Caring For Diabetic Foot Sores

Remember that the following is just general advice, and you should consult with your primary care physician to determine the best techniques for caring for wounds on your diabetic feet, as they will be able to provide some individualized advice. With that said, don’t be surprised if they recommend some of the following tips.

1. Regular Foot Checks – In order to proactively treat foot sores, you need to be aware of their presence. You may think that the development of a sore will be obvious, but diabetes can also affect the sensation level in your feet, meaning you may not always notice small or newly formed sores in certain spots. Get in the habit of conducting daily foot checks to spot the early onset of any new sores.

2. Clean Them – You can reduce your risk of problematic bacteria entering the wound site by keeping the sore clean. Clean the area with water and then pat dry with a clean cloth. Regularly clean the area and change your bandages so they don’t get damp or dirty.

3. Bandage Them – Many providers recommend you apply antibiotic cream and a bandage to the sore after you’ve cleaned the area. Covering the area with a bandage will help to control drainage and protect the area while it works to heal.

4. Limit Pressure On The Area – Try to limit pressure on the area where the sore is located. This may be easier said than done based on the location of the sore, but avoid tight fitting shoes or consider orthotic inserts to help take pressure off the sore. Additional stress can cause the sore to enlarge, so try to be protective of the area while healing runs its course.

5. Manage Your Blood Sugar Levels – When your blood glucose levels are high, our white blood cells can’t work as effectively at helping to heal the wound site. Poor blood glucose control can also damage blood vessels and decrease circulation, further slowing the healing process. Having healthy blood glucose levels is important for a number of reasons if you are diabetic, including for wound management.

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In today’s blog, we share five tips for caring for swollen feet if you have diabetes.

Caring For Swollen Diabetic Feet

If you’ve noticed that your diabetic feet are swelling or retaining fluid more frequently, consider these five actions to help improve fluid movement in and out of the area.

1. Move – Movement helps to get our blood pumping and moving around our body, so get up and move around. Strive to get regular exercise and break up long sedentary periods. This will help to get fluid buildup moving and promote an overall healthy lifestyle.

2. Elevate – If you’re going to spend some time sitting, do it with your feet elevated above your heart. Lay down and prop your feet up on some pillows to make them the highest point on your body. Now gravity will be working in your favor to help drain fluid from your feet and ankles.

3. Compress – Compression socks or stockings are designed to help improve lymphatic flow to and from our feet, and it’s a very passive treatment to pursue, so invest in a couple of pairs of compression socks. The compression gently helps to push blood flow up the leg to help prevent excess swelling and pooling.

4. Drink Plenty of Water – Drinking water may seem like it’s only going to increase the amount of fluid in your body, but water helps to open up blood vessels so that blood can move around more easily. If you drink 8-10 glasses of water throughout the day, you’ll help to keep your body hydrated and your blood vessels open, improving the movement of fluid in your extremities. Staying hydrated is another low effort technique that can really help to reduce fluid retention.

5. Review Your Medications – Some side effects of certain medications include the possibility of blood clots or an increased risk of swelling in the extremities. Really take a closer look at your prescriptions and talk to your doctor to see if your medication could be increasing your swelling risk. See if there are any other treatments that can be as effective without the potential side effects.

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To get a better understanding of hospitalization risk after the onset of an infection, researchers at Johns Hopkins Bloomberg School of Public Health studied more than 12,000 participants in a community cohort study for an average for 24 years. When they reviewed evidence as it related to hospitalization risk after the onset of an infection, researchers were shocked at their stark findings:

• Patients with diabetes faced a 67 percent increased risk of infection-related hospitalization compared to those without diabetes.

• Risk of hospitalization because of a foot infection was nearly six times higher for diabetics compared to non-diabetics

• Diabetes may also be associated with a 72 percent increased risk of infection-related mortality.

In response to the findings, study authors called for “broader guidance on infection prevention and management” in individuals with diabetes.

Diabetes And Infection Risk

This isn’t the first study to highlight the connection between diabetes and infection risk, but it adds to our current knowledge and provides another possible link between the two. Aside from the potential for inhibited blood flow as a result of blood vessel damage because of diabetes, researchers say that glycemic control may also be a factor.

“One likely factor is glycemic control: emerging research suggests patients with diabetes with better glycemic control may be at significantly lower risk of infection-related complications,” researchers wrote.

As you can see, it’s imperative for diabetic patients and their care providers to do everything in their power to help reduce infection risk. For doctors, this involves meticulously reviewing patient charts, talking to the patients about the importance of blood sugar management, strict tool and operation room disinfection, and explaining to patients how to best care for their wounds after the operation.

