Diabetes Prevention Diabetic Foot Precautions

The first is to control blood sugar within the individualized target range for a long time. The second is to conduct foot examination and daily care every day. The third is to see an endocrinologist or podiatry for treatment as soon as possible if there is an ulcer on the foot, even if it is as large as a pinhead. Don't take it on yourself.

These words are really not just empty words to scare people. I just admitted a 62-year-old Uncle Zhang to the outpatient clinic last week. He has a history of type 2 diabetes for 12 years. He usually tests his blood sugar only when he thinks about it. He also takes medicine and forgets about it. The temperature dropped sharply a few days ago and his feet felt cold. When he went to sleep, he put a warm baby on the soles of his feet. When he woke up the next day, A blister the size of a quail egg appeared on the sole of my foot. I used an unsterilized sewing needle to prick it and squeeze out the water at home. I put a band-aid on it and left it alone. As a result, three days later, the entire foot swelled like a steamed bun, with pus and black color. When I arrived, it was found to be a deep soft tissue infection. If I arrived a week later, I might have to amputate the front half of my foot.

Many people think that diabetic foot is just a broken foot. What does it have to do with blood sugar? Don’t think like that. Long-term high blood sugar is like a slow knife, corroding the nerves and blood vessels of your lower limbs bit by bit: After the nerves are damaged, your perception of pain and temperature will become slower and slower, and you may not feel it when it is frayed or burned. After the blood vessels are blocked, the wounds on the feet do not have enough blood oxygen supply, which is not only difficult to heal, but also easy to get infected deep down. Therefore, keeping blood sugar within the target line is the way to fundamentally reduce the risk of foot disease. Oh, by the way, the standard value is not a dead standard as mentioned on the Internet. Young people and those with no underlying diseases can control their glycosylated hemoglobin within 6.5%. For those over 70 years old and those with underlying illnesses such as coronary heart disease and cerebral infarction, it is no problem to relax it to 7% or even 7.5%. Please contact your endocrinologist for the specific decision, and do not adjust the medicine randomly by yourself.

Of course, it does not mean that everything will be fine once blood sugar is under control. I have seen several old diabetic patients whose glycation has been stable at 6.2%. Just because they wore new sneakers with double heel straps, they wore out their heels and did not take it seriously. They put on a band-aid and continued to dance in the square. In the end, they were infected and hospitalized for more than half a month. Take 1 minute to look at your feet after washing them every day. This is really cost-effective. Scan the soles, sides of the feet, the seams of the feet, and around the toenails to see if there are any breaks, blisters, redness, or hardened calluses. If you have bad eyesight, ask a family member to help you look at it, or take a selfie with your mobile phone and take a selfie with your feet. You can still see clearly.

Speaking of foot washing, many people with diabetes ask me whether they can soak their feet. In fact, there is no unified conclusion in the industry. Western medicine generally does not recommend foot bathing for people with diabetes who have developed peripheral neuropathy and have poor temperature perception. After all, there are many cases of foot scalding and amputation every year. However, colleagues in traditional Chinese medicine and endocrinology also have different views. If you do not have neuropathy, If the lower limbs always feel cold, and the syndrome is cold coagulation and blood stasis, under the guidance of a doctor, use a medicine pack to warm the meridians and unblock meridians. The water temperature should be strictly controlled at 37-38°C and soaked for 5 to 10 minutes each time. On the contrary, it can improve the circulation of the lower limbs and is good for preventing foot diseases. But no matter where you stand, there is one principle that everyone must abide by: before soaking your feet, you must use a thermometer to measure the water temperature. Do not test it with your feet. The temperature that you think is not hot may have exceeded 40°C. When washing, do not use a bath towel to rub your feet vigorously. After washing, take a soft dry towel and gently dry it with water. Especially the water in the crevices of your feet must be wiped clean. It is easy to get rotten if it is stuffy for a long time.

Oh, by the way, many elderly people like to use hot water bottles and electric blankets to warm their feet in winter. This is also quite controversial. If you are sure that you do not have neuropathy and you can feel hot or cold immediately, it is not completely unusable if you wrap a hot water bottle with two thick towels and the temperature does not exceed 40°C. However, if you have numbness or decreased sensation, take my advice and don’t take this risk. Wear a pair of thick pure cotton loose socks to warm your feet, which is safer than anything else.

Cutting toenails really needs to be discussed separately. I have seen too many patients who suffered nail groove damage due to nail clipping and eventually developed osteomyelitis. When cutting, just cut it flat. Don't cut it too bald. Don't dig the corners on both sides into the flesh. If you have an ingrown toenail, don't pick it out yourself or go to an outside pedicure shop. The disinfection of those places is really inaccurate. I once had a patient who went to a pedicure shop to have a callus on the sole of his foot repaired, which resulted in a puncture the size of a needle. Eventually, the infection spread, and he spent hundreds of thousands of dollars to save his foot. It was really not worth it.

It is best to choose light-colored pure cotton socks for daily wear. The socks should be loose. Don't buy the kind of tight sports socks, which will leave a red mark around the ankle and affect the blood circulation. Light-colored socks have another advantage. If there is a tear on the foot and leakage, it will be visible when the socks are stained. Black socks will cover everything. By the time you find out, you may have been infected for several days. It is best to buy shoes in the afternoon, as your feet will be slightly edematous in the afternoon. The shoes you try at this time will not squeeze your feet. Don’t buy hard-leather or pointed-toed shoes. Just choose sports shoes with round toes, breathability and soft soles. Don’t wear new shoes for too long after you buy them. Wear them for half an hour on the first day and an hour on the second day. Slowly break them in. Take them off as soon as you feel they are rubbing your feet. Don’t hold on to shopping all afternoon.

In fact, I have seen too many patients with diabetic foot in the clinic over the years. Most of them have accidents not because of any big accidents, but because of a small detail that they don't take seriously: the baby warmer is too hot, the skin is broken when cutting nails, and there are blisters when wearing new shoes. Ordinary people may recover on their own in two days, but for people with diabetes, these small problems may develop into big troubles that require toe amputation. Do you think prevention is difficult? It’s really not difficult. Spend an extra minute every day to look at your feet. Control your blood sugar as the doctor says. Don’t apply medicine blindly to small wounds. Go to the hospital in time. More than 90% of diabetic foot problems can actually be avoided. After all, if you wait until your foot is rotten before you treat it, you may not be able to save it even if you spend money and suffer the consequences, right?