Prevent diabetes problems

NATIONAL INSTITUTES OF HEALTHNational Diabetes Information Clearinghouse

Keep your feet andskin healthyKeep your feet andskin healthy

Prevent diabetes problems:Keep your feet andskin healthy

NATIONAL INSTITUTES OF HEALTHNational Diabetes Information Clearinghouse

2

ContentsWhat are diabetes problems?................................... 3

What should I do each day to stayhealthy with diabetes?............................................... 4

How can diabetes hurt my feet? ..............................5

What can I do to take care of my feet? ...................7

How can I get my doctor to help me takecare of my feet? .........................................................9

What are common diabetes foot problems? ......... 10

How can special shoes help my feet? .................... 13

How can diabetes hurt my skin? ............................ 14

What can I do to take care of my skin? ................. 15

For more information ............................................. 16

More in the series.................................................... 18

Acknowledgments ................................................... 19

3

What are diabetes problems?Too much sugar in the blood for a long time causesdiabetes problems. This high blood sugar candamage many parts of the body, such as the heart,blood vessels, and kidneys. Diabetes problems canbe scary, but there is a lot you can do to preventthem or slow them down.

This booklet is about feet and skin problemscaused by diabetes. You will learn the thingsyou can do each day and during each year tostay healthy and prevent diabetes problems.

High blood sugar can cause feet and skin problems.

Skin

Bone

Nerve

Bloodvessel

4

What should I do each day to stayhealthy with diabetes?

Follow the healthy eating plan thatyou and your doctor or dietitian haveworked out. Eat your meals and snacksat around the same times each day.

Be active a total of 30 minutes mostdays. Ask your doctor what activitiesare best for you.

Take your diabetes medicine at thesame times each day.

Check your blood sugar every day.Each time you check your blood sugar,write the number in your record book.Call your doctor if your numbers aretoo high or too low for 2 to 3 days.

Check your feet every day for cuts,blisters, sores, swelling, redness, orsore toenails.

Brush and floss your teeth and gumsevery day.

Don’t smoke.

5

How can diabetes hurt my feet?High blood sugar from diabetes causes twoproblems that can hurt your feet:

1. Nerve damage. One problem is damage tonerves in your legs and feet. With damagednerves, you might not feel pain, heat, or cold inyour legs and feet. You might let a sore or cuton your foot get worse because you do not knowit is there. This lack of feeling is called diabeticneuropathy (ne-ROP-uh-thee). It can lead toa large sore or infection.

2. Poor blood flow. The second problem happenswhen not enough healthy blood flows to yourlegs and feet. Poor blood flow makes it hardfor a sore or infection to heal. This problemis called peripheral (puh-RIF-uh-rul) vasculardisease. Smoking when you have diabetesmakes blood flow problems much worse.

These two problems can work together to causea foot problem.

6

For example, you get a blister from shoes that donot fit. You do not feel the pain from the blisterbecause you have nerve damage in your foot.Next, the blister gets infected. If blood sugar ishigh, the extra sugar feeds the germs. Germs growand the infection gets worse. Poor blood flow toyour legs and feetcan slow downhealing. Once in awhile a bad infectionnever heals. Theinfection might causegangrene (GANG-green). If a personhas gangrene, theskin and tissuearound the sore die.The area becomesblack and smelly.

To keep gangrenefrom spreading, adoctor may have todo surgery to cut offa toe, foot, or part ofa leg. Cutting off abody part is called anamputation (amp-yoo-TAY-shun).

Make sure you wear shoes thatfit well.

7

What can I do to take care of my feet?● Wash your feet in

warm water everyday. Make surethe water is not toohot by testing thetemperature withyour elbow. Donot soak your feet.Dry your feet well,especially betweenyour toes.

● Look at your feetevery day to checkfor sores, blisters,redness, calluses,or other problems. Checking every day is evenmore important if you have nerve damage orpoor blood flow. If you cannot bend over orpull your foot up to check your feet, use amirror. If you cannot see well, ask someoneelse to check your feet.

● If your skin is dry, rub lotion on your feet afteryou wash and dry them. Do not put lotionbetween your toes.

Look at your feet every dayto check for problems.

8

● File corns and calluses gently with an emeryboard or pumice stone. Dothis after your bath or shower.Move the emery board inonly one direction.

● Cut your toenails once a week. Cut toenailswhen they are soft from washing. Cut them tothe shape of the toe and not too short. Do notcut into the corners because you might cut theskin. Sharp edges can make a sore that can getinfected. File toenails with an emery board. Ifyou cannot cut your own toenails, ask someonewho can or go to a foot doctor.

● Always wear shoes or slippers. Never walkbarefoot, even when you are at home.

● Always wear socks or stockings.Do not wear socks or knee-highstockings that are too tight belowyour knee.

● Wear shoes that fit well.Buy shoes made ofcanvas or leather. Shopfor shoes at the end of theday when your feet arebigger. Break in shoesslowly. Wear them 1 to2 hours each day for the first 1 to 2 weeks.

● Only use medicines your doctor tells you to use.

Always wear slippers orshoes to protect your feet.