Patients also play a big role in helping to prevent infections and complications in the wake of an operation. Strict monitoring and healthy adjustment of blood sugar levels is key, and it’s extremely important to clean the incision site regularly as advised by your physician. You’ll also want to choose a surgeon we has an impeccable track record when it comes to infection and complication prevention, like Dr. Silverman (read real patient reviews here).

So if you are diabetic and a surgical operation is in your future, especially if it is a foot surgery, talk to your specialist about infection prevention and how to spot the signs of an issue at the incision site. These infections can jeopardize the integrity of your surgery, lead to the loss of a limb, and can even be fatal on rare occasions. Trust your operation to an experienced surgeon who will do everything they can to ensure your operation and recovery are a success.

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Because of this, we’re excited to help spread the word about Diabetes Awareness Month on our blog and with the help of the American Orthopedic Foot & Ankle Society. As you may know, I sit on the Communications Cabinet of the AOFAS, and they are also working to spread awareness about diabetes and the toll it can take on your feet. Here’s a press release they created to help spread awareness of National Diabetes Awareness Month.

AOFAS Press Release

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The numbers were reported by the digital health tracking platform Glooko, a web and mobile application that tracks blood glucose levels among more than 1.5 million users across 23 different countries. After looking at the collective data of their users, researchers uncovered that Valentine’s Day was the worst day for users in terms of keeping their blood glucose levels in a healthy range. Here’s a look at the average blood glucose levels on some of the worst days in the calendar year:

• Valentine’s Day – 168 mg/dL (9.3 mmol/L)
• Halloween – 158 mg/dL (8.8 mmol/L)
• Christmas Day – 140 mg/dL (7.8 mmol/L)
• New Year’s Eve – 131 mg/dL (7.3 mmol/L)

Michelle de Haaff, Glooko’s vice president of Strategy, said Valentine’s Day is so problematic for diabetics because of the regular opportunities to snack on chocolate and because many people go out to eat for dinner.

“Valentine’s is known to be a sugary holiday where chocolates are given as gifts and people go out for meals. It is likely that is what drives higher glucose,” said de Haaff.

Diabetic Care on Valentine’s Day

So if you are diabetic or pre-diabetic, we want to share some tips for helping you navigate Valentine’s Day and other holidays. For starters, eat and drink in moderation. And by moderation, we don’t mean just one piece of chocolate every time you come into the break room. One or two pieces are fine with lunch or dinner, but don’t snack on these sugary sweets throughout the day. Other tips to help keep your blood glucose levels in check include:

• Fill up on healthier options so you’re not tempted to overindulge with sweets.
• Drinking plenty of water can help you feel full.
• Try to carve out 30-45 minutes to exercise.
• Limit your alcohol consumption during dinner.
• Monitor your blood glucose levels throughout the day.

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Detrimental Diabetic Foot Ulcers

The newest information on diabetic foot ulcers comes out of Thailand, and it speaks to just have devastating they can be. For their study, lead researcher Dr. Apiradee Sriwijitkamol recruited 254 adults with diabetes to determine which complications from diabetes are the most problematic in terms of decreased quality of life. The complications they studied were:

• Diabetic foot ulcers
• Amputation
• Kidney disease
• Heart disease
• Diabetic retinopathy (loss of vision)

All of the participants were polled about a number of different factors, including their issues, how it affected their life or mobility, their pain scores, their emotional health and other quality of life questions.

Diabetic Foot Ulcers Most Concerning

You might assume that amputation would lead to the lowest quality of life, but that’s not exactly what researchers found. Here are some of the findings they uncovered:

• Compared against all groups, participants with diabetic foot ulcers had the lowest mean utility value, although they had similar utility values as those who underwent amputations.

• 21 percent of participants with diabetic foot ulcers lost their job due to their complications.

• Moderate to severe problems were reported more frequently among participants with diabetic foot ulcers compared to all other groups, except on questions about anxiety/depression levels.

“From this study we show that quality of life in patients with diabetic foot problems is worse than those with other diabetes complications and the quality of life is significantly lower across all dimensions,” Sriwijitkamol said. “Lower quality of life in patients with diabetic foot problems also created a health burden, they cannot walk so they have to depend on others and some even lost their jobs.”

In the end, it’s easy to see how a complication can snowball out of control and end up severely crippling a person’s quality of life. That’s why it is so important to take care of your feet and your overall health if you are diabetic.

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The technology is still in its infancy, but it’s producing some successful results. According to the research, the temperature-monitoring foot mat was able to correctly detect 97 percent of impending nontraumatic diabetic foot ulcers in a high-risk population

“We showed that using this wireless mat and an algorithm that detects temperature rise over several days, it is possible to detect development of an ulcer 5 weeks in advance,” reported Robert Frykberg, DPM, podiatrist at Phoenix VA Healthcare System, Arizona, and lead investigator of the study.

