How can I keep the skin on my feet healthy?
I have low vision. What are some techniques I can use for my daily foot examination?
If it’s hard to see your feet, run your fingers over them to feel for calluses or sore spots. The backs of your hands are sensitive to heat and can be run over your feet to find hot spots, which can indicate infection.
Never walk with bare feet or with just socks on, especially if your feet are numb, to reduce the risk of foot injury. Also, don’t soak your feet unless you’re instructed to do so; this can dry out the skin and increase the risk of injury and infection. Do not use commercial products to remove corns and calluses, strong antiseptics, or heating pads on your feet. All can cause irritation that increases the risk of foot complications.
Try wiggling your toes and rotating your ankles for a few minutes every day to promote blood flow to your feet.
Regular follow-up examinations for people with diabetic ulcers are an important part of treatment; even after they have healed, approximately 30% of ulcers recur.
Putting topical disinfectants such as iodine, acetic acid, or hydrogen peroxide on a foot or leg ulcer may actually impair wound healing. Do not add any steps to wound treatment that are not part of the plan developed with your health-care provider.
People with peripheral neuropathy or with peripheral vascular disease, especially if they have limited joint mobility in the foot or a foot deformity, should check their feet regularly and carefully and should change their shoes midway through each day to reduce the risk of foot irritation.
Signs of peripheral vascular disease include leg pain that occurs only during activity, pain in the foot even while it is at rest, loss of hair on the lower legs and feet, skin that appears tight and shiny on the affected area, and reduced size of foot muscles.
Avoiding all episodes of hypoglycemia may be impossible for many people, especially since maintaining tight blood glucose control brings with it a higher risk of hypoglycemia. However, although hypoglycemia can, at times, be unpleasant, don’t risk your health by allowing your blood glucose levels to run higher than recommended to avoid it.
People who have had chronically high blood glucose levels for a long time may experience symptoms of hypoglycemia when their blood glucose level drops to a more normal range.
In people who take insulin or a drug that spurs the pancreas to release more insulin, not eating enough food at the times the insulin or drug is working can cause hypoglycemia. Physical activity and exercise also lower blood glucose level and can contribute to hypoglycemia if not planned for properly.
For most people with diabetes, a blood glucose level of 70 mg/dl or less is considered low, and treatment is recommended to prevent it from dropping even lower. If you have symptoms of hypoglycemia and do not have your blood glucose meter available, treatment is recommended.
Nephropathy (diabetic kidney disease) is the most common cause of kidney failure in the United States and the greatest threat to life in adults with Type 1 diabetes. It is essential that people with diabetes undergo an annual test for the presence of microalbuminuria, the spilling of small amounts of the protein albumin into the urine, which indicates kidney damage.
The risk for retinopathy, a disease of the retina that is associated with diabetes, can be reduced with control of blood glucose and blood pressure levels.
Should you need to be admitted to the hospital for any reason, ask that a member of your diabetes care team be consulted regarding your treatment to ensure that you maintain the best possible blood glucose control. Keeping your blood glucose levels as close as possible to their target ranges while you are in the hospital can reduce your chance of developing further illness or infection during your stay.
If you have a history of diabetes and are visiting a physician for the first time, you should have a complete physical exam as well as a discussion about your current blood glucose control, the presence of any diabetes complications, and your ongoing diabetes care needs.
If you have hypoglycemia frequently, you may need to raise your blood glucose targets, and you should monitor your blood glucose level more frequently and avoid alcohol.
Many people still make a fair amount of insulin when they are first diagnosed with Type 2 diabetes, so their initial treatment may focus mainly on decreasing insulin resistance. However, a person's treatment may change over time as his degree of insulin resistance or ability to produce insulin changes.
If something has happened in your life that has affected how you care for your diabetes, let your health-care provider know. Remember that your health-care providers are there to help you create a plan that will work for you, not to judge you on your ability to carry out a particular plan.
Ask your health-care providers for any money-saving tips they may have, and tell them if you cannot afford the drugs or other products they recommend.
If you’re having a rough time, or your feelings are keeping you from caring for yourself or doing the things you enjoy, consider seeking out support from others who have diabetes.
If lifestyle changes alone don’t bring your blood glucose, as well as your blood pressure and blood cholesterol levels, into target range, drug therapy may be necessary.
Performing at least 150 minutes of moderate-intensity aerobic activity a week and/or at least 90 minutes of vigorous aerobic exercise a week is recommended.
Fat should make up no more than 30% of your total energy intake, and most of that fat should be monounsaturated or polyunsaturated.
Limiting the amount of saturated fat, trans fat, and cholesterol you eat and engaging in an increased amount of physical activity can help to lower your blood cholesterol levels.
Your cardiovascular risk factors should be assessed by your physician at least once a year.
High LDL (“bad”) cholesterol, high triglycerides, high blood pressure, and uncontrolled blood glucose levels all place you at risk for heart disease. Carrying extra weight around your waist also raises your risk of heart disease, and smoking doubles your risk of developing heart disease. The ACCORD study and others have raised questions about the belief that high blood glucose is the biggest risk factor.
If your new job will mean a big change in your daily schedule or activity level, speak to your doctor before you begin to discuss how and when any changes in your diabetes self-management regimen should be made. If possible, adopt your new schedule before you actually start your new job so you can see what effect, if any, it has on your blood glucose levels.
In most cases, pump users should change the insulin in their pump's reservoir, as well as their infusion set, every 48 hours. However, in mid-July, Novo Nordisk announced FDA approval for a labeling change to insulin aspart (brand name NovoLog) that allows people to use the insulin in their pump for up to six days.
The expiration date on insulin packaging is for unopened, refrigerated vials, disposable pens, or pen cartridges. Once opened, most vials of insulin last for 28 days, even if refrigerated, but many pens and pen cartridges are good for only 7, 10, or 14 days (and should not be refrigerated).
Working with a registered dietitian can be helpful in fine-tuning your carbohydrate-counting skills. Carefully reading nutrition labels on food products and measuring portions will also help you to meet your carbohydrate goals.
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