Foot Care and Diabetes

When it comes to foot care  most people are motivated to take care of their feet  because they want to avoid the nightmare stories they have heard. And this is rightly so. Just about everyone has heard the stories of uncle Bob losing his legs because he had diabetes. More than 65,700 non-traumatic  (this means the person wasn't in an accident) lower limb amputations are performed each year in people with diabetes.
People with diabetes are more likely to have an amputation because of two things: blood vessel disease and nerve disease.  Blood vessel disease narrows the blood vessels and blood flow is slower down to the feet. Nerve damage which is referred to as neuropathy can cause numbness in hands and feet. It can display it self in many ways.The most common displays are

• over sensitivity (where a person cannot comfortable walk on a bare floor)
• pins and needles feeling in feet
• burning sensation in feet (when someone else touches them they are normal temp)
• cold sensation in feet( when someone else touches them they are normal temp)
• numbness
• positional sense (A person doesn't know where their feet are unless they can see them)

Basically, nerve damage takes away the body's ability to protect itself. Think about it. If your feet are numb you cannot tell if you stepped on a piece of glass. And if you don't know then of course you won't clean it and apply a bandage. That is the root of the problem. So the glass stays in your foot and festers. By the time you figure out you have an infection the problem is severe. Remember the blood flow is slower to the feet because they are further away from the heart. So the infection is difficult to fight. Amputation occurs when a persons life is at risk because they cannot get rid of an infection and gangrene sets it.

Proper foot care requires daily effort. The following steps are helpful.

1. Check  your feet daily. You will want to look at the top and bottom of foot as well as between toes. Put a mirror on the floor if needed. Never skip this step!  You are looking for changes in color, changes of shape( I know this sounds weird), and changes in temperature. Contact the doctor with any changes.
2. Wash your feet daily. Use warm water, not hot. You don't want to burn your feet. Carefully dry your feet well, especially between your toes.
3. Put lotion on feet daily to avoid cracking. After the shower is the best time to use lotion to keep feet from cracking. You do not have to you use flowery smelling kinds. A good thick cream is best. Avoid applying lotion between the toes. This leads to athletes foot.
4. Keep toenails cut properly. Toenails should always be cut straight across. Don't cut down into the corners, this leads to ingrown nails and infection. If you cut toenails after bathing they are softer and easier to cut. If you cannot see or reach your toenails have a healthcare provider cut them for you.
5. Choose appropriate shoes. Shoes need to be close-toed to protect the foot from injury. Shoes should fit well, have enough room to move toes inside the shoe, and not rub anywhere. Socks or stockings keep the foot warm and dry.  Wool or cotton socks are best because they offer the most protection.

General foot protection guidelines:

-Never go barefooted. Even in your home.

-Avoid nylon stockings if you have infection in the feet.

-Don't wear seamed socks. These can cause blisters.

-Show the doctor  any corns or excesive calluses. Don't perform surgery on your foot.

-Avoid high heeled and open toed shoes. High heeled shoes put too much pressure on the foot and oped toed shoes pose the risk of injury.

-Be careful with heating pads. They can get too hot and cause burning on feet. This is especially true if a person cannot sense too hot of temperature.

Foot care is simple and can prevent serious problems if performed daily. Have your feet checked at least yearly by a health care professional.

Hypoglcemia----The low down on low blood sugar

Low blood sugar is always a hot topic with diabetes. Many people have experienced it whether they have diabetes or not.  No one like it because the symptoms are so uncomfortable.
Hypoglycemia is classified as a blood sugar of 70 or below. Some of the most common symptoms are shaking, dizziness, rapid heart rate, sweating, irritability, hunger, headache, etc.  One of the tell tell signs is how quickly the symptoms come on. Literally, one minute your fine and the next minute your not.  Generally, thinking is clouded and slower.   The body has these symptoms to warm you the brain is not getting enough sugar. The symptoms will continue to persist and may even worsen until the blood sugar increases up to the normal range of 80-100.
Fixing the problem is fairly simple. You have got to eat carbohydrate. But how much? You'll want to start with 15 carbohydrates. The best foods you should start with are glucose tablets or other forms of simple sugar like juice or milk.  Some would even suggest the "rule of 15". This means a person begins by eating 15 grams of carbohydrates. Then waiting 15 minutes. So, eat 15 grams of carbohydrate and wait 15 minute. Repeat this until the blood sugar is up and symptoms go away. I would suggest sitting down or even laying down to be more comfortable while you wait. The hardest part is waiting. The 15 minutes seem like hours because you will still be experiencing the symptoms. When the blood sugar is up to 80-100 you will need to have hardy snack such as peanut butter and apples, or cheese and crackers if your next meals is more than 1 hour away. If your next meal is within the hour you don't need and extra snack.  This extra snack is to prevent another low reaction before your next meal.
A good idea for a snack could be 3-4 glucose tablets, 1 cup (8 ounces) of low fat milk, 1/2 cup juice, 6-7 lifesaver candies, or a small piece of fruit. Remember  the hard part is next. WAITING!!!  Wait 15 minutes. The reason for this....It takes 15 minutes for your body to absorb the carbohydrate.  Eating more at this point will not help you to feel better faster. It will just cause the blood sugar to go higher after the correction. So instead of being too low your blood sugar is too high.
Oft times a person experiencing a low blood sugar can become irritable and refuse to eat or drink anything.  It is helpful to have pre-planned snacks just in case a low blood sugar occurs. Keep appropriate snacks in the car, at work or school, your pocket, and by your bed

