Winter 2009
Volume 18
No. 1

In This Issue

Take Steps Today To Prevent Foot Ulcers!

Did you know that having diabetes increases your risk of foot amputation?

This is because high blood sugar levels can damage the nerves and blood vessels in your legs and feet.

To prevent foot ulcers, the American Diabetes Association recommends you get these three tests.

  1. Daily - Check your feet at home each day (see How to Check Your Feet­7 Easy Steps article inside)
  2. Every visit - Get your feet checked by your primary care doctor
  3. Once each year - Get a complete foot exam. This is usually done by your primary care doctor or foot specialist (podiatrist).

High blood sugar levels can damage your nerves, causing loss of feeling.

Without the ability to feel pain, small wounds may go undetected. The longer these wounds go untreated, the more likely they are to become larger and infected.

High blood sugar levels also cause blood vessels to become narrow.

The narrowed blood vessels carry less blood and oxygen to your legs and feet. Your body cannot heal and fight infection without enough oxygen and other blood nutrients. Serious infections can develop which threaten your feet or legs for amputation.

Don't wait until it is too late. Keep an eye on your feet.

With the right care, you can help prevent foot ulcers. One of the best ways to keep foot ulcers from developing is to check your feet every day. Finding problems early and reporting them to your doctor will help save your feet.

Get a complete foot exam at least once a year.

The health of your skin, nerves and blood vessels in your feet and legs are tested during this exam. At every office visit be sure to take off your shoes and socks for a foot check. If you haven't had a complete foot exam in the last 12 months, take action today. Call your doctor or foot specialist to set up an appointment.

Avoid serious problems by following these important tips.

  • Keep your A1c level less than 7% · Protect your feet from injury; wear proper footwear
  • Check your feet every day for wounds · Get foot checks when you go to the doctor every three months
  • Use a daily foot care routine
  • Call your doctor at once if you notice any changes in your feet By taking control of your health, you can keep your feet healthy for a lifetime!

How to Check Your Feet ­ 7 Easy Steps

Take care of your feet for a lifetime ­ check your feet every day. The American Diabetes Association recommends that people with diabetes check their feet every day. You may be able to avoid getting a foot ulcer or having surgery to cut off a toe, foot, or part of a leg by taking care of your feet. Call your doctor to report any problems you find. Early treatment can help prevent further complications.

Follow these 7 simple steps when you check your feet each day.

  1. Look for Cracks, Sores, or Ulcers on Your Feet
    • These are caused by dry skin,poor blood flow,or too much pressure on an area of your foot. Check the tops and bottoms of your feet. And, don't forget to look between your toes.
    • If you have impaired vision o rcan't bend over far enough to see the bottom of your feet, use a hand mirror or ask someone to help. Your doctor may refer you to a foot doctor.
  2. Check for Ingrown or Sore Toenails
    • Wearing shoes that are too tight or not trimming your toenails correctly can cause ingrown toenails. Ask your doctor or foot specialist to show you the best way to trim your toenails.
  3. Look for Swelling in Your Feet
    • Look for unusual puffiness. Footswelling can lead to the development of ulcers. Avoid wearing shoes that are too tight!
  4. Feel for Change in Temperature
    • If you always have cold feet,it may be a sign of poor blood flow.
  5. Look and Feel for Hot Spots on Your Feet
    • Hot spots are usually red and warm to the touch.They are caused by friction or pressure. The type of shoe you wear may cause this problem. Hot spots are a warning sign of ulcers.
  6. Look for Color Changes in Your Feet
    • Pale or bluish toe color means poor blood flow
    • Black skin isa sign of dead tissue
    • Redness with streaks may be a sign of infection
  7. Pay Attention to Changes in Foot Sensation
    • Losing the ability to feel pain,cold and heat, or feelings of "pins and needles", numbness, tingling, and burning in your legs and feet may be the result of nerve damage.

Tell your doctor at once if you notice any of these changes in your feet!

Dear Friend,
Unfortunately for many Americans, diabetes has taken away their ability to do a simple task like walking to their mailbox. Did you know that diabetes is the leading cause of non-traumatic amputation? That's why this issue of Diabetes Directions focuses on foot care and how to prevent foot ulcers and amputation. Take these steps to help keep your feet healthy for a lifetime:

  1. Call your doctor today to get an appointment for a complete foot exam if you have not had one in the last 12 months. (You may need a referral to see a foot specialist.)
  2. Write down your appointment information in the spaces provided below.
    · I have an appointment with Dr.__________________________________________
    · Date__________________________ Time of appointment ____________________
    · The office phone number is _____________________________________________
  3. Go to your appointment.
  4. Ask your doctor or foot specialist to explain the results of your examination.
  5. Know what your test result means.

