Diabetes and the Feet: What to Tell Your Patients
Management and Prevention
As a medical professional, you can play a critical role in helping your patients who have diabetes manage existing foot problems and avoid ulceration and amputation. Patient education strategies include the following:
Encourage patients to take a proactive approach to self-management of their diabetes. This includes monitoring blood sugar levels daily. Help ensure also that they maintain a healthy weight, acceptable lipid levels, stay as active as possible, and refrain from smoking and excessive alcohol consumption.
Consider referring patients who have difficulty establishing and/or maintaining a healthy lifestyle to a diabetes educator for information and assistance in developing the skills needed to self-manage their diabetes. Click here for the American Association of Diabetes Educators (AADE) guidelines for self-management of diabetes. Also, the AADE web site provides listings of members in your area for possible referrals: https://www.healthmonitor.com/AADE/finder.do.
If your patients are taking multiple medications (e.g., for diabetes, high cholesterol and high blood pressure) and/or supplements, be aware of any potential drug-drug or drug-supplement interactions. Remind patients of the importance of taking the right medication in the right doses at the right times.
Teach patients how to examine and care for their feet daily. Give them collateral or brochures that assist them in doing so. Click here for information on daily foot care for people with diabetes and feel free to use this information to distribute to patients.
Encourage patients to select and wear protective footwear that fits properly. IPFH’s integrated approach provides a step-by-step method. Click here for a printable integrated approach and professional fitting protocol to give your patients to take with them when purchasing footwear.
Examine your patients’ feet each time they have a regular examination. Look for signs of trauma, swelling, redness, patches of thin or shiny skin, ingrown toenails, fungal infections of the skin and toenails, and any small cuts, abrasions or lesions. If you see any of these signs, treat them yourself or refer the patient to a foot health specialist for treatment (people with diabetes should have their feet examined by a podiatrist or other foot health professional at least once a year). Also, ask the patient if he or she has experienced or is experiencing any numbness, tingling, burning or pain in the feet, which are signs of neuropathy. IPFH also recommends giving patients a vibration perception test using a tuning fork or biothesiometer, or a simple Semmes-Weinstein monofilament tactile sensation test to ascertain the presence of sensation in the feet. The foot assessment process is described in detail in Comprehensive Foot Examination and Risk Assessment: A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. The importance of these regular foot exams in helping to manage and/or prevent ulcers and, by extension, amputations cannot be overstated.
As a medical professional you can have a profound positive effect on the foot health and overall health of people with diabetes. As a trusted health care provider, you are in the best possible position to serve as an advocate for preventive foot health and effective self-management strategies, all of which can improve quality of life for your patients with diabetes.
Reviewed by Rachel Rader, DPM, IPFH Scientific Advisory Board
Last updated April 27, 2016
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