Posts for: December, 2013

 

Dry, cracked skin and winter go hand in hand, but the risk for diabetics is greater than the general population, according to health care workers.

Cold weather makes it harder to keep skin hydrated, but moisturizers can help, according to Katie Kelly, family nurse practitioner for the Durham Diabetes Coalition.
“I think the biggest thing as we go into the winter months is to keep the skin hydrated and moisturized,” Kelly said. “People with diabetes have a tendency for drier skin. If your skin cracks, you’re prone to infection and we want to prevent that.”
Keeping the feet free of infection is especially important, she said.
“Make sure to check your feet for any sore or irritation,” Kelly said. “If you find any cuts, be quick to wash them with soap and water to prevent bacteria from causing an infection.”
If foot infections don’t heal properly, that can lead to a long course of wound care.
“The infection can spread, and can be a precursor to amputation,” she said. “This is why we focus on foot care and preventing any open wound on the foot, because those infections are sometimes slower to heal.”
Using a good moisturizer is important in cold weather. Two that Kelly recommends are  Cetaphil and Eucerin.
Kelly also suggests that diabetics consider not taking a shower or bath daily, and avoid very hot water, which quickly dries the skin.
Keeping the body hydrated by drinking plenty of water can also keep the skin from drying out.
“During the cold months, we encourage people to wear socks and shoes that cover the entire feet and to protect their skin outdoors,” she said.
The American Diabetes Association and Joslin Diabetes Center offer these tips:
- Use talcum powder in areas where skin touches skin.
- Don’t use moisturizers between the toes.
- Keep your home more humid in cold, dry months.
- Inspect skin for spots, blisters or sores.
- Treat cuts right away.
- Drink lots of fluids like water and drinks free of sugar and caffeine to stay hydrated.
- See a dermatologist about skin problems you can’t solve.
- Eat foods rich in omega-3 fatty acids to nourish the skin.

 To watch a video on foot care, visit http://www.youtube.com/watch?v=fzy0g_3hQzU


Tips for people with diabetes to prevent and control neuropathy

 

When you have diabetes mellitus, which is referred to as diabetes, your blood glucose level is consistently high. Untreated, a high sugar level damages your nerves. Blood vessels that take oxygen to your nerves are also damaged. Damaged nerves send messages slowly or at the wrong times, and nerves eventually stop sending messages to the brain. This damage is called diabetic neuropathy.

Diabetic neuropathy can occur in both Type 1 and Type 2 diabetes. In Type 1 diabetes, the body does not produce insulin. Insulin is needed to convert glucose into energy that the body needs. Type 2 diabetes is more common. In Type 2 diabetes, the body does not use insulin properly, which is called insulin resistance. The body begins to make extra insulin. Over time, the body cannot make enough insulin to keep the glucose level normal.

Neuropathy is a serious complication of diabetes, and it affects up to 70 percent of people with diabetes. Neuropathies can occur in any part of the body, including the eyes, heart, lungs and feet.

eripheral neuropathy is the most common type and occurs slowly. Initially, it affects the foot. Peripheral neuropathy eventually spreads to the ankle and leg. Because nerves have been damaged, patients do not feel pain. Patients may be unaware of foot injuries, which can lead to open sores. If these sores don't heal or they become infected, they result in more complications. In severe cases, toes or the foot need to be amputated. Foot ulcers account for 85 percent of toe or foot amputations. Approximately 50 percent of amputees die within five years.

Neuropathy also results in muscle loss. This makes standing or walking difficult. People with neuropathy may become depressed and socially isolated. Neuropathy also decreases quality of life.

Symptoms of peripheral neuropathy

If any of the following statements apply to you, contact your doctor. Tests will be ordered to confirm whether you have diabetic neuropathy:

• My feet tingle.

• I feel "pins and needles" in my feet.

• I have burning or shooting pains in my feet.

• My feet are sensitive to touch.

• My feet hurt at night.

• My feet are numb and feel dead.

