Diabetes and Foot Health

Your Feet Should Not Be Forgotten

If you have diabetes, you are likely aware of the many potential health risks to various parts of the body.  However, one area that often gets overlooked is the potential for negative effects on your feet. Diabetes affects the feet in many ways. Diabetes occurs when the body does not produce enough insulin or does not use it effectively, resulting in elevated blood glucose levels. The high glucose levels can cause nerve damage and reduce circulation in the feet and other parts of the body. 


Let’s take a closer look at some of the potential foot ailments that diabetes can cause as well as some preventative measures that you can take to reduce your risk of developing them.

feet

Diabetes Foot Complications

Foot Ulcers

People with diabetes are more likely to develop open sores (ulcers) on their feet due to poor healing. Poor healing is caused by an impaired immune system associated with diabetes as well as decreased blood flow and sensation in the feet due to nerve damage. The risk of developing foot ulcers is also increased if there is an infection, trauma, or pressure on the feet.



Nerve Damage

People with diabetes are more likely to experience nerve damage (peripheral neuropathy) in their feet due to high blood glucose levels over time. This causes reduced sensation in the feet, which can lead to difficulty feeling pain and detecting potential injuries such as cuts, bruises, or blisters that can lead to infection or ulceration. It also increases the risk of burning sensations, numbness, tingling, or sharp pain in the extremities, including the hands and feet.

feet in a bed

Infection

Reduced blood flow and poor circulation combined with poor sensation increase the risk of developing infections such as athlete’s foot and cellulitis, which can spread quickly without proper treatment. Without proper treatment, these infections can become severe and spread throughout the body, possibly even leading to amputation if left untreated.


Charcot Foot

Also known as neuropathic arthropathy, this is a condition caused by nerve damage that results in weakened bones in the foot, similar to osteoporosis, resulting in painful joints that require surgery to treat.  Charcot foot can also result from increased pressure on nerves from ill-fitting shoes. With diabetes, when your shoes don’t fit correctly, it might be due to a lack of sensation in affected areas resulting from nerve damage. This can make it difficult for diabetics to know when something does not fit properly on their foot, causing further injury or damage.

man lying in a hammock

How to Care for Your Feet

Fortunately, there are preventative measures that people with diabetes can take in order to better care for their feet:


Check Feet Daily

It is important for all people with diabetes since they may have reduced sensation or difficulty recognizing signs of injury or infection due to nerve damage, so checking your feet daily will help you recognize any changes early before they become serious problems requiring medical attention.

bare feet

Wear Proper Footwear

Always wear shoes that fit properly (including socks); avoid wearing sandals or flip flops because they do not provide protection against injury or infection; this applies even when indoors because some areas may have rough surfaces or objects strewn about that could be potential sources of injury or infection if stepped on barefoot; and only wear shoes intended specifically for diabetic patients because these are designed with additional cushioning.  Avoid purchasing used shoes because they may have already been worn down, providing less cushioning and support than new shoes. Never go barefoot, especially outdoors!

woman's feet

Avoid Smoking and Exercise Regularly

Smoking reduces circulation, increasing the risk of infection and ulceration and regular exercise helps maintain healthy blood glucose levels and combats insulin resistance.  While these are among the most commonly recommended health prescriptions for all people, it’s especially important for those with diabetes to adhere to in order to maintain healthy feet.


Regular Visits to the Doctor and Podiatrist 

These visits will help monitor overall health while looking out any signs of potential problems needing attention, such as fungal infections that do not appear right away even after a diligent home-care routine was followed, making sure nothing slips through the cracks and catching anything early before it becomes a serious problem later requiring hospitalization.



If you have diabetes and are looking for convenient and innovative ways to manage your diabetes and protect your foot health, please don’t hesitate to reach out to us at any time!

feet in the sand
legs on a couch
man running on beach
feet
shoes and a heart
footprints in the sand

