medications in order to keep your blood glucose levels very well controlled.
Weekly Foot Care for Diabetics
If you have been keeping track of your blood sugars every day, then it will be easy to look at your levels a week at a time. Did you have a good week where you hit all the blood glucose level goals? Was it a little high one day, and if so, why? Was it your diet, were you under the weather, or did you do a little less exercise that day? All of these can be reviewed on a weekly basis.
Monthly Foot Care for Diabetics
According to Medicare guidelines, many diabetic patients qualify for extra depth diabetic shoes with 3 pairs of accommodative diabetic inserts. These are usually made of alliplast with plastizote, special materials that mold to the bottom of a diabetic patient's feet to accommodate for increased areas of pressure to reduce the chance of blister and ulcer formations. I recommend that you remove your accommodative inserts once a month from your extra depth diabetic shoes and inspect them for wear and tear, areas of indentations, or areas that have worn through. If you see blood stains or drainage stains on your insert, then this indicates that your could have a sore draining on your foot that you may have missed. If there is wear and tear, then it is time to change out the inserts. Remember, every year you are given 3 pairs and it is meant that you change them out every 4 months. If you are not sure whether to change them out or not, then bring the inserts with your shoes to your next appointment with your podiatrist.
Things that can be done every few months for Diabetics
If you are a diabetic patient with neuropathy and have other findings, you may qualify for diabetic foot care per Medicare guidelines. If this is the case, then you will see your podiatrist every 2 1/2 to 3 months. In order to have diabetic foot care covered by Medicare, you must see your primary care doctor every 6 months and report this at your visit. It is a good idea to see you primary care doctor or endocrinologist regularly for consistency of care, and this is just another reminder. Your primary care doctor may order blood work such as a fasting blood glucose level or a test called hemoglobin A1C. The hemoglobin A1C is a measurement of how well your blood glucose levels have been for the past 3 months, which is also helpful for your doctor to help determine if your medication or insulin prescription need to be changed or another medication needs to be added.
As you can see, there are many things you can do as a patient to help take care of your health and the health of your feet as a diabetic. If you have a podiatrist, make sure to visit them on a regular basis; how often can be determined by your podiatrist and the severity of your condition. If you do not yet have a podiatrist, make an appointment with one of our doctors, we always keep in contact with your primary care doctor and will work with them as part of your care team to help keep you and your feet healthy.