• I don't feel pain in my feet.

• I can't feel my feet when I'm walking.

• I'm unsteady when I walk or stand.

• My feet and hands get very cold or very hot.

• I have open sores on my feet and legs that heal slowly.

• It feels like the muscles and bones in my feet have changed.

What factors increase my chances of getting diabetic neuropathy?

People with diabetes can develop nerve problems at any time. The risk increases with age. The highest rates of nerve problems are among people who have had diabetes for at least 25 years.

Neuropathies are more common in people who are overweight and have high cholesterol levels. The risk increases when control of their blood glucose level is inadequate. Other risk factors include smoking, heavy alcohol use and being tall. Having both diabetes and high blood pressure greatly increases the risk for serious complications.

What is the treatment?

There is no cure for neuropathy. Nerve damage cannot be reversed. Treatment focuses on three goals. The first is to slow the progression of neuropathy. The second is to relieve pain. The third is to treat complications such as infections. To slow the progression, it is critical to bring blood glucose to a normal level. Glucose monitoring, meal planning, physical activity and medication help control the glucose level. Good glucose control prevents or delays the onset of future problems.

For patients with diabetic neuropathy, commonly used medications include antidepressants, anticonvulsants, prescription pain medication and topical agents. Many of these medications are approved for treating other conditions. They are used because of their positive effects. Antidepressants and anticonvulsants are generally used first. Depending on the medication, side effects may include constipation, dizziness, headache, nausea, dry mouth, fatigue, diarrhea, weight gain and insomnia.

Medications only partially relieve pain. Typically, pain is reduced by 30 percent to 50 percent. Your doctor may also prescribe medication to lower cholesterol levels. Patients interested in using supplements should first discuss this with their doctor. There is some evidence that L-carnitine and alphalipoic acid help reduce pain.

What can I do to prevent or control diabetic neuropathy?

Diabetic neuropathy can be prevented or controlled. Monitoring your glucose level and adopting a healthy lifestyle can decrease your risk for neuropathy by as much as 60 percent.

Recommendations for Patients with Diabetes

• Get a foot examination at least once a year.

• Lose excess weight. Exercise regularly and follow a healthy diet. Buy a cookbook with recipes for diabetics.

• Limit alcohol use. Quit smoking.

• Keep your blood pressure under control. Monitor it daily.

• Examine your feet daily. Look for blisters, cuts, bruises, ingrown toenails and redness or swelling. Use a mirror to examine the bottoms of your feet.

• Keep your blood glucose level in the range recommended by your doctor. Regularly monitor your glucose level according to your doctor's recommendation.

• Get an A1C lab test twice a year. This test determines your average glucose level for the past two to three months.

• Get an eye examination annually. Your doctor may recommend frequent examinations.

• When complications occur, get treatment right away. Early treatment helps prevent additional complications.

• Protect your feet. If your feet are dry, use lotion, but not between your toes. Wear shoes and socks that fit well. Use warm water to wash your feet, and dry them carefully. Avoid exposing your feet to hot and cold temperatures.

• Use different shoes each day. Ask your doctor if you need special shoes. Avoid sandals, high heels and open toe shoes. Don't go barefoot.

• Be careful when exercising. Some activities are not safe for people with neuropathy. Talk with a diabetes specialist who can give you an exercise plan.

• Keep follow-up appointments even if your diabetes is well controlled.


No one disputes that exercise provides a host of health benefits, from helping control weight to improving cardiovascular functions. But exercising in the wrong footwear can cause more harm than good, especially since foot health is integral to overall well-being.

“To get the most out of your workout or from playing a favorite sport, it’s imperative to choose the right footwear for the type of exercise you’ll engage in,” says Dr. Matthew Garoufalis, a podiatrist and president of the American Podiatric Medical Association. “Improper footwear can lead to irritation and injury.”

