Stephen J. Schueler, M.D.

Overview Symptoms Evaluation Treatment questions for doctor specialist Home Care diet self monitoring taking control using a walker warning signs Prevention Underlying Cause

Foot Ulcer due to Diabetes Home Care

Home care for diabetic foot problems includes:

  • Keep your toenails trimmed.
  • Examine your feet every day for cuts, blisters, or sores:
    • Report abnormal findings to your doctor.
  • Use an emery board:
    • File away any sharp edges on the toenails
  • Wear shoes that protect your feet:
    • Avoid open-toed shoes.
    • Avoid sandals or flip-flops.
  • Avoid pointed shoes.
  • Avoid footwear that places pressure on the foot.
  • Avoid shoes that are too small.
  • Avoid high-heeled shoes.
  • Break-in new shoes slowly.
  • Change shoes and socks when they become wet.
  • Purchase new shoes before your old ones wear out.
  • Wear shoes that provide room for your toes.
  • Take your diabetes medications as directed:
    • Don't skip doses of your medication. This makes them less effective.
    • Avoid running out of your medication. Refill your prescriptions early.
    • Don't stop taking your medication just because you feel better.
    • If you feel worse, talk to your doctor before you stop your medication.
    • Be aware of the common side effects that may be caused by your medication.
    • Do not stop prescription medications without talking to your doctor.

Example of Sliding Scale Insulin Dosing
Glucose ReadingRegular Insulin Dosing
140 - 1602 units, re-check glucose in 2 hrs
200 - 2404 units, re-check glucose in 2 hrs
240 - 3006 units, re-check glucose in 2 hrs
300 - 4008 units, re-check glucose in 2 hrs
400 - 50010 units, re-check glucose in 2 hrs
> 500See doctor now!

Foot Ulcer due to Diabetes Diet

It is important to follow a healthy diet if you have a diabetic foot.

Total Calories
Your daily intake of calories should allow you to maintain a healthy weight. Total calorie requirements vary according to your weight, height and activity. Your doctor and dietitian will recommend a total daily calorie requirement that is right for you.

Carbohydrates should account for 55-60% of your total calories. Carbohydrates include sugars, starches, and fiber. Whole grains, fruits, vegetables and fiber, are better sources of carbohydrate than sugars. Dietary fiber has been shown to prevent constipation, reduce the risk of colon cancer and reduce cholesterol levels. A healthy diet contains 20-35 grams of fiber per day.

Protein should account for 10-20% of your total calories. Those who have normal kidneys should consume about 50 to 60 grams of protein per day. Those who have kidney disease should consume no more than 45 grams of protein per day.

Total Fat
Fat should account for less than 30% of your total calories. Consume only unsaturated fats that are low in cholesterol. About 10% to 15% of your total calories should be in the form of monounsaturated fats, such as olive oil, canola oil and peanut oil. Cholesterol intake should be limited to less than 300 milligrams per day.

Consider replacing sugar with artificial sweeteners. Saccharin (Sweet-n-Low), aspartame (Equal), and sucralose (Splenda) are acceptable alternatives.

Sodium intake should not exceed 3,000 mg per day. Those who have high blood pressure, heart disease, kidney disease or liver disease should consume no more than 2,000 mg of sodium per day.

Vitamins and Minerals
Diabetes does not require vitamin or mineral supplements.

Alcohol should be limited to two drinks per day.

Foot Ulcer due to Diabetes Self Monitoring

An important part of the successful management of diabetic foot problems is close monitoring of blood sugar.

Blood Testing for Glucose

  • Monitor your blood glucose as directed.
  • Learn to use your glucose monitor correctly.
  • Daily home glucose monitoring is essential.
    • Try to keep your glucose level before meals between 70-110 mg/dl.
    • Two hours after meals, your glucose level should be less than 140 mg/dl.
  • Check your blood sugar before operating a motor vehicle. Raise your blood sugar level by eating, if it falls below 70 mg/dl.
  • Carefully monitor your blood sugars when you are ill. Blood glucose increases when you are ill or have an infection.

When to test your blood glucose:
  • Before meals
  • Before bedtime
  • 1-2 hours after meals
  • 2-3 A.M., at least one night per week

Other reasons to test:

Urine Testing for Ketones
In the past, urine testing was very useful and important. With the advent of rapid blood sugar testing, urine testing is usually not necessary. The main reason to perform this test is to check for early ketoacidosis. Small or trace ketones may mean nothing or represent the beginning of ketoacidosis. If you find this result, then perform the ketone test again in several hours. Notify your physician immediately if you discover moderate to large ketones present in your urine.

