Islets of Hope care tips for persons with diabetes
Article compiled and edit by Lahle Wolfe.
NIH Publication (.pdf)
Foot care involves taking special steps to avoid foot problems such as sores, cuts, bunions, and calluses. Good care includes daily examination of the feet, toes, and toenails and choosing shoes and socks or stockings that fit well. People with diabetes have to take special care of their feet because nerve damage and reduced blood flow sometimes mean they will have less feeling in their feet than normal. They may not notice cuts and other problems as soon as they should. They will also heal less well than others. However, foot care is needed and applies to all individuals with foot problems, not only to those with diabetes.
Medline Plus offers a free, online interactive tutorial to help you with foot care.
Medicare Therapeutic Shoe Program – A program under Medicare offering free foot-care for diabetics. The coverage includes a specialized shoe program to help prevent complications for people with diabetes and those with foot problems. Under the program patients are entitled to (annually) one pair of customized shoes, two sets of inserts, and a fitting by a podiatrist or shoe specialist. Patients can order molded or a depth shoe.
Visit our Health Insurance page to find out what your state laws require health insurance to cover for diabetes care.
Diabetes Care Tips
Mini Site Index
Taking Care of Your Feet
Everyone with diabetes needs to pay careful, daily, attention to their feet. Certain diabetes complications can cause the loss of sensation (neuropathy) and circulation throughout the body, including the feet. Diminished sensation can interfere with the body’s injury warning system: pain. Small cuts and abrasions may go unnoticed and become infected due to poor circulation. Diabetics in general, have a tendency towards easier infection, and are slower and harder to overcome infections – especially when blood glucose is not under tight control.
Infections can ulcerate, fail to respond to treatment, and eventually all, or a portion of the foot, may need to be surgically removed (amputated). If the infection persists even after amputation, it may even be necessary to remove part of the leg from below the knee in order to halt the deadly progression, which unattended, can lead to death.
Diabetes Care (Diabetes Care, November 2004;27:2636-2641) reported alarming statistics for the rate of amputation among the diabetic population in Barbados. However, from the data, we are reminded that an ounce of prevention is worth a pound of cure. For example, not wearing shoes tripled the risk of diabetes-related, lower-extremity amputation among Barbados residents and risk of amputation was quadrupled in the same population for those wearing “fashion” footwear, as well as for female walkers wearing sneakers into town. It would seem obvious that good footwear is of relative significance to preventing foot ulcerations which can lead to further complications including amputation.
Other risk factors for amputation (indicated in the report) include the following:
How Problems Can Occur
Chronic high blood sugars restricts blood flow and impedes circulation to the lower limbs, especially the feet. The problem can be worse for older persons and how long someone has had diabetes (either type 1 or type 2), with poorly managed blood glucose levels also increases the risk of foot problems.
Poor circulation makes it harder to treat infections and ulcers. And when blood glucose levels are high a person with diabetes may not respond effectively to treatment. Since neuropathy (damage to nerves) makes it hard to detect problems, it is absolutely crucial for all persons with diabetes to carefully inspect their feet every single day.
Persons with neuropathy can lose all feeling in an area and suffer severe damage to tissue and never even feel it. (One physician stated “neuropathy can leave feet and lower legs so numb patients could walk around with a nail under their foot for a day and not realize it." But early detection and treatment can help avoid amputation.
Preventive Care for Diabetes Foot-Related Complications
Since most problems for diabetics begin with small sores on the skin like scrapes and blisters it is important to visually inspect your feet every single day. Other steps you can take to ensure healthy feet include:
The most frequent reason for hospitalization in persons with diabetes is due to problems with their feet. But many of these problems, including amputation and hospitalization, could be prevented through simple preventive foot care.
How to Have Happy Feet
The rate of depression among diabetics with ulcerations parallels that of those who have already undergone amputation. Part of the reason may be that ulceration often is an impending sign of the need for amputation. Counseling for both those with ulcerations showing signs of depression, and for those having undergone amputation is often advised.
Resources and Information about Amputation
Diabetic Neuropathies: The Nerve Damage of Diabetes – Information about the causes, symptoms, and significant types of neuropathy. Includes information about diagnosis and treatment, and the findings of the Diabetic Control and Complication Trial (DCCT) in relation to neuropathy.
Feet Can Last a Lifetime - A Health Care Provider's Guide to Preventing Diabetes Foot Problems - This comprehensive kit for health care providers contains ready-to-use foot exam forms, Medicare certification forms for therapeutic footwear, a sample disposable sensory testing monofilament, reproducible patient education materials, and current resource and reference materials.
Take Care of Your Feet For a Lifetime - A Guide for People with Diabetes – Discussions complications of diabetes including loss of feeling, changes in foot shape, ulcerations of the feet, and wounds that don’t heal.
Financial Assistance for Prostheses and Other Assistive Devices (Copyright © ACA/NLLIC) – Information about who might be eligible for financial assistance and a list of organizations that can provide assistance with prosthetic devices.
Limb Loss FAQ's (Copyright © ACA/NLLIC) - Contains information about caring for, and reducing the risk of, amputations. Also list of commonly used terms when discussing amputation.
For more information also, see:
Page Updated 04/27/2006