Diabetology

Diabetic Home Care and Monitoring
Foot Health for People with Diabetes

There are three main problems which can occur in the diabetic foot

– A reduced sense of feeling (neuropathy),
– A reduction in blood flow (poor circulation)
– A higher risk of infection.

Neuropathy ….

Sometimes diabetes can affect the nerve supply to the feet. If this occurs, it can lead to pain or ‘pins and needles’, reduce the ability to recognize the difference between heat and cold, or the sensation of touch and pain. If feeling is impaired in this way, damage to feet may occur which goes unnoticed.

YOU MAY NOT FEEL PAIN AT ALL

Poor circulation ….
In the same way that diabetes can affect the nerve supply to the feet, it may also affect the circulation. The arteries may narrow, reducing the flow of blood to the feet and legs. When this occurs it may slow down healing of wounds and cause pain and discomfort in the legs and feet. The chances of this occurring are greatly increased by smoking.

SMOKING IN CONJUNCTION WITH DIABETES IS PARTICULARLY DANGEROUS TO THE CIRCULATION

Infection ….

Due to high blood sugar levels, small injuries to the skin can become infected more easily than someone who does not have diabetes and these wounds may take longer to heal. If then left untreated, they could give rise to more serious complications, such as ulceration, deep infection and gangrene. Having diabetes does not necessarily mean that you will develop any of these complications; most people who have diabetes enjoy healthy feet all their lives.

However, always remember ……. PREVENTION IS BETTER THAN CURE

HOW TO CARE FOR YOUR FEET

Keep your feet clean ….

Wash your feet daily with mild soap and warm water (not hot).Always check the temperature of the water first, with your elbow, before putting your feet in, as your sense of feeling may be reduced.
Dry your feet well ….

Use a soft towel to dry your feet, paying particular attention to the area between the toes.

Apply skin cream ….

If the skin is dry or rough, apply a moisturizing cream daily, especially after washing your feet. Avoid using moisturizing creams between the toes. Most non-perfumed hand creams or body lotions can be used.
CHANGE SOCKS OR STOCKINGS DAILY

Wear well-fitting shoes ….

Make sure footwear is wide enough, deep enough and long enough, with adequate fastening to prevent your foot from slipping and rubbing inside the shoe. Try to buy shoes with a complete upper so that there are no seams or stitching which may rub on your toes.

Inspect footwear ….

Inspect the insides of footwear before putting them on to check for nails, seams, etc. which may stick into or rub your feet, or anything which may have got into your shoes since you last wore them.

Cutting nails ….

Always take great care when cutting toe nails. Cut the nails straight across – never cut them too short or down into the corners and use a nail file after cutting. If you find it difficult to cut your nails use a long emery board or nail file and file the nails regularly.

Check feet daily ….

Check your feet each day. A mirror can be used to check the soles of your feet. If your eyesight is poor, ask a relative or friend to check your feet.

Injury ….

If an injury occurs on your foot, clean the wound at once with warm clean water and cover with a sterile dressing. If the wound does not show signs of healing within a few days, or there is any swelling, redness or discharge, seek advice from your doctor or podiatrist.

HOW BEST TO AVOID PROBLEMS

Do not remove corns or hard skin ….

Never use corn plasters, corn lotions, knives or razor blades to remove corns and hard skin. This could result in injury to the skin, leading to infection and ulceration.

Avoid extremes of temperature ….

Never put feet on hot water bottles or sit too close to the fire. Check the temperature of your bath water with your elbow or a thermometer before getting in. Wrap up well when going out in cold weather.

Do not ‘break shoes in’ ….

This is bad practice and your feet will suffer. Always make sure shoes are well fitting to start with. Ask at your shoe shop to have your feet measured.

Never wear tight garters or socks….

Tight fitting garters or socks, or sitting with legs crossed can constrict the circulation.

Avoid walking barefoot ….

Walking in your bare feet will increase your risk of injury.

Never neglect the slightest injury….

Neglect of a foot injury could lead to infection.

Cancer

Suggested written discharge advice card for people aged over 12 years who have sustained a head injury
We think that it is all right for you to leave hospital now. We have checked your symptoms and you seem well on the road to recovery. When you get home it is very unlikely that you will have any further problems. But if any of the following symptoms do return we suggest you come back, or get someone to take you to your nearest hospital A&E department as soon as possible:

unconsciousness, or lack of full consciousness (for example, problems keeping eyes open)

any confusion (not knowing where you are, getting things muddled up)

any drowsiness (feeling sleepy) that goes on for longer than 1 hour when you would normally be wide awake

difficulty waking up

any problems understanding or speaking

any loss of balance or problems walking

any weakness in one or more arms or legs

any problems with your eyesight

very painful headache that won’t go away

any vomiting – getting sick

any fits (collapsing or passing out suddenly)

clear fluid coming out of your ear or nose

new bleeding from one or both ears

new deafness in one or both ears.

Things you shouldn’t worry about

You may experience some other symptoms over the next few days, which should disappear in the next 2 weeks. These include a mild headache, feeling sick (without vomiting), dizziness, irritability or bad temper, problems concentrating or problems with your memory, tiredness, lack of appetite or problems sleeping. If you feel very concerned about any of these symptoms in the first few days after discharge, you should go and see your own doctor to talk about them. If these problems do not go away after 2 weeks, you should go and see your doctor. We would also recommend that you seek a doctor’s opinion about your ability to drive a car or motorbike.

Things that will help you get better

If you follow this advice you should get better more quickly and it may help any symptoms you have to go away.

DO NOT stay at home alone for the first 48 hours after leaving hospital.

DO make sure you stay within easy reach of a telephone and medical help.

