DIABETES FOOT CARE TIPS
Preventing Foot Problems with Diabetes: 10 Tips for Healthy Feet Foot-related problems are a common complication experienced by individuals living with diabetes. However, there are several simple tips that you can implement to decrease your chances of developing these complications. By following these tips, you can significantly lower your risk of experiencing diabetes-related foot issues. Look closely for skin dryness, scaling, cracking, redness, sores, blisters, or any other changes in the skin or nails. If you cannot see the bottom of your foot, use a mirror or take help from a family member. Image by fabrikasimf on Freepik Image: <a href=”https://www.freepik.com/free-photo/tired-aching-female-feet-after-walking_20989733.htm#query=feet&position=1&from_view=search&track=sph”>Image by fabrikasimf</a> on Freepik Wash your feet daily with lukewarm water and mild soap.Gently pat dry your feet with a clean absorbent towel. You can apply a gentle moisturiser on the top and bottom of your feet. Do not apply moisturiser between the toes. Do not use hot water or soak your feet in water. Wear well-fitting shoes with comfortable cotton socks. Before putting on the shoes, look for any sharp surfaces or small rocks inside them. If you have foot deformities, talk to your doctor about special shoes or inserts. When you buy new shoes, use them for short durations initially to prevent blister formation. Use a nail cutter and cut the toenails straight across. Leave the corners at the sides long enough. Use a nail file to smoothen any sharp edges that can dig into the skin. If you cannot see or reach your feet, have a family member or professional (podiatrist) trim your toenails. Contact your doctor if you notice corns or calluses on your feet. Do not remove them by yourself. Do not use any over-the-counter creams or stickers to remove them, as they can result in injury to your skin. Exercise is good for circulation in the feet. Use comfortable shoes while exercising. Engage in feet-friendly exercises like walking, cycling or swimming. Check with your doctor about exercises that are appropriate for you and those you should avoid. Do not go barefoot. You can step on sharp objects without realising it. Do not use hot water bags or heating pads on your feet. Check the temperature of the water in the bathtub before stepping into it. By keeping your blood sugar levels as near to the target suggested by your doctor, you can reduce the risk of all diabetes complications. Make healthy diet and lifestyle changes and take medications regularly as recommended by your physician to keep your blood sugars in control. Smoking can affect your heart and blood vessels and decrease the blood circulation to the feet. If you are a smoker, quitting the habit will reduce your risk of getting foot complications. If it is difficult for you to quit smoking, talk to your doctor about getting medical help to quit smoking. Diabetes can cause damage to the nerves in the long run, especially if it is uncontrolled. . This can cause symptoms such as pain, burning, tingling, numbness, extreme sensitivity and weaknesses of muscles in the feet and legs. If you notice any of these symptoms, visit your doctor to get professional advice. Neglecting such symptoms can result in advanced disease where sensations can be lost completely in the foot and leg. GET REGULAR FOOT EXAMS Remember to get your feet examined by the doctor at each visit. Also, visit your doctor for a foot examination at least once every year (more frequently if you have nerve damage). This will include check-ups for blood flow and sensations in your feet. If you notice any alarming skin changes, visit the doctor immediately. References American Diabetes Association. Diabetes Foot Care Tips. https://diabetes.org/healthy-living/seniors/foot-care-tips Centers for disease control and prevention. Diabetes and Your Feet. https://www.cdc.gov/diabetes/library/features/healthy-feet.html
Understanding Diabetic Neuropathy
