According to the Centers for Disease Control, diagnosed and undiagnosed diabetes in the United States has increased over 500% (from 5.5 million to 29.10 million) in the past 25 years. Yet, lower limb amputations among diabetics due to peripheral neuropathy (diabetic nerve damage) and peripheral vascular disease (poor circulation) have decreased by approximately 60% in the last decade. Doctors attribute the decrease in lower limb amputations to diabetic management programs consisting of strict blood glucose control and foot care plan.
Blood glucose is the naturally occurring sugar that provides energy to your cells. Diabetes disrupts this natural exchange causing damage to your body’s cells, making it necessary for you to adhere to medication and lifestyle changes. Control over blood glucose levels decreases damage to your organs and systems – heart, blood vessels, nerves, kidneys, bone and skin – vital to the health of your feet. Strict blood glucose control means minimizing hypoglycemic (low blood glucose) or hyperglycemic (high blood glucose) levels – striving for a normal blood glucose range (determined by your health team) minimizes risks of diabetic complications such as amputation. A diabetic management program incorporating a foot care plan will decrease your risk of foot wounds and possible amputation.
Diabetic Management Program
Meet Your Diabetic Health Team. Composed of your primary doctor, diabetic nurse educator, nutritionist, podiatrist and, most especially, you. Your team will determine your blood glucose goal for success, and will educate and monitor your progress to achieving this goal. They will show you how to care for your feet and monitor for signs of wounds. They are your “go to” people, use them to protect the health of your feet.
Eat Well. Your diabetes educator or nutritionist will collaborate with you to create a healthy diet plan including fresh vegetables, lean proteins, fish and fruit. Eat smaller portions and try not to go in for seconds. A good diet protects the health of your blood vessels by lowering cholesterol and blood pressure. Healthy blood vessels transport the nutrients to your feet.
Exercise. Your diabetic health team will encourage you to start exercising gradually and increase to at least 30 minutes a day, 7 days a week. Always check your blood glucose levels before exercising to avoid a hypoglycemic or hyperglycemic event. Low impact exercises such as swimming, walking, yoga and dancing are wonderful alternatives for diabetics who already experience some degree of peripheral neuropathy or for diabetics just beginning an exercise program. There are so many activity choices – if you get bored, don’t stop, just try something new. Exercising not only strengthens your heart and lung health, it also improves your circulation allowing nutrients to flow into your body’s cells and wastes to be eliminated.
Lose Weight. Eating well and exercising may result in weight loss. Losing just 5% of your body weight may lower your blood glucose level, decrease your blood pressure and cholesterol rates, and increase your energy level.
Follow Your Doctor’s Prescription. Proper medication administration is vital for maintenance of controlled blood glucose levels. You need to understand when and how to administer your medication, as well as consequences of possible drug interactions if you are taking multiple medications. Even something as simple as over-the-counter cold medicines may interfere with your blood glucose levels. If you have questions, speak with your diabetic health team.
Monitor Your Blood Sugar Levels. Check your blood glucose levels before each meal, before bedtime, and before exercising. Your daily monitoring provides a gauge on how well you’re maintaining control over blood glucose levels. Look at it as an historical record of how your food intake, exercise routine and lifestyle modifications affect your blood glucose level, and “adjust” accordingly.
Your diabetic health team with administer a blood test called a HbA1c test at least twice a year which will indicate the average amount of blood glucose during the previous three months. High test results (above 7%) mean that your diabetes is not well controlled and there is an increased risk of complications. Meet with your diabetic team to “tweak” your diabetic management program.
Quit Smoking. The results are in, nicotine increases blood glucose levels. Research in 2011, led by Xiao-Chuan Liu of California State Polytechnic University, concluded that nicotine raised levels of hemoglobin A1c (HbA1c) by as much as 34%. High blood glucose levels caused by smoking not only damage your heart, lungs and kidney, but contribute to blood vessel compromise and poor circulation. Consequently, the risks of peripheral neuropathy and vascular disease, and subsequent amputation markedly increase. So, if you smoke, speak with your diabetes team and let them find the right smoking cessation program.
Develop a Daily Foot Care Routine. Bathe your feet in warm water, pat dry and check the bottoms of your feet and between your toes for any wound problems. Signs and symptoms such as redness, pain, corns, bunions open wounds, and changes in foot shape need to be addressed by your diabetic team. The risk of wounds increases if you walk barefoot – always wear low-heeled shoes or boots outside the home, and slippers inside the home. Speak with your diabetic educator regarding a foot care routine.
Take advantage of your diabetic health team’s knowledge. Adhering to a diabetic management program will decrease the risk of peripheral neuropathy and vascular disease, as well as amputation.
For further information, call a member of your diabetic health team, and you can find information at the following sites:
American Chemical Society. (2011, March 29). First identification of nicotine as main culprit in diabetes complications among smokers. ScienceDaily. Retrieved November 15, 2016 from www.sciencedaily.com/releases/2011/03/110327191036.htm
Barshes, N.K., Sigireddi, M., Wrobel, J.S., Mahankali, A., Robbins, J.R., Kougias, P., and
Armstrong, D.G. (2013) The System of Care for the Diabetic Foot: Objectives,
Outcomes, and Opportunities, Diabetic Foot & Ankle. 4: 21847. Retrieved from
Nemcová, J., & Hlinková, E. (2014). The efficacy of diabetic foot care education. Journal Of
Clinical Nursing, 23(5/6), 877-882. Retrieved from
Shrivastava S.R., Shrivastava P.S., and Ramasamy J. (2013) Role of self-care in management
of diabetes mellitus. Journal of Diabetes & Metabolic Disorders. 12:14. Retrieved from