Diabetes Care: Diabetes Foot Self-Care
Dr. Shalini Jaggi
Dr. Shalini Jaggi, Senior Consultant, Diabetology is currently associated with Paschim Vihar based Sri Balaji Action Medical Institute’s Action Diabetic Centre. Dr. Jaggi has a special training in handling CSII Insulin pumps and CGMS and is well versed with all aspects of diabetes management (outpatient as well as inpatient care including diabetic emergencies and foot care). A believer in holistic diabetes care, she has been actively involved in numerous diabetes awareness camps and programmes.
In India, more and more people are getting diabetes because of a sedentary lifestyle, increased intake of junk food, smoking and drinking. Most people only become aware that they have diabetes, after they develop major complications. These complications generally affect the eyes, heart, blood vessels, kidneys, nerves, teeth and gums. However, one of the most dreadful health complications that diabetes can cause is the diabetic foot.
Diabetic foot usually occurs as a consequence of diabetic neuropathy, which means damage to the nerves because of uncontrolled blood sugars. According to the World Health Organization, almost 27 per cent of diabetics develop periphery neuropathy and more than 50 per cent of those develop foot ulcers, gangrene and amputation resulting in a high mortality rate.
With increasing blood sugar levels, the blood circulation in the legs and feet may deteriorate and the nerves may become less sensitive leading to diabetic foot. This occurs due to neuropathy, peripheral vascular disease and infections. Nerve damage or diabetic neuropathy results in loss of sensation in the feet and makes diabetics more prone to other foot infections. There is also a diminution in sweat and oil gland functionality that lubricates the skin of the foot. As a result, the foot loses its natural ability to moisturise the overlying skin and becomes dry. These factors can lead to abnormal pressure on the skin, bones and joints of the foot during walking and can lead to a breakdown of the skin on the foot. Since there is no pain, most patients do not realise the gravity of the situation and tend to ignore minor injuries like a shoe bite. Peripheral Vascular disease, on the other hand, contributes to ulcerations and leads to delayed healing of those ulcers. Also, the diabetic foot can get infected and if the infection spreads down to the bone, it can lead to an amputation of the affected limb.
Symptoms of Diabetic foot:
- A tingling or burning feeling in the toes and foot
- Numbness or loss of sensation in the foot
- Acute or piercing pain
- Serious foot problems such as ulcers, deformities in foot
- Difficulty in walking
Self Care for Diabetics:
- The foot should be cleaned thoroughly and then moisturised with skin cream at least twice a day in order to avoid dryness.
- Lukewarm water and soap should be used for cleaning the feet.
- One should check his/her feet everyday to look for any major or minor traumas. There should not be any pressure marks or cracks between the spaces of the toes, redness or swelling around nails.
- One should wear comfortable and sturdy shoes, which are not too tight or loose to avoid shoe bites or pressure ulcers. The best socks to wear are woolen or cotton socks.
- Toe nails should be trimmed with nail clippers after washing the feet.
- One should quit smoking as it damages the blood vessels and leads to poor blood circulation.
- One should avoid immersing the foot in hot water.
- One should not self-treat blisters occurring due to tight footwear. If there is blood or pus in the blister, a doctor should be consulted immediately.
- A proper control on blood sugar levels should be maintained by eating a balanced diet and taking prescribed medications.
There are some treatments that slow the progression of the disease, relieve pain and prevent complications. Most people need a combination of medications to relieve the pain. Some antidepressants (like amitriptyline, imipramine and duloxetine) can be given to diabetics to give them relief from pain. However, their prolonged use can have side effects like constipation, drowsiness and headaches. Nerve supplements such as methylcobal and gamma linolenic acid (GLA) as well as certain other medications can also be prescribed by the doctor.
Diabetic foot, if not treated on time, can lead to amputations. Although, there is no cure for diabetic neuropathy, most of the amputations can be prevented with timely treatment and proper education.
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