DO have plenty of rest and avoid stressful situations.

DO NOT take any alcohol or drugs.

DO NOT take sleeping pills, sedatives or tranquillisers unless they are given by a doctor.

DO NOT play any contact sport (for example, rugby or football) for at least 3 weeks without talking to your doctor first.

DO NOT return to your normal school, college or work activity until you feel you have completely recovered.

DO NOT drive a car or motorbike, ride a bicycle, or operate machinery unless you feel you have completely recovered.

Long-term problems

Most patients recover quickly from their accident and experience no long-term problems. However, some patients only develop problems after a few weeks or months. If you start to feel that things are not quite right (for example, memory problems, not feeling yourself), then please contact your doctor as soon as possible so that he/she can make sure you are recovering properly.

Emergency Care

Home Care (Discharge) Advice The following instructions contain information and advice regarding your condition and are designed to provide you with a guide on how best to safeguard your health. However, they are not intended to be exhaustive. In specific cases you may receive different/additional instructions from your doctor. You are advised to follow any specific written or oral instructions given to you by your doctor or health care worker. Please seek clarification when you are in doubt.

INSTRUCTIONS FOR PATIENTS WITH DIARRHOEA

1. Rest if you feel weak.

2. Drink lots of water, fruit juice and clear soup until the diarrhoea has stopped.

3. Do not eat your usual meals for a day to rest your bowels.

4. If your baby has diarrhoea, give him quarter strength feeds by mixing a quarter of his usual amount of milk powder with the usual amount of water. Also give plenty of fluids.

5. Take your medications as instructed.

6. Consult your doctor :-

If there is severe abdominal pain.
If diarrhoea persists for more than 3 days or exceeds more than 5-6 times a day.
If you cannot retain any fluids at all because of vomiting.
If the stool is black, bloody, looks like rice water or canned pea soup.

INSTRUCTIONS TO PARENTS OF A CHILD WITH FEVER

1. Fluids

Give plenty of fluids. A child with fever needs a lot of water because fever forces the body to use up more of its water content. Fluids also help the body temperature to stay closer towards normal. Frequently, a child with a fever does not have an appetite. The appetite will improve as the child begins to feel better. Therefore, fluids are important.
2. Skin Exposure

Children lose heat through their skin. Dress the child lightly, if heavy clothes or blankets are used, the body cannot give off that extra heat to the environment and the fever may go higher. Keep your child near moving air such as a fan.
3. Sponging

If the child's temperature is over 38°C then sponge the child. Use ordinary tap water to bring the temperature down gradually over 30 minutes. Avoid ice cold bath, as the child will shiver, which will raise the temperature. When sponging, use a wet towel and dab over face, neck, armpits and body.
4. Fever in children is often due to a viral infection. They often recover after a few days. However, it is advisable to seek medical attention either from the Government Outpatient Clinic or your own family doctor if your child has the following:

Persistent fever of more than 38°C
Repeated vomiting
Abdominal pain and discomfort
Other associated symptoms such as cough and ear pain
Any other abnormal and/or prolonged symptoms which cause concern

INSTRUCTIONS TO PATIENT AFTER REMOVAL OF FOREIGN BODY IN THE EYE

1. Protect your eyes from bright light or sunlight by wearing dark glasses temporarily.
2. Do not rub the eye.
3. Take medication as prescribed.
4. Apply eye drops using the following technique:
Wash hands before applying the eye drop.
Clean affected eye before instillation.
Hold the bottle close to the eye without touching it.
Look upwards, pull your eyelids apart and instill one or two drops into your lower eyelid.
Avoid dropping eye drops directly onto the eyeball.
Move the eyeball around to allow it to come into good contact with eye drops. Then close your eyes.
Wipe off excess eye drops around the eye with a clean tissue.
5. Keep eye drops in a cool place.
6. After treatment, you may still experience the sensation of having something in your eye. However this feeling should go off in about 2 days.
7. When to see a doctor
a. Worsening of vision.
b. Eye becomes more red and swollen.
c. Any other abnormal and/or prolonged symptoms which cause concern.
INSTRUCTIONS FOR PATIENT AFTER HEAD INJURY

1. You have just been treated for mild head injury. However, over the next 24 to 48 hours, should the following symptoms occur, it is advisable that you return to the Emergency Department for further evaluation:
a. Difficulty to arouse or drowsiness.
b. Persistent headache, giddiness or vomiting.
c. Abnormal behaviour - disorientated, confused or irritable.
d. Double vision.
e. Fits.
f. Weakness of arms or legs.
g. Slurring of speech or loss of speech.
h. Any other abnormal and/or prolonged symptoms which cause concern.
2. Refrain from taking any alcoholic drinks or sleeping pills for the next 48 hours.

3. It is advisable that you do not drive a car or ride a motorcycle for next 48 hours.

4. After a mild head injury, slight blurring of vision or one to two episodes of vomiting may occur. This may not required immediate medical attention unless the symptoms are persistent.

INSTRUCTIONS TO PATIENT WITH BACKSLAB/PLASTER CASTS

1. Plaster casts are used to help immobilize an injured part of the body after fractures and other injuries.
2. Keep cast dry. The cast will only be completely dry after 2 to 48 hours.
3. While the cast is drying, protect it from pressure so that it does not flatten or break.
4. Raise the injured part to reduce swelling. Evaluate the injured hand in an arm sling.
5. Exercise your exposed finger/toes and adjacent joints to help keep your muscles in tone.
6. DO NOT
Bear weight on the injured part. Use crutches as instructed
Remove any padding from the cast
Scratch or use sharp objects to scratch under the cast when itchy
Put powder inside the cast as this will cake and cause irritation to the skin
Wet or heat the plaster