9

How can I get my doctor to help metake care of my feet?

● Tell your doctor right away about anyfoot problems.

● Ask your doctor to look at your feet at eachdiabetes checkup. To make sure your doctorchecks your feet, take off your shoes and socksbefore your doctor comes into the room.

● Ask your doctor to check how well the nervesin your feet sense feeling.

● Ask your doctorto check how wellblood is flowing toyour legs and feet.

● Ask your doctor toshow you the bestway to trim yourtoenails. Ask whatlotion or cream touse on your legsand feet.

● If you cannotcut your toenailsor you have a footproblem, ask your doctor to send you to a footdoctor. A doctor who cares for feet is called apodiatrist (puh-DY-uh-trist).

Take off your shoes and socksso your doctor will check yourfeet.

10

What are common diabetesfoot problems?Anyone can have corns, blisters, and athlete’s foot.If you have diabetes and your blood sugar stays high,these foot problems can lead to infections.

Corns and calluses arethick layers of skin causedby too much rubbing orpressure on the same spot.Corns and calluses canbecome infected.Corn and callus

Blister

➔➔

➔

Blisters can form if shoesalways rub the same spot.Wearing shoes that donot fit or wearing shoeswithout socks can causeblisters. Blisters canbecome infected.

11

Bunion➔

Ingrown toenails happenwhen an edge of the nailgrows into the skin. Theskin can get red and infec-ted. Ingrown toenails canhappen if you cut into thecorners of your toenails

when you trim them. If toenail edges are sharp,smooth them with an emery board. You can alsoget an ingrown toenail if your shoes are too tight.

Ingrown toenail

➔

Plantar warts

➔

A bunion forms when yourbig toe slants toward thesmall toes and the placebetween the bones nearthe base of your big toegrows big. This spot can

get red, sore, and infected. Bunions can form onone or both feet. Pointy shoes may cause bunions.Bunions often run in the family. Surgery canremove bunions.

Plantar warts are causedby a virus. The wartsusually form on thebottoms of the feet andtend to go away withouttreatment.

12

Dry and cracked skin canhappen because the nervesin your legs and feet do notget the message to keepyour skin soft and moist.Dry skin can becomecracked and allow germsto enter. If your bloodsugar is high, sugar feedsthe germs and makes theinfection worse.

Hammertoes form whena foot muscle gets weak.The weakness may be fromdiabetic nerve damage.The weakened musclemakes the tendons in the

foot shorter and makes the toes curl under the feet.You may get sores on the bottoms of your feet andon the tops of your toes. The feet can change theirshape. Hammertoes can cause problems withwalking and finding shoes that fit well. Hammertoescan run in the family. Wearing shoes that are tooshort can also cause hammertoes.

Hammertoe

Dry andcracked skin

➔

➔

13

Athlete’s foot is a fungusthat causes redness andcracking of the skin. It isitchy. The cracks betweenthe toes allow germs to getunder the skin. If bloodsugar is high, the sugarfeeds the germs and makesthe infection worse. The

infection can spread to the toenails and make themthick, yellow, and hard to cut.

All of these foot problems can be taken care of.Tell your doctor about any foot problem as soonas you see it.

How can special shoes help my feet?Special shoes can be made to fit softly around yoursore feet or feet that have changed shape. Thesespecial shoes help protect your feet. Medicareand other health insurance programs may pay forspecial shoes. Talk to your doctor about how andwhere to get them.

Athlete’s foot

➔

14

How can diabetes hurt my skin?Diabetes can hurt your skin in two ways:

1. If your blood sugaris high, your bodyloses fluid. With lessfluid in your body,your skin can getdry. Dry skin can beitchy, causing you toscratch and make itsore. Also, dry skincan crack. Cracksallow germs to enterand cause infection.If your blood sugar ishigh, the sugar feedsgerms and makesinfections worse. Skin can get dry on your legs,feet, elbows, and other places on your body.

2. Skin can also get dry because the nerves in yourlegs and feet do not get the message to sweat.Sweating helps keep your skin soft and moist.

Drinking fluids helps keepyour skin moist and healthy.

15

What can I do to take care of my skin?● After you wash with a mild soap, make sure

you rinse and dry yourself well. Check placeswhere water can hide, such as under the arms,under the breasts, between the legs, andbetween the toes.

● Keep your skin moist byusing a lotion or creamafter you wash. Askyour doctor tosuggest one.

● Drink lots of fluids,such as water, tokeep your skin moistand healthy.

● Wear all-cottonunderwear. Cottonallows air to movearound your bodybetter.

● Look at your bodyafter you wash. Make sure you have nodry, red, or sore spots that might lead toan infection.

● Tell your doctor about any skin problems.

Keep your skin moist bywashing with a mild soapand using lotion or creamafter you wash.

16

For more informationDiabetes Teachers (nurses, dietitians, pharmacists,and other health professionals)

To find a diabetes teacher near you, call theAmerican Association of Diabetes Educatorstoll-free at 1–800–TEAMUP4 (1–800–832–6874),or look on the Internet at www.aadenet.org andclick on “Find an Educator.”

