Diabetic Education

General Education for Diabetics:

Avoid any at home care for nails and calluses

Avoid constrictive bandages

Avoid open toed or opened back shoes

Be careful with adhesives and tape on the diabetic insensate foot

Buy shoes at the end of the day when the feet are the largest

Check the bath temperature before submerging the feet

Diabetics with impaired vision need someone to inspect there feet daily

Do not use chemical substances for removing corns or calluses

Dry the feet and between the toes thoroughly after showers

Inspect the feet and toes daily for any lesions

Inspect the shoes for objects before placing on feet

Never walk barefooted

Professional nail care at a podiatry office with regular visits

Protect the feet from sunburn

The use of a high toe box to accommodate hammertoes

The use of an insert to accommodate any lesions

The use of shoes with a wide toe box with extra depth

The use of water based lotion daily without moistening between the toes

Wear a shoe with an appropriate fit to avoid friction which can cause blisters

Diabetic Peripheral Neuropathy

Diabetic Peripheral Neuropathy is the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes.
Neuropathies are characterized by a progressive loss of nerve fibers

Noninvasive Testing

• Nerve conduction studies and Electromyography- A test commonly used to evaluate the function and the ability of electrical conduction of the motor and sensory nerves.
• Quantitative sensory testing
• Autonomic Function Tests
• Monofilament testing - If the patient does not feel the wire at 4 or more at 10 testing sites- the test is positive for neuropathy

Pathophysiology of Diabetic Peripheral Neuropathy

Result from vascular disease:

• Endothelial dysfunction
• Deficiency of myoinositol-altering myelin synthesis
• Chronic hyperosmolarity-causing edema of nerve trunks
• Increased sorbitol and fructose

Diabetic Neuropathy can contribute to Structural foot deformities

Hammertoes

Bunions

Metatarsal deformities

Charcot foot

Eventual tissue breakdown

The symptoms of peripheral neuropathy include the following

• Hyperesthesia-Is a condition that involves an abnormal increase in sensitivity to stimuli of the senses.
• Paresthesia- Is a sensation of tingling, pricking, or numbness of a person's skin. It is more generally known as the feeling of "pins and needles".
• Dysesthesia-It is defined as an unpleasant, abnormal sense of touch, and it may or may not be, considered as a kind of pain.
• Radicular pain-Is pain "radiated" along the dermatome (sensory distribution) of a nerve due to inflammation or other irritation
• Anhydrosis-Means lack of sweating.

Peripheral Neuropathy Signs

• Loss of sensation in the foot- Results in repetitive stress
• Injuries and fractures
• Loss of vibratory and position sense
• Loss of deep tendon reflexes
• Trophic ulceration
• Foot drop

Treatment


Diet

• Patients with diabetic neuropathy should develop a realistic diet for lowering blood glucose. This should be guided by a nutritionist or doctor

Medicines widely used to help with painful symptoms

• Selective serotonin and norepinephrine reuptake inhibitors- example:Duloxetine (Cymbalta)
• Tricyclic antidepressants- example: Amitriptyline (Elavil)
• Anticonvulsants- example:Gabapentin (Neurontin)
• Pregabalin (Lyrica)- FDA approved for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia.
• Capsaicin cream (Capsacin)- A natural chemical derived from plants of Solanaceae. This is a topical medicine and is the active component of chili peppers.
• Neuremedy (Benfotiamine)- For the nutritional management of peripheral neuropathy.

Attention Diabetics

Attention Diabetics, Have you checked your feet recently??

Here is a friendly reminder to check your feet today in case they have been overlooked this past winter. This is an easy exam you can do to see if you need a professional to look at your feet.

Check your feet: for cuts, punctures, irritation, or bruises.
- If you find any of these consult your podiatrist especially if these spots are red, warm or draining.

Check your shoes: make sure you don’t feel any sharp objects in your shoes that would poke your feet.
- If find anything remove it from your shoe and check again.

Check your circulation: push lightly on the tips of your toes that will be pink and reddish in color. The color should change to white when you lift your fingers and then back to pink-red in about 2-3 seconds.
- If the change does not take place right away there might be something affecting your blood flow and you should see your podiatrist asap.

Helpful tip for those with circulation problems… don’t cross your legs when you sit. This will make it even harder for your body to get blood to your feet.

Keep in mind to never put your feet into hot water… only warm water.

Check your feet today!! You never know what you will find.