Getting a Foot Up On Diabetes Care

“Check your feet.”


How many times have we heard it? Many times, however, that’s all we’re told: Check your feet.

What am I looking for? What do I do if I find it?!

And, come to think of it, why am I checking my feet?

Furthermore, they tell us, put lotion on our feet, but not between our toes.

Huh? Why not?

It’s a puzzlement. So I asked my podiatrist, Ken Krueger, DPM, to ‘splain some of this stuff.

What we’re looking for are things such as:
• A red spot
• A crack or opening in the skin
• A blister
• Any drainage (or odor)
• Any change in skin color

“All of these are signs of an injury that can easily lead to a much more significant situation,” Krueger says.

Reduced blood flow, decreased nutrients in the blood and/or decreased feeling (nerve damage, or neuropathy) results in an inability to physically feel that something is wrong. Therefore, a visual inspection is necessary to see if there is a problem with a foot or your feet. And get into the habit of checking your feet every day.

“I cannot tell you how many times I have patients come in and, when I look at the bottom of the foot, there is something like a child’s toy imbedded into the tissue and it had been there for months,” Krueger says.

Don’t go in with a Lego or Polly Pocket imbedded in your foot. Check ’em. If you can’t see the bottoms of your feet, have somebody else look at them or use an unbreakable mirror. Check with a medical supply store for a mirror on a stick especially made to check the bottoms of your feet.
If you do notice any changes, make an appointment with your health-care provider or podiatrist. “NEVER think any change is not a problem,” Krueger says. “Any podiatrist would rather tell somebody with diabetes there is nothing wrong or nothing to worry about than treat a wound.”

Which reminds me…your health-care provider should be checking your feet, too. “And if he doesn’t,” a CDE once told me, “take off your shoes and socks and put your blood-glucose diary between your toes.”
Say you’re looking at your feet and you see something that looks a little “off.” Is it time to go into panic mode and present yourself at your healthcare provider’s office demanding to be seen “right now” – or can you safely ignore it?

“That depends on ‘it,'” Krueger says, explaining that it depends on the significance of the problem and the person’s general health. If it’s a minor problem, some extra attention by the person can get it to heal.

On the other hand, “the reality is that I cannot tell you how many amputations I have performed that, had I seen the problem earlier, it could easily have been treated.”

Now, your feet have been washed in warm water that’s had the temperature checked with a thermometer or your elbow, patted dry with a fluffy towel, including between your toes, thoroughly inspected and ready for some lotion or salve.

Stop and ask yourself, “is this something I can put between my toes or not?” All I know is that my former CDE, Sonja, told me I could put Bag Balm between my toes. Anything else, I’d ask Krueger about.

But why in the Sam Hill can’t I put lotion between my toes?

“When moisture accumulates between toes and it lingers, the tissue can become macerated,” Krueger says. That occurs when the skin is consistently wet – it’s kind of like soaking raisins in water. It results in skin that’s softened, turns white, and is easily infected.

The possibility of maceration “is why we urge people to dry between their toes after a bath, Krueger says. “In the case of salves, it depends on how the salve or cream is absorbed into the tissue so it doesn’t remain on the skin.”

The bottom line? Don’t put anything between your toes unless your doctor tells you to, or says it’s okay. It might defeat the purpose of all that checking.

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  • BK

    Excellent article. I love the idea of putting your BG record between your toes. That should remind them! And someone should be checking with a monofilament at least once a year. You know that little bendy plastic they ask you if you can feel it touching here, here, here and here?

  • Richard Lowery

    I just became a diabetic two weeks,well more like three months but I did know,until I had a terrible dizzy spell.
    Gosh I am all cofused,afraid to eat this or that.
    I love jelly beans but I can’t have those anymore.
    When checked my blood sugar came in a whopping 491!
    Lately I have been getting 112-160.
    My medicine does have metamorphin in it and I decided to start taking B-12.
    I am so fatiqued I can barely do my job.
    I need help,I don’t think my doctor cares enough.

  • Richard Lowery

    It’s not metamorphin,it is actually Jamunet xr with metformin HCI

    Just wanted to get that straight.

  • Jan Chait

    Sorry you’ve had to join the club, Richard, but it may be good to know that your fellow club members are nice folks.

    We all go through the “I’m afraid to eat (whatever)… I can’t have (name your poison)… I’m so tired…” So YIPPEE! You’re just like the rest of us!

    Have you been referred to a registered dietitian who’s a certified diabetes educator? If not, ask to be. You can also find out lots of great information by reading Amy Campbell’s blog.

    If your BGs are normally 112–160, that’s awesome! Maybe you had sugar on your finger when you checked after eating those jelly beans. Or many you ate the whole package at once – which is what I always want to do. Nope. Gotta watch those portions. Then, after you indulge, take a walk to help get your sugar back down. There’s no reason you can’t eat jelly beans; you just have to figure out how to do it without blowing your BGs into the stratosphere.

    At one point, I was so tired I was afraid to drive because of fear I’d fall asleep at the wheel. Once I got my blood glucose under control, the lethargy went away.

    Let us know how you’re doing, OK?

    Jan Chait