For diabetics, walking better than running
Q: I have diabetes and have been told by friends that it causes poor circulation in the feet and can lead to amputation. Would taking up jogging this summer help my circulation? A: Your friends are not giving you accurate information. It is true that diabetes is the primary reason for limb amputation in the United States. Since poor circulation leads to diminished sensation and ability to feel pain, many diabetics are unaware when they sustain foot injuries and are less likely to manage or treat the injury immediately. Those injuries can become infected and that is what leads to amputation. Having diabetes doesn’t mean you are pre-ordained to lose limbs.
And for people with diabetes summer can be a particularly dangerous time of year for the feet.
From playing sports on the beach and swimming, to walking in sandals or open toed shoes, many summer activities put people with diabetes at risk for foot injuries that could lead to more serious diabetic complications – even amputation.
Dr. Riccardo Perfetti, director of the Diabetes Outpatient Treatment and Education Center at Cedars-Sinai Medical Center, offers these five tips every diabetic should know before stepping outside this season so they can protect feet from injury while still enjoying fun summer activities.
– Maintain proper glucose levels: You should maintain a glucose level lower than 126 mg/dl on a consistent basis. You can do this through regular exercise and close attention to how often you eat and what types of foods you consume. See your physician or nutritionist to develop a diet plan that works for your individual needs and lifestyle.
– If the shoes fit, wear them … all the time: Diabetics should never walk barefoot, even indoors. Something as minor as stubbing a toe on a coffee table or bumping a soccer ball at the park can lead to a serious foot ulcer. While at the beach, seashells, glass or debris from the ocean can puncture the skin and cause serious infections that can be perpetuated by diabetes. For diabetics with circulation problems whose sensation in the feet is diminished, walking barefoot on hot pavement is especially dangerous and can lead to severe burns and infection. There are a variety of closed-toe beach shoes on the market that help protect feet against these types of injuries.
– Be a smart shopper: Wearing the right shoes and socks is particularly important for diabetics to reduce the risk of blistering, developing painful calluses and overall protection of the feet. One major trigger for amputation is bone infection among diabetics. This is more likely to happen with puncture wounds where bacteria are introduced deep in the tissue. It is very important to buy shoes that are a perfect fit. Shoes that are too big or too small can cause unnecessary blisters or calluses, so make sure to have your feet measured each time you buy shoes. Adult feet usually change sizes four or five times during the course of a lifetime – and weight fluctuations, changes in weather and poor circulation can further change the shape and size of your foot. Since heat and activity throughout the day can cause temporary swelling in the feet, it is usually best to do your shoe shopping at the end of the day.
– Inspect your feet daily, especially during the summer: Inspect your feet every day before putting shoes on and after taking them off. Using a magnifying mirror can be helpful for those who are not flexible enough to see underneath the foot. Check between the toes and at the heel. Before putting your shoes on, diabetics should always inspect the inside of the shoe for debris that may rub your feet the wrong way.
– See a podiatrist regularly. During the summer months, feet have the tendency to be at risk for more fungal infection and calluses because of heat. For diabetics, fungal infections like athlete’s foot and calluses can lead to dangerous complications if they are not treated appropriately. A callus is a thickening of the skin that may be yellow, layered or even scaly due to excessive dryness. Occasionally the skin cracks and forms a fissure – which can become infected and even bleed. Though there are many over the counter medications that can be used to treat these, it is best to seek the professional treatment of a podiatrist who can care for the special needs of diabetics so these minor infections don’t lead to major complications.
(Send your questions to Steve Infanti, A Fit Life Column, 801e BAB, University Park, PA 16802 or via e-mail to SCInfanti@compuserve.com.)