Diabetes: Foot Care

How does diabetes affect my body?
Diabetes causes your blood sugar levels to be higher than normal. Over time, high blood sugar levels can damage the blood vessels and nerves in your body. Damage to your nerves means that you may have burning pain or lose feeling in a part of your body (this is called diabetic neuropathy). Damage to the blood vessels means that your feet may not be getting a good supply of blood.

Why do I have to worry more about my feet?
People with diabetes often have trouble with their feet. Part of the problem is that the loss of feeling in your feet makes it hard for you to tell if you have a blister or sore. If little sores aren't taken care of, they can get worse and turn into ulcers (serious, deep sores). If these ulcers become infected, you may have to go to the hospital or, in very serious cases, have a foot amputated (removed). This handout will give you some tips on how to care for your feet.

How can I avoid problems with my feet?
Keep your blood sugar level as close to normal as possible. Also, follow your doctor's advice on diet, exercise and medicine. Here are some other ways to protect your feet:

Wash your feet every day with lukewarm (not hot) water and mild soap.
Dry your feet well, especially between the toes. Use a soft towel and pat gently; don't rub.
Keep the skin of your feet smooth by applying a cream or lanolin lotion, especially on the heels. If the skin is cracked, talk to your doctor about how to treat it.
Keep your feet dry by dusting them with nonmedicated powder before putting on shoes, socks or stockings.
Check your feet every day. You may need a mirror to look at the bottoms of your feet. Call your doctor at the very first sign of redness, swelling, pain that doesn't go away, or numbness or tingling in any part of your foot.
Don't treat calluses, corns or bunions without talking to your doctor first.
Cut toenails straight across to avoid ingrown toenails. It might help to soak your toenails in warm water to soften them before you cut them.
Don't let your feet get too hot or too cold.
Don't go barefoot.

What should I look for when choosing shoes and socks?
Don't wear shoes without socks.
Don't wear sandals or other open-toed shoes.
Avoid high-heeled shoes and shoes with pointed toes.
Wear well-padded socks or stockings that are 1/2 inch longer than your longest toe. Don't wear stretch socks, nylon socks, socks with an elastic band or garter at the top, or socks with inside seams.
Don't wear uncomfortable or tight shoes that rub or cut into your feet. If you've had problems before because of shoes that didn't fit, you may want to be fitted for a custom-molded shoe.
Talk to your doctor before you buy special shoes or inserts.
Shop for new shoes at the end of the day when your feet are a little swollen. If shoes are comfortable when your feet are swollen, they'll probably be comfortable all day.
Break in new shoes slowly by wearing them for no more than an hour a day for several days.
Change socks and shoes every day. Have at least 2 pairs of shoes so you can switch pairs every other day.
Look inside your shoes every day for things like gravel or torn linings. These things could rub against your feet and cause blisters or sores.

How often will my doctor check my feet?
Your doctor or nurse should check your feet periodically when you go in for a visit. If you are having any problems, such as loss of feeling, sores or ingrown toenails, tell your doctor right away.

Monitoring Your Blood Glucose Levels

This article is an excerpt from the book Living Well with Diabetes from the Cleveland Clinic Foundation. Unlimited Diabetic Supplies and shop4diabetics.com are publishing articles such as this as a health resource for diabetics and to provide useful information on the self management of diabetes. Topics ranging from medication and monitoring to exercise and nutrition will be covered.

Unlimited Diabetic Supplies is a Medicare Participating Provider of diabetic supplies for Medicare and private insurance members. If you are a diabetic on Medicare or have private insurance, please visit shop4diabetics and complete the enrollment form to find out if you are eligible to receive no-cost diabetic supplies delivered to your home. Shop4diabetics carries a full range of diabetic testing supplies to help monitor your blood sugar. Arthritis heating pads and impotence devices are also available at no cost to qualified Medicare and private insurance members.

Here is a summary of the guidelines that will help you manage your diabetes for a lifetime of good health.

Blood Glucose Testing

How to Test Your Blood Glucose
To know if your meal plan, exercise and medication are working to control your blood glucose, it is important to test your own blood glucose.Selecting and maintaining your personal blood glucose goal is the basis for your treatment plan according to the American Diabetes Association.

The traditional blood glucose testing method involves pricking your finger with a lancet (a small, sharp needle), putting a drop of blood on a test strip and using a meter that displays your blood glucose level. Blood glucose meters and test strips are available at your local pharmacy.

Meters vary in features, readability, portability and cost. Some meters also feature management software kits that retrieve information (data) from the meter and display graphs and charts of the meter owners own blood glucose levels.This data can be used with your health care provider to determine how your diabetes is being managed.

A newer blood glucose testing method was approved in November. 1988 and features a laser to draw blood. The laser device produces a precise beam of light, which penetrates the skin on the finger instead of pricking it to reduce pain and discomfort.

Blood glucose testing is usually done before meals and/or at bedtime. Your health care provider will tell you when and how often you should check your blood glucose.Only testing your blood glucose before breakfast can be misleading and is not an accurate method. A random sampling of blood glucose before breakfast, before dinner and at bedtime is most helpful. More frequent testing is suggested if you are sick.

The chart below gives you an idea of where your blood glucose level should be. Your blood glucose range may be different from another person's and will change throughout the day.

Recommended Blood Glucose for People with Diabetes*

Time of test Goal Acceptable
Before Meals 80-120 mg/dl 80-140 mg/dl
Before Bedtime Snack 100-140 mg/dl 100-160 mg/dl

When to Call Your Doctor

In most cases, fasting blood glucose more than 180mg/dl is too high and blood glucose less than 70mg/dl is too low.If your blood glucose is less than 70mg/dl and you have more than one unexplained blood glucose reaction a week, call your doctor.

If your blood glucose is greater than 180 mg/dl for more than a week or if you have two consecutive readings greater than 300 mg/dl, call your doctor. In most cases, your doctor will suggest changes in your diabetes management.

Testing Urine for Ketones

When your body uses its own fat for energy instead of glucose, ketones appear in your urine. This usually happens when your blood glucose is more than 300 mg/dl. If ketones build up in your blood, an emergency condition called ketoacidosis can occur.

Testing for ketones is done by dipping a ketone strip into your urine. The test strip changes color and is then compared to a color chart.

If you have type 1 diabetes, test your urine for ketones when:

Your blood glucose is over 300 mg/dl
You feel sick (have a cold, the flu, or other illness) and have nausea or vomiting

If you have type 2 diabetes, test your urine for ketones when:

You feel sick (have a cold, the flu, or other illness) and have nausea or vomiting
Your blood glucose level is high most of the time

Recording Your Test Results

Keep good records of any blood, urine or ketone tests you do. Your records can help alert you to any problems. Also, these test records help your doctor make any needed changes in your meal plan, medication or exercise program. Bring these records with you every time you visit your doctor.

When to Call Your Doctor

The result of your urine test for ketones should always be negative. Any positive results should be reported to your doctor immediately. You should also call your doctor right away if your blood glucose remains elevated or if you have stomach pain, nausea, vomiting, rapid breathing or sweet smelling breath.