Hi everybody,

I am a still fairly new LADA diabetic, I am trying to be very thorough about all the recommended check ups like regular blood work, urine test, blood pressure, eyes etc..
The one thing i am a bit confused about is the foot care thing. I ve been doing some research but getting conflicting information. I ve been reading these very unsettling things about (fungal) infections or injuries that might even lead to the loss of the foot. On some websites it reads like: you oversee a cut or a blister one minute and suddenly you re at risk of your feet falling off the next- very disturbing- surely it cant happen that fast? As a photographer I often work long days, on my feet for hours, and sometimes even in the most comfortable shoes I end up with blisters.
Hell, I have a blister on my toe right now!
-Do I now have to make a doctors appointment every time that happens? When should I be alarmed? And who is the specialist to see about this issue? A foot doctor or a foot care specialist (like those ladies that also give pedicures?)
Am I even allowed to cut my own toenails? Can I paint my toenails red in summer and show them off in my sandals (because I love having red toe nails), or are those days over forever because my toe could be turning purple underneath and I cant see it??
I realize I must sound like a bit of a sillybilly right now, but I m kind of freaking out here a little...
Any answers to shed light on this footy subject are very much appreciated..;))

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I wear sandals a lot in the summer and don't worry about diabetes and wearing them. I think that it is important to stay on top of blisters, cuts and other things.

I had one weird thing, the first week I ran > 30 miles, it was January in IL so I wore 2 pairs of socks and had been in size 11 shoes for a while (although I've since run in 11.5 and 12...I saw an Oprah show years ago where she had someone on who explained your feet keep growing...) and one of my toenails turned black. My BG is ok and all of that but it got a little bit pink and puffy so I went to the convenient care place and they were like "you are absolutely correct to come in for this" and RX'ed some sort of powerful antibiotic I'd never heard of and also referred me to a podiatrist. All's well that ended well but their reaction showed me that it's nothing to mess around with. I've run a lot more since then and had a few blisters here and there but nothing permanent. I think exercising helps the blood flow to your extremities.

Yes, it can be confusing. To my understanding (and anyone will jump in to add things if I'm missing them) there are really two things to worry about with feet: First, the same thing we worry about with other parts of our bodies, that if we get an infection we are slower to heal. So if, for example I get a small cut, usually on fingers, I always apply antibiotic creme and a bandaid. If it got worse instead of better then I'd go to the doctor.

The other thing to worry about with feet is neuropathy. If you develop neuropathy your toes will feel numb and/or tingly. The danger of this is that you could get your foot pierced with a nail or something and not even feel it, then it will get infected, and that is the dangerous road that can lead to amputation. But my understanding is in order to start down that road at all you need to have uncontrolled high blood sugars for a prolonged period of time. So foot care is good, foot checks are good, but excessive worrying is not needed.

Hi,

Acid and Zoe gave some very good advice and I'd just like to fill in a little bit. If you can see your feet easily there is no reason not to cut your own nails especially as you haven't had time to develop many problems and your blood sugars are well controlled. I wouldn't recommend "those ladies that also give pedicures" for foot care or pedicures because of potential infection issues. If you do go for a pedicure, you might bring your own foot soaking bowl and tools.

I'm sure you know this but good (and that usually means expensive) work shoes are your best friend. I've always believed in spending whatever is necessary to get a good fit. I personally find Ecco's to work very well.

One way to put your mind to rest is to see a podiatrist every year or so. She can examine your feet and test to see if you are losing any sensitivity.

Maurie

Good comments by all. I agree with everything that has been said and want to add one thing. When it comes to pedicures, I never go to the cheap places anymore. They aren't as careful when it comes to tools and sanitation practices. The last time I went, the girl was filing my heel and accidentally scraped up the ankle, leaving me with a nasty scrape. Since then, I only go to good spas, and always tell the aesthetician that I have diabetes. If they don't understand why I'm telling them that, then I ask for a different aesthetician. They should immediately acknowledge that my feet are very important to me as a diabetic, and that they need to exercise extreme caution. I went to a spa one time where the aesthetician immediately put all cutting tools away when I told her, and just used a nail file on my nails instead of cutting them. It was great! Just be careful and aware.

I was very worried too when first diagnosed.... but the real dangers are, like Zoe said,
neuropathy in your feet that causes loss of feeling, and poor circulation in the feet.

The loss of feeling means you may not notice an injury and it may fester for a long time and get infected. Your endocrinologist should test the feeling in your feet on every visit to make sure you are not losing sensation. He/she does this by brushing your feet with a little whisker like a broom straw and asking if you can feel it . Another test is they hold a vibrating tuning fork on your foot and ask you to say when you stop feeling it vibrate.

Peripheral vascular disease - poor circulation in the extremeties - is another cause of foot problems. Poorly controlled blood glucose causes damage to the small blood vessels all over your body. This is the source of many diabetic complications including retinopathy, kidney disease, etc. In the case of the feet, poor circulation can lead to poor healing, increasing the chance of serious complications when you are injured. The poor circulation is also a cause of neuropathy. Your endo or podiatrist may also periodically check your "pedal pulses" (foot pulses) to check the circulation in your feet. Another test they do is to press briefly on the skin of the foot. It will turn white as the blood is squeezed out, but then should turn pink again quickly (within about 2 seconds) as blood flows in to the capillaries.

The best thing you can do to avoid these problems is to maintain good control
of your blood sugar. Inspecting your feet nightly is a good habit and protecting them.

The circulatory and neuropathy complications that lead to foot problems take long periods (years) of poor control to develop, so it is not something that will happen right away (or even at all if you keep good control).

Ok, now that I've reassured Julez...HPN, you seem to know a lot about circulation. I have bad circulation in my feet and hands that's unrelated to D. My father had it too and all my life I've had cold hands and feet. But it's definitely gotten worse and sometimes my hands and feet are off color, including a shade of grey, almost black. I showed my feet to my doctor a couple months ago and he agreed it was bad circulation, not neuropathy. But do you think that bad circulation can lead to neuropathy even without uncontrolled blood sugars?

I would think that, since the blood feeds the nerves, no blood can lead to nerve death which is what causes (or is?) neuropathy. I'm always concerned about that stuff. The hair is falling out of my legs, which the doc says is a symptom of long term diabetes, but isn't really chatted about all that much and stuff. Eeek.

So many things to worry about, no? Though I wouldn't think loss of leg hair would have any negative repercussions. My nephew used to shave his legs when he bike raced which I thought was pretty funny.

It's not a big deal, but it suggests something is amiss and I'm leery of just saying "whee, no complications" since I presume my hair wouldn't fall out if all systems were functioning properly. First the hair falls out, then your feet fall off, eek indeed!

Thanks, Shawnmarie. Someone had mentioned that to me awhile back and I looked it up and it didn't resemble my symptoms. But I'll check it again, thanks. Do you do anything for it besides the hot water? I always run hot water for my first blood test of the morning as I have a hard time getting blood if I don't.

We're not doing a good job of reassuring Julez..lol

I did look at the information and it mentioned several options (and also I don't think that's what I have). Good luck at your appointment; I hope the endo can suggest some treatment for you.

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