Foot or ankle sprains and fractures are the most common types of injuries related to exercise and footwear. The type of exercise or sport you prefer can influence the type of injury you could experience. In general for example, foot and ankle sprains and fractures are more common among football players, while basketball players may suffer more ankle sprains and runners experience stress fractures to feet or ankles.

Some guidance on how to avoid foot injury while exercising:

• Always warm up before exercise.

Just as you stretch to warm up leg and arm muscles, your feet need to warm up gradually too.

• If you experience foot pain while exercising or engaging in physical activity, stop immediately.

Foot pain is not normal and you shouldn’t feel any when you exercise. If pain persists even after you stop your workout, see a podiatrist.

• Always wear supportive shoes that are appropriate for the type of physical activity you’re engaging in.

Choosing the right footwear can help ensure you minimize the risk of injury and enjoy a more productive and comfortable workout. When choosing workout or sports footwear, keep these pointers in mind:

• Choose a running shoe based on your foot type: low/flat arch, normal arch or high arch.

You can find a graphic of what each foot type looks like on the APMA website. If you have a low or no arch, you need a supportive shoe designed for stability and motion control. Normal arched feet require a shoe with a balance of stability and cushioning to help absorb shock when your feet meet the ground. For people with high arches, a cushioned running shoe with a softer midsole and more flexibility compensates for the poor natural shock absorption of the higher arch.

• Also take into account the kind of activity you’ll do.

Runners need more arch support and cushioning to absorb impact. Basketball players require extra ankle support to prevent injury from side-to-side movement – which is why basket ball shoes come up over the ankles.

• Don’t go it alone when you’re shopping for a workout or sports shoe.

Go to a store that specializes in athletic footwear and ask to be professionally fitted before you buy. Shoes should fit comfortably as soon as you try them on; never assume you’ll “break in” an uncomfortable athletic shoe. Shop toward the end of the day, when feet are at their largest due to normal daily swelling.

• Whatever your exercise or sport of choice, your athletic shoes should offer plenty of support in the front and back.

Finally, when athletic shoes begin to show signs of wearing out, it’s time to replace them. Examine the tread, especially around mid-sole. Generally, you should replace athletic shoes every year, and running shoes every 300 to 400 miles.


WEDNESDAY, Dec. 4, 2013 (HealthDay News) -- New research shows that many Americans who are at risk for type 2 diabetes don't believe they are, and their doctors may not be giving them a clear message about their risk.

American Diabetes Association researchers surveyed more than 1,400 people aged 40 and older and more than 600 health care providers to come to this conclusion. The investigators found that 40 percent of at-risk people thought they had no risk for diabetes or prediabetes, and only 30 percent of patients with modifiable risk factors for diabetes believed they had some increased risk for diabetes.

Less than half of at-risk patients said they'd had regular discussions with their health care provider about blood pressure, blood sugar levels and cholesterol, and didn't recall being tested as often as health care providers reported actually testing them.

Only 25 percent of at-risk patients are very or extremely knowledgeable about their increased risk for type 2 diabetes or heart disease, according to health care providers.

While patients do know what helps lower diabetes and heart disease risk, such as a healthier diet and more exercise, many of those who are at-risk are overweight or obese (about 70 percent) and/or sedentary (37 percent).

Health care providers said the greatest barrier to treating at-risk patients is non-compliance with recommended lifestyle changes. This could be because nearly 80 percent of at-risk patients think they are in excellent or good health.

It is critical for health care providers to ensure that patients understand the link between risk factors and diabetes development, said Virginia Peragallo-Dittko, the incoming chair of the American Diabetes Association's prevention committee and executive director of the Diabetes and Obesity Institute at Winthrop-University Hospital in Mineola, N.Y.

While health care providers think their at-risk patients are making the connection, a quarter of these patients said they weren't concerned because they don't have any health problems, she noted in a news release from the American Diabetes Association.

More information

The U.S. Office of Disease Prevention and Health Promotion explains how to prevent type 2 diabetes.

-- Robert Preidt

SOURCE: American Diabetes Association, news release, Dec. 4, 2013

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