Q&A with Dr. Douglas Diekevers, DPM
What Puts the Diabetic Patient’s Foot at Risk?
Dr. Diekevers: Oftentimes, patients with diabetes have problems with their circulation. They’ll have decreased sensation and high blood sugar diminishes the healing process.
How Often Should Diabetic Patients See You?
Dr. Diekevers: The American Diabetes Association recommends yearly checkups for the diabetic patient. If a patient has a more complex problem, poor circulation or loss of sensation, they should be seen more frequently depending on the abnormality and the degree of the deformity. I could have a husband and wife in, for example, and I might see the husband back yearly and the wife every two months.
Can Vitamins and Diet Help to Keep the Diabetic Foot Healthy?
Dr. Diekevers: A patient should speak with their primary care physician and a nutritionist or dietitian. It’s extremely important so they can help the patient maintain blood sugars and A1C at a proper level that has been predetermined by their physician. Supplements are good, but they are just that. The main goal is to control the A1C to the ideal level. B6 or pyridoxine, is good in treating symptoms of the nerves.
How Can You Tell if Someone Has an Ideal A1C Level?
Dr. Diekevers: If someone comes in with a hemoglobin A1C, a measure of someone’s blood sugar that incorporates the last three months, 6-7 is the desired range. This bigger picture view is the more important finding in my opinion relative to a random blood sugar reading.
What Creams, Lotions or Chemicals Are Appropriate for the Diabetic Foot?
Dr. Diekevers: A moist foot is a happy foot but we don’t want to moisturize between our toes. A good moisturizer doesn't have to be expensive. It can be what you use on your hands. Anytime you’re a diabetic there’s going to be a warning on a label for a chemical. If you notice something on your foot you should get your podiatrist’s recommendation prior to getting any treatment on your own. The problem is that acids don’t know when to stop and if you don’t have pain you can develop an ulceration.
How and When Should the Diabetic Foot Be Inspected?
Dr. Diekevers: A normal patient with diabetes should inspect their feet daily. A diabetic who has loss of sensation should check them in the morning, mid-day and when they take their socks off at night. Check on the top, the bottom, and in between the toes and if you need to, you can use a mirror to see the bottom of your foot. If you see something, you should call me right away. The main goal of preventive care is to maintain the integrity of the skin. If the skin is intact there are fewer problems that can occur.
What Should Patients Look for on the Diabetic Foot?
Dr. Diekevers: They’re looking for any changes, any signs of redness, any signs of drainage, or infection. Because they’ve been looking at it frequently, they’ll notice any changes. Be cautious. There’s nothing I like better to say to patients than, “This is no big deal, but I’m glad you came in.”
Is There Any Special Care of the Diabetic Foot When Bathing?
Dr. Diekevers: Diabetic patients oftentimes will have problems with sensing temperature. If they do, they need to check the temperature with their elbow prior to getting into a tub. I have seen, (not frequently) people with burns on their skin, ankles and butt and realize that it’s from scalding water. Use warm water, not cold or hot, for bathing and showering. With showering in wintertime, we need to moisturize more frequently because our skin dries out more. Especially the heels because they can crack and develop fissures. These little cracks on the skin are typically quite painful and can be a portal site of entry for an infection.
Is It Okay for Patients with Diabetes to Wear Socks to Bed?
I have no problem with patients wearing socks to bed, but they need to make sure that their feet do not perspire and do not get excessively moist or wet. Some people have to wear them to sleep.
What About Foot Wounds?
I think that if they have seen me, then they would likely be told exactly what to do. We would give them a handout to tell them what to do to care for them, and, if need be, we would arrange for home health care to assist them in their care. Care varies depending on the cause of ulceration. Ulcers are caused by one of three things; lack of circulation, lack of sensation or swelling or venous congestion.
Can Patients with Diabetes Get Pedicures?
As a diabetic, if you have good circulation and sensation, there’s no reason why you can’t get a pedicure. If you have loss of sensation or poor circulation, then I strongly advise against these or if your vision is impaired, which often occurs in diabetics. Follow up with foot care with your podiatrist.
Is It Safe to Walk Barefoot? Why or Why Not?
Diabetics should never walk barefoot because they have a loss of sensation and they could step on something. Non-diabetic patients can go ahead and walk barefoot; they can step on something and address it as needed.
How Common Are Infections in the Diabetic Foot?
In the office setting, I see quite a few infections. These are typically people who have been seen by their primary care physician and have been referred to me. The infection can range from very mild to severe.
A mild infection could be an ingrown toenail or a mild abrasion. A severe issue could be an ulceration due to a lack of sensation. It can go unnoticed if the patient doesn’t have a sensation of pain, a good sense of smell, or good eyesight. It can require surgery and long-term antibiotics. It presents as a very red toe that gets darker and darker and oftentimes patients don’t feel the pain because the toe is not viable. They’ll think they’re getting better when they’re actually getting worse.
What Do Physicians Look for When Examining the Diabetic Foot?
When someone is diagnosed with diabetes, they should see a foot doctor to get a baseline reading. I check the pulse of the foot, hair growth on the feet, which is an indication of good circulation, I poke the toe to check color, I check the skin turgor, which is the resiliency of the skin. This tends to become more fragile when you have poor circulation.
At that time we also check their sensation to see if it’s adequate with a Semmes Weinstein Monofilament test, an excellent way to determine your predisposition to ulcerations due to lack of sensation.
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