A diabetic patient needs to see their medical doctor to keep the blood sugars under control as this maintains the bodies ability to fight infection.
The skin is the first line of prevention against infection. We know that if there is poor circulation, a lack of feeling and a lot of pressure on the skin, you can potentially walk a hole in the skin allowing infection.
Infections can increase blood sugars and elevated blood sugar over 200 leads to the bodies inability to fight infection.
So depending on the examination patients need to be observed for evidence of skin breakdown prior to the breakdown, and preventative measures shoud be in place for the at risk patient. The risks have to be identified as well.
So, what is the standard of care for diabetic foot care? This is actually a great question. So, diabetes is a microvascular disease that can affect the small vessels that supply blood to the retina, peripheral nerves and kidney. This can result in the classic triad of diabetic retinopathy, peripheral neuropathy, and nephropathy. So, when evaluating the diabetic foot, there are certain things to pay close attention to. During a diabetic foot exam, I examine the patient's skin, nerves, blood supply, and their overall foot structure. More common issues I experience in the diabetic foot are infection, wounds, thick fungal nail, callouses, and poor circulation. Uncontrolled diabetics are susceptible to lack of sensation in their feet, i.e., neuropathy. So, these patients do not feel their feet like someone who does not have neuropathy. This will lead to ulcers and infection. The best advice I can give to my diabetic patients is to check their feet daily, wear proper shoes that do not cause areas of irritation, use a moisturizer to combat dry skin, and get a referral from your PCP to see a podiatrist.
Thank you so much for your question and I wish you the best!
Diabetics are prone to diseases of these systems resulting in poor circulation and loss of nerve function that may leave an individual susceptible for injury to include wounds as well as bone and joint trauma. It is for this reason that we recommend to our diabetics vigilant regular examination of their lower extremities and feet to include visual examination and manual palpation. Stringent glycemic control is the mainstay of care, but when complications do develop immediate attention by a specialist well-versed in the diabetic foot is critical to prevent significant sequelae. Patients with identified compromise to include neurologic and vascular of the lower extremities warrant regular examination by such a specialist and in fact hygienic care to include management of nail disorders and skin disorders is typically covered by insurance with the understanding of this risk.