What is Diabetic Neuropathy? Nerves are specialised tissues that carry signals to and from the brain to different parts of the body. These signals help you move your body parts, help you feel sensations such as touch, pressure, pain and temperature, and allow you to control certain body functions such as heartbeat and digestion. The medical term ‘neuropathy’ means nerve damage. Diabetic neuropathy is nerve damage that is seen in individuals with Diabetes. In diabetes, the high sugar (glucose) levels can result in nerve damage in various parts of the body. Most often, the nerves in the legs and feet are affected (peripheral neuropathy). According to research studies, diabetic neuropathy develops in as many as 50% of people with diabetes during their lifetime. Neuropathy can be seen in both type 1 and type 2 diabetes. What are the symptoms of Diabetic Neuropathy? Four main types of neuropathy are seen in individuals with diabetes. The symptoms depend on the type of neuropathy and the nerves involved. A person can develop one or more than one type of neuropathy. In the initial stages, no symptoms may be noted. Symptoms develop slowly when significant nerve damage has happened. This is the most common type of diabetic neuropathy. In this condition, nerve damage is seen in the limbs. The feet and legs are more often affected than the arms and legs. It is also known as distal symmetric polyneuropathy (DSPN). Symptoms of peripheral neuropathy can include: Autonomic nerves control the functions of internal organs of the body such as the heart, digestive system, eyes, urinary bladder, sex organs, and sweat glands. When diabetes affect nerves in these organs, you may experience certain symptoms that include: Mononeuropathy is a condition where there is damage to a single nerve, most commonly in the arm, leg, head or torso. Mononeuropathy can appear suddenly and subside by itself within a few weeks or months. The symptoms depend on which nerve is involved and may include: This is a rare but disabling form of nerve damage that can affect the hips, buttocks, or thighs. It can also affect the chest area. It usually affects one side of the body, but may rarely spread to the other side. Symptoms of proximal neuropathy can include: When should I visit a doctor? You should visit your doctor if you have any of the following: According to the American Diabetes Association (ADA), you should get screened for neuropathy by the doctor once you are diagnosed with Type 2 diabetes or 5-years after you have been diagnosed with Type 1 diabetes. After that you should visit at least yearly once for neuropathy screening. References: Pop-Busui R, Boulton AJ, Feldman EL, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136–154. Feldman, E.L., Callaghan, B.C., Pop-Busui, R. et al. Diabetic neuropathy. Nat Rev Dis Primers 5, 41 (2019). Deli G, Bosnyak E, Pusch G, Komoly S, Feher G. Neuroendocrinology. 2013;98(4):267-80. Diabetic neuropathies: diagnosis and management. Izenberg A, Perkins BA, Bril V. Diabetic neuropathies. Seminars in Neurology. 2015;35(4):424–430. Hicks CW, Selvin E. Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Curr Diab Rep. 2019 Aug 27;19(10):86. Retinopathy, Neuropathy, and Foot Care: Standards of Medical Care in Diabetes-2022. Diabetes Care December 2021, Vol.45, S185-S194. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes- 2023. Diabetes Care 2023;46(Supplement_1):S203–S215
Biothesiometry: A Non-Invasive Method for Detecting Peripheral Neuropathy
Peripheral neuropathy is a condition that affects the peripheral nerves and causes pain, numbness, and tingling in the extremities. It can be caused by a number of factors, including diabetes, chemotherapy, and certain medications. Early diagnosis is important to prevent further nerve damage and the development of more serious complications. One tool that is commonly used for diagnosing peripheral neuropathy is the biothesiometer. What does a Biothesiometer do? The biothesiometer is a non-invasive device that is used to measure the vibration perception threshold (VPT) of the skin. VPT is the lowest amplitude of vibration that a person can perceive, and it is a measure of the sensitivity of the peripheral nerves. The biothesiometer works by applying a small vibration to the skin at various points on the foot and measuring the patient’s response. The device consists of a small handheld unit that produces the vibration, and a probe that is placed on the skin. The probe is controlled electronically and adjusted to vary the intensity of the vibration. The vibration frequency used in biothesiometry is typically between 50 and 200 Hz. Biothesiometry is a painless and non-invasive test that can be performed in a doctor’s office or clinic. Patients do not need to prepare in any special way, and there are no risks associated with the test. The procedure takes only a few minutes to complete, and patients can return to their normal activities immediately after the test. How is a Biothesiometer different from a tuning fork? Biothesiometry is a superior diagnostic tool compared to the traditional method of using a tuning fork for measuring vibration perception threshold (VPT). Tuning forks have