Foot Ulcer due to Diabetes Taking Control

The successful treatment of diabetic foot problems requires your participation. Here are answers to some important questions.

Do you have control over your health and wellness?
Many people believe they have no control over their health and wellness. Many ignore personal health decisions or simply leave them to their doctors, relatives, or friends. In reality, you have the greatest potential to determine your relative health.

How is this possible? Do people really have control of their own health? The biggest killers are heart disease and cancer. Although many of these diseases seem to strike at random, our lifestyle choices greatly influence personal risk.

How can you participate in your health care?
To participate you must:

  • Learn to take responsibility for your own health.
  • Learn to partner with your doctor.
  • Learn how to make active decisions about your health.

How can you learn what you need to know?
  • Educate yourself.
  • Be skeptical: Learn to separate fact from fiction.
  • Billions of dollars are spent each year marketing dietary supplements, vitamins, and new medical treatments. Much of this is unnecessary and wasteful.
  • Be careful about where you get your health information.
    • Some of the best sources for health information on the web are professional societies and non-profit organizations.
    • Ask your doctor what he or she recommends.
  • Examine the credentials of the authors.
    • If you are reading about symptoms and disease, your best source is a licensed physician.
    • Pay attention to when the content was last updated.
    • Make sure the person is not just trying to sell you something.

Important questions you need to answer:
  • What things in your control can increase your risk for disease?
  • What can you do to decrease this risk?
  • What are vaccines and how can they help you?
  • How do your lifestyle choices increase your risk for disease?
  • How can you reduce stress?
  • What minor health problems can you treat at home?
  • When is a medical problem "serious"?
  • When should you call the doctor?

How can you find the right doctor?
Key points:
  • Everyone should have a primary care physician or family doctor. A primary physician is usually a family practitioner, internist, or pediatrician.
  • Establish a relationship in advance with your doctor.
  • Make sure you are comfortable with your primary care physician.
  • The internet contains many resources where you can do research to locate the doctor that is best for you.
  • You may wish to schedule a brief visit with the doctor to see if he or she is right for you.
    • Be open-minded, and allow your doctor to know you well. This will improve communication.

Important information you need to make your decision:
  • Physician credentials:
    • Internship and residency training is usually best from respected institutions, universities, and major hospitals.
    • Look for board certification in the specialty.
    • Ask about membership in medical societies.
  • Community and professional reputation are also important.
    • Are other patients happy with the doctor?
    • Has the doctor been disciplined by hospitals or agencies?
    • How long has the doctor been in practice?
    • In general, more than a few malpractice suits over a 5-10 year period should trigger caution.
  • Does the doctor communicate well? Are your questions answered during busy times?
  • Does the doctor welcome you to help make decisions about your care?
  • Is the doctor available when you need care?
  • What is the doctor's after-hours coverage?
  • Is he or she a member of a large group?
    • Do the doctors' cross-cover one another?
  • Where do they admit patients?

What is shared decision making?
You and your doctor must work together to jointly decide the best course of action to manage your health. This process is called "shared decision making". Your doctor becomes a guide and teacher and helps steer you toward the best treatment. Most doctors welcome this partnership. You must learn about your illnesses for shared decision-making to work.

For any recommended test, medication, or surgery, remember to ask:
  • How will this help me?
  • How much will it cost?
  • Is it covered by your insurance?
  • What are the potential side effects and risks?
  • What are my alternatives?

For tests, remember to ask:
  • Is it done in the office or at another facility?
  • Is it painful?
  • How will the results of this test influence my care?

For surgery or other procedures, remember to ask:
  • How long will it take to heal?
  • How many cases has the doctor done?
  • What would your doctor do if he or she were the patient?
  • Where is it done?
  • Who will perform it?
  • What are the doctor's qualifications?

What should you expect?
Shared decision making becomes impossible if you do not know what to expect from your doctor.

The American Hospital Association has published a "Patient's Bill of Rights" that is a good guide. It states that you have the right:
  • To be spoken to in words that you understand
  • To be told what's wrong with you
  • To know the benefits of any treatment and any alternatives
  • To know what a treatment or test will cost
  • To share in treatment decisions
  • To read your medical record
  • To refuse any medical procedure

What should you do before an office visit?
  • Bring all important medical information with you to the visit.
  • Make sure you can answer questions about the following:
    • Allergies and side effects to medicines
    • Current medicines you are taking. This includes herbs and vitamins. Make a list if necessary.
    • Insurance information
    • Marital and sexual history
    • Past injuries and hospital stays
    • Past medical problems
    • Past surgeries and operations
    • Pre-visit questionnaires
    • Use of tobacco, alcohol and drugs
    • Work history