Benefits of Temperature Monitoring

When you suffer an injury, you may notice that the injured area is a little warm to the touch. This warming sensation occurs because blood vessels dilate as more blood is brought to the site. A similar process occurs in diabetic foot ulcers, but this change in temperature happens before the ulcers fully develop on the foot. By checking for heat spikes or temperature abnormalities, researchers have been able to predict the onset of ulcers before they develop on a person’s foot, which aids in treatment and reduces severity and likelihood of problems.

Medical experts have been aware of this temperaure change in a person’s foot, and current US guidelines for diabetic foot care suggests daily thermometry of the foot, but there hasn’t really been a good way to track the temperature of an area of a foot or changes in temperature, so few diabetics and doctors rely on the insight when it comes to foot care. That may soon change with the development of the temperature-mapping foot mat.

The technology is relatively simple yet ingenious at the same time. The wireless floor mat requires the patient to stand still for 20 seconds each day. The mat reads the temperature of the person’s feet in a number of different areas to obtain plantar-temperature mapping data which is then cataloged in a monitoring center. A program studies the map, and by comparing it to previous readings, it can predict the onset of diabetic foot ulcers with high certainty.

“Essentially, the mat detects areas of increased inflammation that often precede ulceration,” explained Dr Frykberg. “It has been shown, in this and other studies, that when this device is used with early intervention, it can very likely reduce the development of recurrent ulcers.”

One Drawback

However, there is one drawback with the technology in its current form. Although it accurately predicted the onset of diabetic foot ulcers in 97 percent of instances where an ulcer eventually formed, it also had a 57 percent false-positive rate. So while the vast majority of ulcers are being identified by the machine, it’s also currently flagging a number of areas that don’t turn out to be ulcers. It’s better to be safe than sorry, but researchers will need to reduce that high false positive rate if the device is going to gain widespread attention.

“The standard temperature difference used was 2.22°C, but we can probably become more specific with new algorithms to eliminate many of these false positives.”

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Over the years, diabetes rates have soared in rich countries, but now it appears that poorer, third world countries are following suit. Type 2 diabetes accounts for the vast majority of the increase, which is the most common form of the disease.

The Lancet noted that the findings suggest a notable shift in disease management across the globe. Communicable diseases like malaria and tuberculosis have declined sharply since 1990, but we’ve seen a large increase in chronic diseases like cancer and diabetes. Researchers say the pattern is linked to increased life spans and overall economic improvement, but the shift has left countries scrambling to treat the new, oftentimes expensive, conditions.

Diabetes Study

For the study, the Institute for Health Metrics and Evaluation (IHME) examined health data from more than 35,000 sources across 188 countries. The study sought to uncover the rate of disease disability in a given population. After tracking numerous disorders, researchers uncovered.

• The overall rate of disability fell from 114 per 1,000 in 1990 to 110 per 1,000 in 2013.

• The prevalence of diabetes in China increase 56 percent over the last 23 years.

• The United States saw a 71 percent increase, Saudi Arabia had a 60 percent increase, and Mexico had a 52 percent increase in diabetes rates over the same period.

• In Saudi Arabia, estimates suggest that there are 17,817 cases of diabetes per 100,000 people. Comparably, China has 6,480 per 100,0000, and the US had 6,630 per 100,000.

Although the sharp increase is troubling, on an encouraging note, death rates from diabetes have decreased substantially. Theo Vos, a professor of global health at IHME said people with diabetes are living longer because medical systems have gotten better at preventing problematic symptoms and conditions associated with the disease. That said, the increase in patients with diabetes is taking a toll on our medical system.

“On balance the burden is coming down — it’s better to be alive, even if you have disability,” Vos said. “But the downside is that it requires much more health system resources to treat people with these chronic problems.”

Dr. Silverman comments

It’s not surprising that diabetes rates are going up. It seems like there’s a fast food joint on every corner, and we’re becoming a more sedentary society thanks to smartphones.

It’s also not surprising that doctors are getting better at treating the condition. The more people you see with a disease, the better you’ll get at managing and treating the symptoms and side effects.

Related source: Time

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The findings published yesterday in the Journal of the American Medical Association made the claim after analyzing diabetes rates since 1980.

“There’s been a lot of good news lately in terms of rates of complications decreasing…but this is the first time we’ve been able to detect a change in the incidence of diabetes in a good way,” said Linda Geiss, chief of diabetes surveillance at the CDC.