been used for decades to measure VPT, but they have several limitations. Firstly, tuning forks can produce inconsistent results, and a skilled practitioner is needed to use them effectively. Secondly, they may not produce a consistent frequency and amplitude of vibration, which can affect the accuracy of the test. In contrast, biothesiometers are designed to produce a consistent frequency and amplitude of vibration. This consistency helps ensure the accuracy of the test and allows for more reliable and objective measurements. Moreover, biothesiometers are automated and easier to use, eliminating the need for a highly trained practitioner. Another advantage of biothesiometers is their sensitivity in detecting changes in VPT that may not be noticeable with a tuning fork. Biothesiometers can measure VPT more precisely and accurately, making it an essential tool for detecting peripheral neuropathy in its early stages. This early detection allows for prompt treatment and better outcomes for patients. When is the Biothesiometry test recommended? Biothesiometry is particularly useful in the diagnosis of diabetic peripheral neuropathy. Diabetes is a common cause of peripheral neuropathy, and it is estimated that up to 50% of people with diabetes will develop neuropathy at some point in their lives. Early diagnosis of diabetic neuropathy is important because it can be treated with medication and lifestyle changes. However, many people with diabetes do not experience symptoms of neuropathy until it has progressed to a more severe stage. Biothesiometry can detect peripheral neuropathy in its early stages, allowing for earlier intervention and better outcomes. Biothesiometry is also useful in the diagnosis of other types of peripheral neuropathy, including those caused by chemotherapy, alcoholism, and certain medications. It can also be used to monitor the progression of neuropathy over time, which can help doctors to adjust treatment plans as necessary. What do the results of the Biothesiometry test indicate? The results of a biothesiometry test are expressed in terms of the VPT. A higher VPT indicates a reduced sensitivity to vibration, which is a sign of peripheral neuropathy. The results are typically reported in Vibration units or Volts (V) and a range between 0 to 50 V is tested. A value above 25 V indicates that you have a high chance of neuropathy, 15 V to 25 V indicates you have intermediate risk and less than 15 V indicates that you are in the normal range. It is a screening test and not a diagnostic test, and further testing may be needed to confirm a diagnosis of peripheral neuropathy. When should I undergo neuropathy screening? Diabetes patients should undergo neuropathy screening at least once a year, but the frequency may vary depending on the patient’s risk factors, age, and duration of diabetes. Annual screening is recommended for all diabetes patients because neuropathy is a common complication of diabetes that can lead to severe health problems, including foot ulcers, infections, and amputations. However, patients who have had diabetes for many years or those with poor glycemic control are at higher risk of developing neuropathy and may need more frequent screening. In some cases, patients may need to undergo neuropathy screening more frequently, such as those with pre-existing peripheral neuropathy or other risk factors for neuropathy, including smoking, alcohol consumption, and a family history of neuropathy. Therefore, it is essential to work with a healthcare professional to determine an appropriate screening schedule based on individual risk factors and medical history. Regular screening for neuropathy is critical to identify the condition early, when it is more manageable, and to prevent serious complications that can lead to disability or even death. Conclusion In conclusion, biothesiometry is a non-invasive and painless method for detecting peripheral neuropathy. It is particularly useful in the early diagnosis of diabetic neuropathy, but it can also be used to diagnose other types of neuropathy and monitor the progression of the condition over time. It is a valuable tool for doctors in the diagnosis and treatment of peripheral neuropathy. If you are experiencing symptoms of peripheral neuropathy, such as pain, numbness, or tingling in your extremities, talk to your doctor about whether biothesiometry may be an appropriate diagnostic tool for you. Those who have diabetes, should undergo annual screening for neuropathy as part of their regular
Biothesiometer vs. Monofilament : Which is Better for Diabetic Neuropathy Testing?
