Taking Steps Toward Healthy Feet

The ADA currently recommends keeping blood glucose levels before meals between 90 mg/dl and 130 mg/dl and keeping blood glucose levels one to two hours after meals below 180 mg/dl for most people. (Both of these ranges assume a meter that gives plasma glucose readings.) Your diabetes care team may recommend slightly different blood glucose goals for you based on personal characteristics such as your age and other health conditions you may have. Be sure you know what your personal blood glucose target range is.

Controlling blood fats. High blood levels of low-density lipoprotein (LDL) cholesterol (the so-called bad cholesterol) and the fats called triglycerides can contribute to atherosclerosis (hardening of the arteries) and heart disease. Atherosclerosis is also a contributor to the development of peripheral arterial disease, which itself increases risk for foot complications by interfering with the healing of wounds. Peripheral arterial disease can be symptomless or it can manifest itself in a number of ways including coolness of the fingers or toes, loss of hair on the hands or feet, or intermittent claudication (pain in the legs or buttocks that starts with activity and subsides with rest).

People with diabetes tend to have LDL levels similar to those of people who don’t have diabetes, but diabetes often causes decreased levels of high-density lipoprotein (HDL) cholesterol (the so-called good cholesterol) and increased levels of triglycerides. The ADA recommends that people with diabetes achieve LDL levels below 100 mg/dl, triglycerides below 150 mg/dl, and HDL levels above 40 mg/dl (some experts recommend that women aim for HDL levels above 50 mg/dl). Depending on your levels and symptoms, your health-care team may recommend dietary changes, including lowering your intake of saturated and trans fats, exercise, and medicines.

Controlling blood pressure. High blood pressure is a major contributor to heart disease, the leading cause of death for people with diabetes. It also increases risks for peripheral arterial disease and impaired circulation to the feet. The ADA advises people with diabetes to attain blood pressures below 130/80 mm Hg. Dietary changes such as decreasing the sodium in your diet, exercising, and medicines are all possible treatments for high blood pressure.

Smoking cessation. As mentioned earlier, smoking is related to early development of vascular complications in people with diabetes. If you smoke, therefore, your risk for foot problems increases; lowering your risk, obviously, involves quitting. Several options are available to assist with smoking cessation such as individual or group counseling and use of nicotine products or certain prescription medicines. Your diabetes care team may be able to offer guidance on choosing an option for you.

Daily foot inspection. Take time to inspect your feet every day. Look at the tops and bottoms of your feet as well as between your toes. Rubbing the back of your hand (which is especially sensitive to temperature) along your foot can help you to detect cool spots, which may indicate impaired circulation, or unusually warm areas, which could be signs of inflammation and infection. If you examine your feet every day, you are likely to notice if something has changed. Check with your diabetes care team if you find a change that concerns you or if you notice any of the following in your feet and legs: redness, swelling, or increased warmth; any change in size, odor, or shape; pain, either at rest or when walking; any open sores; sores that do not heal; ingrown toenails; and corns or calluses (especially if there’s any skin discoloration). In addition, call your diabetes care team if you experience high blood glucose levels for which you can determine no cause; this may be a sign of infection.