What should you expect from the visit?
  • You should plan to wait if you go without an appointment. Emergencies or sick patients in the hospital may interrupt your doctor.
  • Bring along a book or toys for the kids. You may also have to wait during busy times.
  • Tell your doctor about your problem in a clear manner. Start from the beginning and go through each symptom as it appeared.
  • Before the visit, think about what makes your problem better or worse. Your doctor will probably ask you questions about this.
  • Most doctors ask many questions about unrelated symptoms. These questions help assure that there are no other problems that need attention.
  • Be sure to answer all questions truthfully. This includes sensitive questions about smoking, drug use, sexual activity, and work. Your history is the most important part of deciding what is wrong with you.
  • If you have any difficulty communicating your concerns, bring a family member or friend to assist in this task.
  • Talk to your doctor and do not leave the office without asking necessary questions. Your doctor can make you more comfortable if he or she understands your concerns.

What should you know about your medications?
Every year many people become ill because of problems with medications.

Remember to ask:
  • What side effects to expect.
  • What drug interactions are possible.
    • Find out if a new medicine reacts with those that you are taking now.
    • Many over-the-counter drugs and dietary supplements can also cause serious side effects and drug interactions.
    • Some drugs interact with certain foods, vitamins, nicotine, and alcohol.
  • Make sure you can drive or operate machines safely while taking a medicine.
  • Ask your doctor how much a prescription costs.
    • Is there a less expensive option or a generic version?

What is a treatment plan?
A treatment plan is what you and your doctor decide to do for an illness. A treatment plan cannot be effective without your participation.

Three simple questions can help you get the most from your treatment plan:
  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do these things?

Other important points:
  • Be sure you understand your treatment plan.
  • Stick with the treatment plan and allow time for improvement.
  • Don't stop medicines when you feel better; check with your doctor first.
  • Call your doctor if your condition is becoming worse.
  • Your doctor should tell you what to expect and when to follow-up or call the office.

Foot Ulcer due to Diabetes Using a Walker

Some people with diabetic foot problems may require more support than a cane or crutches can offer. Walkers with four solid feet on the bottom give you the most stability. A walker is much more stable than crutches or a cane. A walker allows you to keep weight off one leg while you walk. It is also lends support if both of your legs are unstable or painful.

The handles of your walker should reach the crease in your wrist when you stand upright and the walker is placed on the floor. Moving slowly is important when you use a walker.

Using a Walker

  • Place your walker one stride ahead of you. Make sure that the legs of your walker are level on the ground.
  • With both hands, grasp the handles on the walker. Lean forward and support your weight on your arms.
  • Step forward with your good leg. Place your foot in the center of the square that is made by the walker feet.
  • Step forward with the bad leg.

Walker Rules
  • Take small steps when you turn.
  • In order to sit in a chair, back up until your legs touch the chair. Reach behind you in order to feel the seat and then sit down.
  • In order to get up from a chair, push yourself up with your arms and then grasp the handles on the walker.
  • Make sure that the rubber tips on the legs of the walker are tightly fastened. Replace the rubber tips if they become worn.
  • Do not use your walker to climb stairs.
  • Do not use your walker on an escalator.

General Safety Tips
  • Remove small area rugs, electrical cords, spilled liquids or other items that may cause you to slip.
  • In the bathroom, install non-slip bath mats, toilet grab bars, a raised toilet seat, shower grab bars, and a shower tub seat.
  • Keep needed household items in close reach. Store less used items out of the way.
  • Use a backpack, fanny pack, apron or briefcase in order to carry items.

Foot Ulcer due to Diabetes Warning Signs

Notify your doctor if you have diabetic foot problems and any of the following:

  • Pus draining from a foot ulcer or wound
  • Worsening foot ulcer
  • Fever
  • Foot skin redness and pain
  • Swelling and tenderness over a bone in the foot
  • Red streaks spreading away from a foot ulcer or wound

Continue to Foot Ulcer due to Diabetes Prevention

Last Updated: Feb 15, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Foot Ulcer due to Diabetes References
  1. Edmonds M, Foster A. The use of antibiotics in the diabetic foot. Am J Surg. 2004 May;187(5A):25S-28S. [15147988]
  2. Olson DE, Norris SL. Diabetes in older adults. Overview of AGS guidelines for the treatment of diabetes mellitus in geriatric populations. Geriatrics. 2004 Apr;59(4):18-24. [15086070]
  3. Ulbrecht JS, Cavanagh PR, Caputo GM. Foot problems in diabetes: an overview. Clin Infect Dis. 2004 Aug 1;39 Suppl 2:S73-82. [15306983]
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