Early detection of diabetic neuropathy is critical to preventing its complications. There are different types of tools used for diabetic neuropathy testing, but two of the most commonly used ones are the biothesiometer and the monofilament. In this article, we will examine the differences between these two tools and which one is better for diabetic neuropathy testing. Monofilament Test The monofilament test is a simple and inexpensive tool used to detect diabetic neuropathy. It uses a thin nylon filament that is pressed against the foot to test the patient’s ability to feel the filament. If the patient cannot feel the filament, it indicates that the patient may have diabetic neuropathy. Biothesiometer Test The biothesiometer is a device that measures the sensitivity of the nerves in the foot. It uses a vibrating probe that is placed on the foot to stimulate the nerve endings. The biothesiometer measures the level of vibration that an individual is able to detect. If an individual can only detect higher intensity vibrations or cannot sense any vibration stimuli, it may indicate the presence of diabetic neuropathy. Which one is better? The choice between the biothesiometer and the monofilament test depends on several factors. Let us examine a few of those: 1. Qualitative vs Quantitative testing Monofilament can be described as a qualitative testing tool because it gives a binary response (yes or no) to the question of whether a patient can feel pressure or not. Biothesiometer, on the other hand, is a quantitative testing tool because it provides numerical measurements of a patient’s vibratory perception threshold. 2. Sensitivity in detecting neuropathy When it comes to detecting neuropathy, a biothesiometer is a more sensitive tool compared to the commonly used 10-gram monofilament test. This is because the biothesiometer tests a wider range of vibrational intensities, allowing it to detect early loss of vibration sensations. In contrast, the 10-gram monofilament test only picks up on loss of sensation at a slightly advanced stage 3. Long-term monitoring Biothesiometer is a device that measures the level at which an individual perceives a vibration stimulus (known as vibration perception threshold), which is a sensitive indicator of neuropathy. This threshold can be monitored over long periods of time, making it useful for detecting changes in neuropathy over time. On the other hand, monofilament testing only provides a snapshot of neuropathy at a single point in time and cannot be used for long-term monitoring. 4. Size The monofilament is a small, flexible strand that can be easily carried. The conventional biothesiometers are more cumbersome and heavy (measuring between 2-5 kilograms) and necessitate a constant supply of electricity. However, the difficulty of carrying handheld biothesiometers has been simplified by the availability of battery-operated devices, such as Vibrasense, which can be conveniently transported in one’s pocket. 5. Time and Cost The monofilament test is a simple and inexpensive test that can be performed by any healthcare professional. The test involves eliciting only yes or no responses, which makes it quicker to conduct compared to other tests, and the cost of the filament used for the test is low. It is recommended that a monofilament should be discarded after using it on 70 to 90 subjects. Biothesiometer on the other hand is more expensive and requires additional training to perform. Paying the additional cost for a biothesiometer can be helpful because it has been shown to detect more cases of neuropathy than monofilament testing. Biothesiometer testing can detect neuropathy in patients who may have normal pressure sensation but abnormal vibration perception, which may be missed by monofilament testing. This early detection of neuropathy can be critical in preventing further nerve damage and managing the condition effectively. What do the medical guidelines say? In order to identify the risk of foot ulceration, the International Working Group of the Diabetic Foot ( IWGDF) suggests that patients who show no signs of sensory loss during the monofilament test should undergo screening for vibration perception using a tuning fork or biothesiometer. This advice is based on the fact that reduced sensitivity to vibrations can also be an indication of such risk, which may not be disclosed by the monofilament test in isolation. Therefore, conducting screening for vibration perception is critical to identifying those who are susceptible to foot ulceration, and the IWGDF highlights its importance as a complementary approach to the monofilament test. Conclusion The choice between the biothesiometer and the monofilament test should be based on the needs and circumstances of the healthcare practitioners. The monofilament is a useful clinical tool mainly for detecting more advanced neuropathy and identifying patients at increased risk of ulceration and amputation. However, it may not detect diabetic neuropathy as early as the biothesiometer test. The biothesiometer is typically used to detect early signs of peripheral neuropathy. Detecting neuropathy early allows for prompt treatment and management, which can prevent or slow down the progression of the condition, improve quality of life, and reduce the risk of complications. References Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, Sosenko JM, Ziegler D. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017 Jan;40(1):136-154. Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, Raveendhara R. Bannuru, Florence M. Brown, Dennis Bruemmer, Billy S. Collins, Christopher H. Gibbons, John M. Giurini, Marisa E. Hilliard, Diana Isaacs, Eric L. Johnson, Scott Kahan, Kamlesh Khunti, Jose Leon, Sarah K. Lyons, Mary Lou Perry, Priya Prahalad, Richard E. Pratley, Jane Jeffrie Seley, Robert C. Stanton, Jennifer K. Sun, Robert A. Gabbay; on behalf of the American Diabetes Association, 12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2023. Diabetes Care 1 January 2023; 46 (Supplement_1): S203–S215. Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Hinchliffe RJ, Lipsky BA; IWGDF Editorial Board. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020 Mar;36 Suppl 1:e3266. Miranda-Palma B, Sosenko JM, Bowker JH, Mizel MS, Boulton AJ. A comparison of the monofilament with other testing modalities