Recognized Diabetes Education Programs(teaching programs approved by the AmericanDiabetes Association)

To find a program near you, call toll-free at1–800–DIABETES (1–800–342–2383), orsee www.diabetes.org/education/edustate2.aspon the Internet.

17

Dietitians

To find a dietitian near you, call the AmericanDietetic Association’s National Center forNutrition and Dietetics toll-free at1–800–366–1655, or look on the Internet atwww.eatright.org and click on “Find a Dietitian.”

Government

The National Institute of Arthritis andMusculoskeletal and Skin Diseases (NIAMS)is part of the National Institutes of Health. Tolearn more about feet and skin problems, writeor call the National Institute of Arthritis andMusculoskeletal and Skin Diseases InformationClearinghouse, 1 AMS Circle, Bethesda, MD20892–3675, (301) 495–4484; or seewww.nih.gov/niams on the Internet.

18

More in the seriesThe “Prevent Diabetes Problems” series includesseven booklets that can help you learn more abouthow to prevent diabetes problems.

For free single copies of these booklets, call, write,fax, or email the

National Diabetes Information Clearinghouse1 Information WayBethesda, MD 20892–3560

Phone: 1–800–860–8747 or (301) 654–3327Fax: (301) 907–8906Email: ndic@info.niddk.nih.gov

These booklets are also available under “HealthInformation” at www.niddk.nih.gov on the Internet.

19

AcknowledgmentsThe National Diabetes Information Clearinghousethanks the people who helped review or field-testthis booklet.

For AmericanAssociation of DiabetesEducatorsLynn Grieger, R.D.,C.D.E.Arlington, VTCelia Levesque, R.N.,C.D.E.Montgomery, ALTeresa McMahon,Pharm.D., C.D.E.Seattle, WABarbara Schreiner, R.N.,M.N., C.D.E.Galveston, TX

For American DiabetesAssociationPhyllis Barrier, M.S.,R.D., C.D.E.Alexandria, VALinda Haas, Ph.C., R.N.,C.D.E.Seattle, WAKathleen Mahoney,M.S.N., R.N., C.D.E.Drexel Hill, PARandi Kington, M.S.,R.N., C.S., C.D.E.Hartford, CT

Diabetes Research andTraining CenterAlbert EinsteinSchool of MedicineNorwalk HospitalNorwalk, CTJill Ely, R.N., C.D.E.Sam Engel, M.D.Pam Howard, A.P.R.N.,C.D.E.

Diabetes Research andTraining CenterIndiana UniversitySchool of MedicineIndianapolis, INMadelyn Wheeler, M.S.,R.D., F.A.D.A., C.D.E.

Diabetes Research andTraining CenterVA/JDF DiabetesResearch CenterVanderbilt School ofMedicineNashville, TNOk Chon Allison,M.S.N., R.N.C.S.,A.N.P., C.D.E.Barbara Backer, B.S.James W. Pichert, Ph.D.Alvin Powers, M.D.Melissa E. SchweikhartMichael B. SmithKathleen Wolffe, R.N.

Grady Health SystemDiabetes ClinicAtlanta, GAErnestine Baker, R.N.,F.N.P., C.D.E.Kris Ernst, R.N., C.D.E.Margaret Fowke,R.D., L.D.Kay Mann, R.N., C.D.E.

Health Care FinancingAdministrationBaltimore, MDJan Drass, R.N., C.D.E.

Indian Health ServiceAlbuquerque, NMRuth Bear, R.D., C.D.E.Dorinda Bradley, R.N.,C.D.E.Terry Fisher, R.N.Lorraine Valdez, R.N.,C.D.E.

Indian Health ServiceRed Lake, MNCharmaine Branchaud,B.S.N., R.N., C.D.E.

Medlantic ResearchCenterWashington, DCResa Levetan, M.D.

Texas Diabetes CouncilTexas Departmentof HealthAustin, TXLuby Garza-Abijaoude,M.S., R.D., L.D.

20

National DiabetesInformation Clearinghouse

1 Information WayBethesda, MD 20892–3560Phone: 1–800–860–8747 or (301) 654–3327Fax: (301) 907–8906Email: ndic@info.niddk.nih.gov

The National Diabetes Information Clearinghouse (NDIC)is a service of the National Institute of Diabetes andDigestive and Kidney Diseases (NIDDK). NIDDKis part of the National Institutes of Health under the U.S.Department of Health and Human Services. Establishedin 1978, the clearinghouse provides information aboutdiabetes to people with diabetes and to their families,health care professionals, and the public. NDIC answersinquiries; develops and distributes publications; and worksclosely with professional and patient organizations andGovernment agencies to coordinate resources aboutdiabetes.

Publications produced by the clearinghouse are carefullyreviewed for scientific accuracy, content, and readability.

This publication is not copyrighted. The clearinghouseencourages users of this booklet to duplicate anddistribute as many copies as desired.

This booklet is also available under “HealthInformation” at www.niddk.nih.gov on the Internet.

20

U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICESNational Institutes of Health

National Institute of Diabetes andDigestive and Kidney Diseases

NIH Publication No. 00–4282May 2000