Diabetes is a condition where there is too much glucose in the blood, because the body cannot use it properly. This is because the pancreas does not produce any insulin, or not enough, or the insulin it does produce is unable to work properly. Insulin is vital as it aids glucose to enter the body’s cells, so with diabetes the body is unable to use glucose as fuel and instead glucose builds up in the blood. Patients are diagnosed mainly as type 1 or type 2.
There are many associated problems with for patients who are diabetic. Foot care is essential for people with diabetes. It is important to check your own feet regularly and to have regular check ups with a diabetes nurse or with a Foot Health Practitioner trained in diabetic foot care. Diabetic patients should eat balanced meals, monitor blood sugar and, if possible get some physical activity each day. People with diabetes are at high risk for major foot complications, which are often unseen and hundreds of hospital admissions are due to the complications of uncontrolled diabetes.
If it is not controlled, it can cause nerve damage in the hands and feet which limits pain sensation in many people with diabetes. Be aware of any loss of feeling in your feet because you may not feel if you hurt your feet. Nerve damage also leads to poor circulation, which means wounds take longer to heal, and makes you prone to infection.
It is important to remember that impaired sensation itself does not cause infection and ulceration. Those complications can start as small blisters or cuts which are easy to overlook. It is important to always wear something on your feet to prevent any injuries. It is difficult for the body to fight off bacteria in wounds. These risk factors leave you prone to further skin infections, open wounds called ulcers and sometimes where necessary, amputation. When an ulcer develops on the foot, staying off the wound is often recommended but that makes it difficult to get the activity needed to control your blood glucose and blood pressure levels, and may lead to more problems.
Your check list to examining your own feet:
- Check your feet every day. Look for any signs of redness, pain, build-up of hard skin or changes in the shape of your feet from swelling. Ask someone at home to monitor the feeling in your feet by doing the quick, easy toe touch test, which a Foot Health Practitioner will also do with a thinly wired instrument, also known as a “neurovascular test”. My personal training in this also involves touching over areas of the whole underside of the foot, but at home you can follow the below instruction.
- Ask a friend or relative to lightly touch the tips of the 1st, 3rd and 5th toe on each foot with your legs raised in front of you, confirming each touch you feel. (I ask my patients to close their eyes while I do the test, to make sure they do not react to just watching their toes being touched). If you can’t feel two of the six toes touched you have loss of sensation. This should always then be checked by the diabetic nurse, your doctor or Foot Health Practitioner.
- Use moisturising cream every day and wear well-fitting shoes that protect and support your feet. I highly recommend a cream called Flexitol which is suitable for patients with diabetes.
- Always examine the inside of your shoes for sharp objects or stones before putting them on. Avoid socks, stockings or tights with wrinkles or prominent seams. Socks with elasticated tops should also be avoided because they can restrict the circulation. Never wear socks with holes.
- Do not use corn-removing plasters as these can damage healthy skin. Look after your toenails. Always ask a qualified Foot Health Practitioner to do any necessary treatments.
There are other checks that a diabetes-qualified Foot Health Practitioner will perform when monitoring a patient with diabetes. Regular check-ups on a six weekly basis are recommended, unless there are other problems which need treating, usually on a four weekly basis. However every person is an individual. Remember, your Foot Health Practitioner may spot problems which you can not and can treat many other foot related problems, and not just monitor your diabetes.
Ruth Walters, Breckland and Waveney Foot Health Clinic, www.bwfhc.co.uk