Self-Care Steps Can Increase Safety
Individuals living with diabetes face increased risk in a severe winter because of cold, damp conditions and must take many precautions to avoid serious side effects.
“People with diabetes should avoid going out in severe cold,” said Cindy Kolenda, BS, CWCN, CFCN, a wound care specialist at Catholic Medical Center. “Their poor circulation can be worsened in cold temperatures, which increases the risk of frost bite.”
What makes cold temperatures even more risky is that some people with diabetes cannot feel their feet. Diabetic neuropathy is a type of nerve damage that can occur with diabetes. High blood sugar can damage nerves in the legs and feet. About 60 to 70 percent of people with diabetes have some form of neuropathy according to the National Institutes of Health. Symptoms may occur at any time and intermittently.
“Diabetes works from your feet to your knees,” explained a 69-year old man participating in CMC’s Diabetes Self-Management Education (DSME) class. “It started as a tingling feeling in one foot then went to the other.” He likens it to the sensation of having a limb “fall asleep.” His doctor ordered tests for nerve damage. “You lie down and they stick needles from your knees to the bottom of your feet and toes. I had no feeling in the bottom of my feet. On the top of my toes, I felt a little bit there. ‘You have a case of neuropathy,’ I was told. ‘You may have a dead nerve and it won’t come back,’ they told me.”
“I had to start doing something about my sugar, because my feet were getting worse and my nurse practitioner said you don’t want to have to have to cut any body parts off and that scared me. Now I am doing OK, I am watching what I eat,” said the DSME class member. He faces challenges with snacking on the foods he likes, such as chocolate and chips, at night. But he says he is learning a lot in the classes about how to keep his blood sugar down, which will prevent further damage to the nerves in his feet. “I kind of like it…I find it very interesting. The [instructors] are well trained, well established, and know what they are talking about. I am very happy with it.” His goals are to lose about 40 pounds and keep his blood sugar in the targets established by his treatment team.
Many people living with diabetes are vulnerable to foot problems. The American Diabetes Association estimates that one in five people with diabetes who seek hospital care do so for foot problems. Even small foot injuries can cause serious trouble. Poor foot care may lead to amputation of a foot or leg.
Manchester has an elevated incidence of diabetes with a rate of 28.5 per 100,000 compared to 24.8 for the state. Slightly more than 3 percent of all Manchester deaths are directly attributed to diabetes, a rate that exceeds rates for state and national trends according to the City of Manchester Diabetes Report Card.
About 73,000 amputations were performed in people with diabetes in 2010 according to the American Diabetes Association. Diabetes can lead to peripheral arterial disease (PAD), which reduces blood flow to the feet. Reduced sensation from nerve disease is common. Together these problems can result in ulcers and infections that may lead to amputation.
“Avoid the cold and don’t let your feet get and stay wet,” said Kolenda. “Find boots that are a good fit and protective.” Footwear that is too loose or too tight can cause minor irritations like a blister that if not properly cared for may pose major risks. Diabetes treatment specialists also warn people about how to warm up their feet, indicating that hair dryers, fireplaces, and heating pads are unsafe. Without normal heat sensitivity, it is easy for someone to accidently burn themselves.
The layer between the shoe and your foot is important. Avoid socks with seams as they can cause rubbing and irritation. Do not wear socks that cut into your leg or ankle or that fall down and bunch up in your shoe. Choose a sock that is made of a breathable material, such as cotton, or a wicking material, such as microfiber, to keep bacteria from forming.
CMC cautions people to exercise proper foot care. Wash your feet every day. Dry them carefully, especially between the toes. Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes. Wear shoes and socks at all times. Never walk barefoot. Always protect your feet by wearing shoes or hard-soled slippers or footwear.
People with diabetes should inspect their feet every day. “Look at your bare feet for red spots, cuts, swelling and blisters,” said Kolenda. “If you cannot see the bottoms of your feet, use a mirror or ask someone for help.” Kolenda said to call or see your health care provider if you notice cuts or breaks in the skin. Also, tell your health care provider if your foot changes color, shape, or just feels different (for example, becomes less sensitive or hurts).