A Simple Guide to Foot Care

A Simple Guide to Foot Care
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What is Foot Care?
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Typically the foot is furthest from the heart and therefore more easily plagued with problems like poor blood circulation or neurological deficit.

Therefore taking care of the foot is very important especially in diabetic patients.

Foot care is an important tool in prevention of foot problems at all ages.


What is important in Foot care?
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Footwear:

1.Shoes should fit comfortably.

2.Soft shoes like canvas or soft leather is preferred because they cause less
pressure points.
Foam rubber shoes cause fewer planter calluses

3.The toe box should be wide and high enough to accomodate any exostosis or contractures.

4.Shoes should have anterior as well as a posterior heel.
This protects the metatarsal heads from coming under stress.

5.Wearing sport shoes which are comfortable and has air bubbles at the front and back of the shoes will prevent friction in sports like jogging and brisk walking.

6.Woman's shoes should not have high heels as these increase increased pressure
on the planter surface and the metatarsal bones.
A low heel lace shoe is more comfortable because of the bigger toe box.

7.Specially constructed shoes may be necessary for patients with deformities of the foot.

8. Full length soft molded inlays can be used when pressure sores or painful calluses are present.

Socks:

1.Socks or stocking should fit comfortably and kept dry at all times

2.Tight constricting stocking should not be worn.

3.Loose stockings which can wrinkle should also be avoided

Foot:

1.Inspect and clean foot daily.

2.wash feet daily with bland soap and lukewarm water.

Pat dry gently and thoroughly especially between the toes after wash.

Do not rub the foot vigorously.

3.keep your toe nails short,trimming them straight across to avoid ingrowing toenails

4.moisturise feet daily to prevent dryness and cracking of skin

5.web spaces should be kept dry with powder or small pieces of cotton wool in between toes.

6.examine feet daily for scratches, cuts, blisters and corn

7.use a mirror to check the sole of your feet

8.Avoid going barefoot

9.Seek prompt treatment for cuts and sores

10.annual review for foot ulcers, risk of neuropathy(poor sensation), blood circulation( palpable pulses)

General Measures:

1.Smoking should be avoided as it causes constriction of the blood vessels

2.Avoid extreme temperatures such as excessive heat or cold

3.Home surgery should avoided in diabetes and those with vascular disease.

Avoid cutting calluses or corns yourself.

Also avoid applying strong chemicals to calluses or corn.

Instead try changing the weight bearing stresses on the foot.

4.When ulcers do appear they are most commonly on the weight bearing surface of the foot.

Vigorous local care such as removal of infected tissues and control of infections with antibiotics and antibiotic creams are indicated.

If the foot is warm and the blood flow good(feel pulse), healing of ulcers
usually will occur.

Raise the foot and exercise the foot to improve blood circulation.

5.Any injuries or cuts in the foot should be treated instantly to prevent any complication such as infection

6.Good balanced diet and a healthy lifestyle is important.

A Simple Guide to Diabetes Part 2

A Simple Guide to Diabetes Part 2
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What is the treatment of Diabetes?
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Control of Diabetes
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Diabetes is a chronic disease which cannot be cured.
It can be controlled to prevent the development of the above serious complications by :
Living a healthy lifestyle
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1.diet -

Reduce your intake of sugar and sweet food
Increase intake of more high fibre and wholegrain food like brown rice, wholemeal bread and oats
Take food with less fat content like lean meat, fish, skinless poultry and low fat milk
Have at least 2 servings of vegetables and 2 servings of fruits a day
Use healthier methods of cooking such as grilling and steaming rather than deep frying and use less salt and sauces
Take multiple (4-6) small meals a day that contains enough complex carbohydrates (e.g. rice), some lean meat or fish and vegetables.
Have regular meals and avoid skipping meals
Do not overeat

2.regular exercise-

This helps your body to use glucose more efficiently
Frequency: 3-5 days per week(daily if low intensity)
Intensity: 60-85% of maximum heart rate till the patient feels warm or sweats and breathes deeply but easily
Time: 20-60 mins each time
Type: aerobic exercises like walking, jogging, swimming, cycling

For those who have not been active for some time should start with walking first, then increase to more active exercises

3.weight control -

lose extra body weight by proper dieting and exercise
Aim for half kg loss per week
Aim for a BMI of 18.5-22.9kg/m2

Insulin works better in a lean healthy body.