Healthy Bites

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Telemedicine can make diabetes care less expensive and easier to access, but it may not always be a suitable replacement for an in-person visit. Learn what happens during a telehealth visit and see if you could benefit from using telemedicine for your diabetes care. The pandemic upended a lot about life as we knew it. Notably, it was responsible for a 63-fold increase in telehealth visits . For people managing diabetes, however, having a doctor visit over video brings up a host of questions and potential issues. How can a doctor properly check my eyes and feet through a computer screen? Will telehealth replace in-person discussions about my blood sugar? Will I get the same level of care through a computer? According to a 2022 article in American Family Physician , telehealth is promising for diabetes treatment and has been shown to help improve glucose management. In a separate analysis of glucose data from people with type 2 diabetes, people who received remote monitoring of their glucose levels saw significant improvements in A1C over a period of three months. That being said, no study or physician is implying that telehealth fully replaces in-person medical care for diabetes. Here’s what to consider and who might be the best candidates for telediabetes care. What happens during a diabetes telehealth visit? Telediabetes care involves two types of interactions. One is a video meeting with a physician or care team to discuss challenges and potential solutions. During this type of visit, the healthcare provider can see some physical signs or changes, such as rashes or wounds. The second type of interaction is virtual monitoring of glucose levels through a monitoring device that sends data to the care provider. The provider might also follow up with a video call to discuss the data. “Many of the things that are important for diabetes care – blood glucose data review, medication review, insulin teaching – can all happen over video,” said Dr. Varsha Vimalananda, an endocrinologist and associate professor of medicine at Boston University. “CGM data can be uploaded and reviewed remotely, which is also very helpful.” Different providers use different video platforms for telehealth appointments, but most will look and function much like a Zoom call. The benefits of telehealth in diabetes care Not all elements of diabetes care are best suited for telehealth, but many lend themselves naturally to the conversation and convenience that an electronic visit facilitates. For type 2 diabetes in particular, telehealth has been shown to be more effective than in-person care at helping people manage their condition. One reason for the improved outcomes is simply better access to care. Dr. Keta Pandit, an endocrinologist at Texas Diabetes & Endocrinology in Austin, Texas, says continuous glucose monitoring (CGM), along with telehealth options, have changed the landscape of diabetes care. “One of the benefits of being able to offer telemedicine to our patient population is that it has increased the access to care, especially with any ongoing illnesses, hospitalizations, COVID, post-COVID, or any other situations when patients notice their glucose levels are going out of their standard range. Patients often contact us for these types of situations, and we can quickly get them seen via telemedicine to make adjustments to their diabetes medications,” she says. “While this was still an option prior to telemedicine days, the opportunity to see their provider on short notice, not having to worry about transportation, and not having to put in advance notice to take time off of work to travel to the doctor’s office, are some of the ways access to care has increased.” Pandit says this is particularly true for older patients who require frequent visits and women who are pregnant, as well as those who need to optimize their glucose levels before and after surgery. Jasmine Meidas, 51, of Cleveland, Ohio, is one such patient. She was diagnosed with type 2 diabetes 15 years ago. “During the COVID-19 pandemic, I was much more comfortable with telehealth than going into my endocrinologist’s office, which is in a hospital. I still am,” she says. Meidas has a one-hour telehealth visit every three months. “They can order blood work to be taken locally, [and] we review [the results] together. We also review food choices, lifestyle challenges, stressors, and more. We set action steps and goals for the next 90 days,” she says. Meidas periodically sees her endocrinologist in person as well. At Vimalananda’s clinic in Boston, specific groups are making great strides with telehealth options. “Veterans, mostly,” she says. “I have a few [Veteran patients] who have severe [post-traumatic stress disorder]. Driving out to the clinic, dealing with traffic, and navigating the hospital are all things that cause a lot of distress. It’s been a game-changer for them to be able to have the visit from home.” When is telehealth not the best option? “If you have diabetes, please remove your socks and shoes.” This type of sign is frequently displayed in doctors’ offices. How would a foot exam work in telehealth? This is a real concern for people with diabetes, as up to 15% of patients will have a foot ulcer in their lifetime. Pandit and other experts acknowledge the limitations telehealth can have. “The medical team [must depend] on the patient [to provide] data and limited access to other parameters that are needed, including blood pressure measurements or foot examinations. When visits are conducted via telemedicine…care is not as comprehensive,” says Pandit. “There are times when the telemedicine model may pose risks. The limitation is clearly noted in visits with patients who are not technologically savvy, may have hearing issues, or [have] poor [internet] connection at the time of the visit.” Telehealth can also give health care providers a direct view into the home environment, which may result in a patient’s hesitancy to share openly — with family members potentially nearby — and impede the building of relationships and rapport. 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Figuring out when and how to exercise can be one of the most difficult parts of living with diabetes. Hear from experts who discuss the benefits and share strategies for safely exercising. Having diabetes doesn’t mean you have to let go of the things you love doing, which may include playing sports. Exercise is an essential part of diabetes management, leading to improved weight management, reduction in cardiovascular disease risk factors, and great mental health benefits. Experts like Dr. Lori Laffel, chief of the pediatric, adolescent and young adult section at Joslin Diabetes Center, discussed the benefits and strategies for safely exercising with diabetes. Laffel pointed to the ADA’s Standards of Care, which recommend adults get 150-300 minutes per week of moderate-to-vigorous exercise and youth get 420 minutes per week of moderate-to-vigorous exercise. 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According to Michael Riddell, professor of kinesiology and health sciences at York University, an optimal glycemic range is “unclear and very individualized for the athlete with diabetes.” Factors that influence one’s glucose response to exercise include the type of activity, time of day, whether you’ve recently taken insulin, what food was recently consumed, stress, sleep, and more. Athletes who compete may want to consider how their levels vary between training days versus competitions. While it might not always be doable in practice, Riddell recommends a time in range of 70% during training and 75% on competition days – while paying special attention to minimizing hypoglycemia to less than 1%. For competitive athletes, other important things to manage include sleep, meals, basal/bolus insulin, hydration, and workout schedules. The type, duration, and intensity of exercise are main factors that influence glucose response. 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Helpful guidelines and tech for exercise Activity monitors and devices can significantly help with diabetes management while exercising. Connected pens and insulin pumps provide timely dosage; continuous glucose monitors (CGM) let you follow trends to guide your insulin dosing and carb intake; and automated insulin delivery (AID) can protect you from hypoglycemia and possible hyperglycemia. Laffel provided a few basic guidelines if you’re engaging in aerobic exercise for more than 40 minutes. If you’re on multiple daily injections (MDI) or an open-loop pump, consider the following insulin adjustments: For those on MDI, start with a 20% reduction in basal insulin dose. For people on insulin pump therapy, reduce basal rate by about 50% (as a starting point) 1-2 hours before, during, and about one hour after exercise. Reduce bolus insulin by 50% for meals or snacks two hours before and up to two hours after exercise. 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