That said, Geiss cautioned that diabetes rates still remain at a disturbing level. Rates aren’t increasing, but they also aren’t decreasing.

“It’s not disappearing, it’s leveled off….We need to continue all our efforts to help combat it, to prevent the complications of diabetes in those who have the disease, and to prevent diabetes itself.”

She concluded by saying that physicians will play a key role going forward in the prevention and reduction of diabetes cases.

“It’s certainly important for physicians to recommend lifestyle intervention programs to their patients at high risk,” said Geiss. “We know that these work and can help prevent diabetes.”

More Diabetes Data

Researchers at the CDC said diabetes prevalence and incidence rose between 1990 and 2008, with annual increases of 4.5 percent and 4.7 percent respectively. Between 2008 and 2012, the US saw a 0.6 percent increase in the prevalence of diabetes, but a 5.4 percent drop in incidence. Other findings during the past two decades include:

• Diabetes incidence and prevalence increased at a significant rate for younger adults than older adults.

• Black and Hispanic diabetes rates increased at a greater rate than for white adults.

• Individuals with only a high school level education had a bigger increase in diabetes prevalence than those with more than just a high school degree.

Dr. Silverman comments

We write about diabetes pretty frequently on the blog, and although the article appears to state that rates have plateaued, the number of individuals affected by the disease is too high, and we should never take a study simply at face value.

In all, we’re slowly moving in the right direction, but there’s still work left to be done. Take care of your body. Follow the four lifestyle pillars to avoid death or the five health habits of healthy individuals and you’ll surely decrease your risk of diabetes or heart disease. There is no magic pill to counteract all the junk food you put in your body. Exercise and a healthy diet are two great ways to ensure your body stays in tiptop shape.

Related source: Medscape

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“Our study is really the first in the US to quantify the burden of type 2 diabetes at the population level — and not just in a clinic or group of clinics, [but] in all major racial/ethnic groups in the US — and documents increasing trends in several racial-ethnic groups,” emphasized lead author Dana Dabelea, MD, PhD, from the Colorado School of Public Health, Aurora, in an interview with Medscape Medical News.

The results of the study found that Type 2 diabetes rates rose 35 percent between 2001 and 2009, while Type 1 rates increased 30 percent during the same period.

“[The findings] were consistent with worldwide estimates,” the researchers wrote.

The Study

For their study, researchers analyzed data from 38 counties in five states, as well as American Indian communities in the Southwest between 2001 and 2009. Aside from the above findings, researchers noted:

• The biggest rise in Type 2 diabetes cases occurred in Hispanic children, followed by blacks and whites.
• The biggest increase in Type 1 diabetes occurred in white children, but there were also significant increases in blacks, Hispanics and Asian Pacific Islanders.

Intervention Techniques

Dr. Dana Dabelea, of the Colorado School of Public Health and lead author of the study, said intervention techniques need to be instilled early on in life to combat Type 2 diabetes.

“It is likely that prevention of type 2 diabetes in youth will require sustained lifestyle changes that need to be implemented and maintained throughout the life course but starting very early in life, during (or even before) pregnancy,” she said. “This will include optimizing maternal weight gain and nutrition patterns during pregnancy, promotion of breastfeeding, and promotion of healthy diets and physically active behaviors at the earliest possible times.”

She added that minority families should also do their part to promote healthy eating habits, as Type 1 diabetes is becoming a larger risk factor.

“Historically, type 1 diabetes has been considered a disease that affects primarily white youth; however, our findings highlight the increasing burden of type 1 diabetes experienced by youth of minority racial/ethnic groups as well,” Dabelea wrote.”It is likely that something has changed in the environment in which our children are born and raised — both in the US and elsewhere in the world — causing more youth to develop the disease, maybe at increasingly younger ages.”

Dabelea concluded that further studies are needed to determine the causes of Type 1 and Type 2 diabetes increases, and she hope the latest findings can help “draw attention to the public-health impact of pediatric diabetes.”

Dr. Silverman comments

While I commend Dr. Dabelea and her team for their research, it’s pretty obvious why diabetes rates are soaring across the country. The spike has been documented on this blog over the last two years. Soda consumption is on the rise, and the rising availability of sugar means it’s easier for parents and children to fall into poor eating habits.

Although we’ve uncovered some beneficial ways to treat diabetes, as is the common theme throughout so many of these blogs, prevention is far preferred to treatment. Start by making small lifestyle changes and work to improve on those choices. Put down the soda and reach for a water. Go for a walk after dinner instead of plopping down in front of the TV. Set a good example for your children, and they’ll follow suit.

Related source: JAMA, Medscape

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