Depression and Diabetes....Is there a connection?

Many patients I visited with over the years suffer from some level of depression.  In fact, it is estimated that 80% of those with ANY chronic disease suffer from depression. Diabetes however, has an interesting twist. Elevated blood sugar worsens depression and depression causes an elevation in blood sugar.  I know what you are thinking....How the heck can a person get out of that downward spiral?   First, control the blood sugar the best you can with diet, exercise, and diabetes  medications. If you are doing all you can and your blood sugar is not in target ( 80-110) before meals, then call your doctor's office. You need get an appointment with them or the diabetes educator. A change needs to be made. The sooner the better.   As long as blood sugar is high, depression can not easily improve. Sure there are antidepressant medications but your body is working against itself.
For those who feel like there is a stigma associated with anti-depressant medications...Get over it!  This is enjoyment of life and your happiness at stake.   Second, Exercise everyday. Get moving for at least 10 minutes. More is better. Work up to 6o minutes per day. Exercise is a natural anti-depressant. Working on a hobby, reading a book or watching a movie are all activities that give you a break from your life. It is a good idea to do one of these daily.

HbA1c--What's that? Why should I care?

HbA1c is a blood test commanly talked about with diabetes. First, this test should be taken every 3 months by your doctor. During pregnancy it is reccomended to be taken monthly.  The simplest way to explain the HbA1c test is to think of it as a running average with the last month having a larger impact then the first two. It tells the doctor what your blood sugars have been for the past three months. 
How in the world is it possible to see what my blood sugars were 3 months ago?  It is actually is pretty simple.  We need to discuss the life of a a single red blood cell. A red blood cell generally lives and circulates for 90-120 days.  Blood sugar attaches to the red blood cell and never lets go. If blood sugar is high then the HbA1c will be high. When the red blood cell dies it takes the sugar with it.  Every day red blood cells die and new ones are made. It is a constant turn over.
The HbA1c test is essentially counting how much sugar is attached to the red blood cell.  It tells the doctor your risk for developing complications associated with diabetes.  The higher the number the bigger the risk. In order to reduce the HbA1c number you need to have good blood sugar readings. Good blood sugar is around 100.  Because the life of a red blood cell is 90-120 days it will take a few months to reduce the number.
The ideal range for diabetes is 6.5% or less.  This is the reccomendation from the American Diabetes Association and the ACE guidelines from the Americam Association of Endocrinologist.  These guys are the doctors that specialize in "glands" or in other words diabetes.
This test should be taken every 3 months. If you see a diabetes specialist every three months, your doctor is probably taking this test already. If you see a regular family doctor for your diabetes it may not be done. You should ask the doctor to take this test for you. Find out the results and do everything you can to keep your HbA1c number  at 6.5% or less. 

Can exercise "cure" my diabetes?

Lets first consider some benefits of exercise with diabetes or anyone for that matter. It lowers weight, blood pressure, blood sugar, improves depression, improves sleep, decreases appetite, improves HDL(good) cholesterol, improves insulin sensitivity, and increases energy. The list goes on and on.
We know from several studies exercise is one of the most beneficial steps a person can take to control blood glucose. Interestingly, I have personally viewed blood sugar logbooks side by side to exercise logs. On the days exercise was done the blood sugar was 30 points lower.On the days exercise was not done the blood sugar was higher sometimes requiring more medications.
Exercise can in fact, cause enough weight loss, reduction in blood pressure, and reduction in blood sugar to greatly improve ones health. Maybe their doctor says to them "You have done so well with exercise you no longer need your blood pressure medication or lets reduce your diabetes medications".
In this case the improvement in ones health allows them to reduce or even omit medications. This is a huge success for the diabetic. Think of all the money saved on medications!
Unfortunately, there is no cure for any type of diabetes.  Consistent exercise along with weight loss can cause symptoms to disappear, but diabetes will always be present.
If a person exercises consistently and can reduce or omit medications think of how much better their health is. The possibility  to "pushing off or delaying" diabetes symptoms into the future is golden