the tops and bottoms of your feet, but not between your toes, after you wash and dry your feet.
• Gently smooth corns and calluses with an emery board or pumice stone. Do this after your bath or shower, when your skin is soft. Move the emery board in only one direction. Don’t use over-the- counter products or sharp objects on corns or calluses. • Trim your toenails with a nail clipper straight across. Do not round off the corners of toenails or cut down on the sides of the nails. After clipping, smooth the toenails with an emery board.
management of a. Hypoglycemia b. Hyperglycemia c. Ketoacidosis 2. Understand importance of blood glucose monitoring and use of the results
3. Know conditions under which exercise is not appropriate 4. Learn to detect and manage complications 5. Identify where to access information and resource persons in the community
Glycemic Control
Optimal glycemic control is fundamental to diabetes management. Both fasting plasma glucose (4.0 – 7.0 mmol/L), 2-hour postprandial levels (5.0 – 10.0 mmol/L) and glycated hemoglobin (A1C) < 7.0 percent correlate with the risk of complications. Postprandial hyperglycemia is a powerful predictor of adverse outcomes. The Diabetes Intervention Study found that in patients with type 2 diabetes, a 1-hour postprandial plasma glucose level <8.0mmol/L conferred the lowest risk of myocardial infarction or death, while levels > 10.0mmol/L were associated with the highest risk.
Nutrition
Nutrition therapy is an integral part of the treatment and self- management of diabetes. Diabetics should meet their nutritional needs by eating a well-balanced diet that should include complex (higher fibre) carbohydrate foods such as corn, brown rice, yam, green bananas, cassava and ground provisions. Supplementation with 10 ug (400 IU) vitamin D is recommended in people >50 years of age, and folic acid (400 ug) for women who could become pregnant. Routine vitamin and mineral supplementation is generally not recommended. Antioxidant supplements (vitamin E, vitamin C or beta-carotene) have not demonstrated benefits in cardiovascular disease outcomes or glycemic control. There is no evidence that dietary supplements such as meal replacements, specialty bars or formulas designed for diabetes are needed for glycemic control, and no studies have identified which foods they displace from the diet.
Foot Care
Neuropathy is caused by damage to the nerves of the foot from uncontrolled blood glucose levels, which can lead to such conditions as bunions, hammer toes, and collapse of the Charcot joint in the middle of the foot. Good foot care can help prevent these common foot problems before they cause serious complications if you:
• Adhere to proper nutrition, exercise, and diabetes medication. • Keep blood glucose level within the recommended range.
• Wash feet daily in warm, not hot, water with mild soap. Do not soak your feet. Dry them well, especially between the toes. Check your feet every day for sores, blisters, redness, and calluses.
• If the skin on your feet is dry, keep it moist by applying lotion over BusinessFocus • December/January 11/12 | 77
• Always wear socks or stockings and closed-toe shoes or slippers. Do not wear sandals and never walk barefoot, even around the house. Feel inside your shoes before putting them on each time to make sure the lining is smooth and there are no objects inside.
• Wear shoes that fit well. Buy extra wide shoes made of canvas or leather and break them in slowly.
• Protect your feet from heat and cold. Wear shoes at the beach or on hot pavement. Wear socks at night if your feet get cold.
• Keep the blood flowing to your feet. Put your feet up when sitting, wiggle your toes and move your ankles up and down for 5 minutes, 2 or 3 times a day, don’t cross your legs for long periods of time.
• Don’t smoke.
By Dr. James Sutton
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