4.Avoid smoking-

smoking increases all the risks associated with diabetes

5.Avoid stress -

by meditation, yoga, deep breathing exercises

Medication for Diabetes
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1.oral tablets:

a. Insulin secretagogues - drugs that increase insulin release from pancreas

eg. glibenclamide, repaglinide
Side effects: low blood sugar

b.Insulin sensitisers- drugs that make insulin work better especially in muscles and liver
eg.metformin
side effects: gastric discomfort, metallic taste in mouth
eg. rosiglitazone
side effect: water retention

c. Alpha-glucosidase blocker -slows digestion of carbohydrates in the intestine

eg. acarbose
side effect: stomach discomfort, bloating, diarrhea

If the oral medicines even in combination cannot bring down the blood sugar, the insulin injection may be required either alone or together with oral medication.

2.insulin injections

Insulin is destroyed in the stomach so it cannot be taken orally and has to be given as an injection.
Best place to inject the insulin is in the abdominal area where there is a lot of subcutaneous fat.
Avoid 2 fingers around the navel and below the rib cage where there is a rich nerve supply and therefore more painful.
Injection is usually done in the morning and evening.
Night injection controls the glucose when the patient sleep and avoid early morning high glucose.

a.Rapid and short acting insulin

eg. regular soluble insulin
onset 30-60min, peak 2-4 hrs, duration 6-8 hrs

b.intermediate and long acting insulin

eg. NPH insulin
onset 1-4 hrs, peak 8-12 hrs, duration 12-20hr

c.premixed or biphasic insulin

eg. NPH/regular 70/30
more convenient and less injections

Important hygience tips:

Use needles once only
Mix well by shaking bottle or injection pen 20 times
Store all unused insulin in fridge(will keep until expiry date).
Do not freeze insulin.
Insulin in use can be kept at room temprature away from sunlight and direct heat and must be discarded 4-6 weeks after use

Follow the instructions very carefully and keep detailed records of your treatment.

Home blood glucose monitoring
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1. monitor your progress with the help of your daily home blood glucose records.
Monitor;
a. before and after meals
b. before and after exercise
c. when feeling giddy to confirm low blood glucose
d. when sick and not eating well

Type 1 diabetes should be monitored 3-4 times a day

Type 2 non-insulin diabetes 1-2 times a day followed by 1 every 2-3 days

Type 2 insulin diabetes 2-3 times a day followed by 2-3 days a week.

Pregnant diabetic patient should also monitor their blood glucose daily

Aim for a Fasting Blood glucose 4.0 -7.0mmol/l
Blood HbA1c 4.5 -7.0

This will check if your diabetes is under control.

If not, you need more medicines or further change in diet.

High blood pressure and high blood cholesterol level
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Reducing high blood pressure and high cholesterol level help to keep diabetes under control and protect against its complications.

Aim for a blood pressure of 130/80 or less
LDL cholesterol of 2.6mmol/l

Regular checkups is important in the treatment of Diabetes
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1. Regular monthly checkups for diabetes until fully controlled, bimonthly after that.

2. Check for hypertension and heart disease at the same time

3. Check for high blood cholesterol once a year.

4. Check eyes once a year.

5. Check for kidney problems at least once a year.

6. Check teeth once a year

7. Check you feet for signs of infection, gangrene and neuropathy.

Foot care:
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1. wash feet daily with soap and water
2. After washing ,dry thoroughly especially betwwen the toes
3. keep yor toe nails short,trimming them straight across to avoid ingrowing toenails
4. moisturise feet daily to prevent dryness and cracking of skin
5. examine feet daily for scratches, cuts, blisters and corn
6. use a mirror to check the sole of your feet
7. wear shoes that fit well and wear clean cotton socks which has loose fitting elastic tops
8.Avoid going barefoot
9.Seek prompt treatment for cuts and sores
10.annual review for foot ulcers,risk of neuropathy(poor sensation), blood circiulation( palpable pulses)

Health education
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It is important to increase your knowledge of diabetes and its complications.

With knowledge, diabetes can be more easily controlled.

A well controlled diabetic patient can live a normal life.