After your complete foot exam is over, ask your doctor:

  1. What is my risk score? (Low Risk) 0 1 2 3 (High Risk)
  2. How can I reduce my risk?
  3. What does my risk score mean?
Foot Risk Category What Does That Mean? Safety Level for Having an Amputation or Ulcer Next Foot Exam
0 Your feet have good feeling and blood. You have no foot abnormalities. Very Safe Get a foot exam in 12 months. See your primary care doctor or foot specialist.
1 The nerves in your feet are not able to feel pain, pressure, hear or cold. Somewhat unsafe Get a foot exam every 3-6 months. See your primary care doctor or foot specialist.
2 The blood flow to your feet is not good. The nerves in your feet may or may not be able to feel pain, pressure, heat or cold. Unsafe Get a foot exam every 2-3 months by a foot specialist.
3 History of ulcer or amputation. Very Unsafe Get a foot exam every 1-2 months by a foot specialist.

Please read this newsletter to learn how you can prevent ulcers and amputation. For more information, call 1-877-783-2177 to speak with one of our certified diabetes educators. If you would like to listen to a pre-recorded Better Care "Newsflash" about the health of your feet, call 1-866-310-5838 during the months of January, February, and March, 2009.

Sincerely,
Lorraine Farrar, RN, APN, MSN, BC-ADM, CDE Director, Better Care

Meal Planning from the Better Care Kitchen

Breakfast
  • 1/2 cup whole grain cereal flakes (1 carb)
  • 1 cup (8 oz.) 1% milk (1 carb)
  • 1/2 cup of unsweetened canned fruit (1 carb)
  • 1 slice of whole grain toast (1 carb)
  • 1 tsp. margarine 1 hard boiled egg Water or coffee
Snack
  • 1 oz. of low-fat cheese
  • 6 unsalted whole-wheat crackers (1 carb) Water
Lunch
  • 3 oz. sliced turkey topped with 1/2 cup applesauce (1 carb)
  • 1 slice of tomato 3 oz. sweet potato (1 carb)
  • 1 large banana (2 carbs) Diet drink or water
Snack
  • 1/2 English muffin (1 carb)
  • 1 tbsp. of sugar free jam or jelly Water
Evening
  • 3 oz. of baked chicken
  • 1/2 cup of onions, peppers, and mushrooms sautéed in olive oil. (Place over chicken.)
  • 1 cup of vegetable soup (1 carb)
  • 1 cup of raw salad with 10-15 croutons (1 carb) and 1 tbsp. of light dressing 1
  • (2 oz.) slice of unfrosted Angel Food cake (2 carbs) Diet drink or water
Snack
  • 1 cup (8 oz.) low-fat yogurt with artificial sweetener (1 carb)
  • 2 celery sticks or carrots
  • Water

This advice is a compilation of research studies and should not be taken as medical advice. Always seek the advice of your health care provider before acting on any medical information.

What is a Complete Foot Exam?

A complete foot exam is a group of tests done at least once a year by your primary care doctor or foot specialist. The doctor will ask you some questions and then look at your feet and check for any foot abnormalities. The exam does not hurt.

The foot exam tests:

  • Your risk of developing ulcers
  • Your risk of needing surgery to remove your toes, feet, or leg(amputation)
  • The health of your nerves and blood circulation in your legs and feet

A monofilament test will be done to check to see if the nerves in your feet work. It is important to find out if you have the ability to feel temperature changes, pain, and pressure. A monofilament is like a stiff piece of fishing line. You will be asked to close your eyes while the doctor presses the monofilament on the bottom of your foot. It will tell the doctor if you have normal feeling and sensation in your foot. The doctor may also use another type of test to check your nerves and reflexes. To get a free foot test kit,visit http://www.ask.hrsa.gov/leapindividual.cfm.

An ankle-brachial index test may be done to check the circulation in your legs and feet. This testis done only when the doctor cannot detect a pulse in your feet or if you have symptoms of poor circulation in your legs.

After your doctor has performed a complete foot exam, ask your doctor:
What is my risk score?
How can I reduce my risk?

WHAT OUR CUSTOMERS ARE SAYING

I was so sick from my diabetes, but now that I have joined the Better Care Program I am staying within my target range and feeling great!

The representative I spoke with was so helpful. I told her I was out of supplies and she had AmMed send me my supplies the next day.

I saw AmMed's TV commercial several times before calling. Now that I have joined the Better Care Program I wished I would have called sooner. Not only do I get diabetes test supplies - I get my perscriptions too! Best of all they call me with a friendly reminder when it's time to reorder.

I have to say no other mail order company can imitate what AmMed is doing for their customers.

It was so frustrating trying to get my supplies throught the doctor that I just cried. They were always out or had some excuse why they couldn't give me the supplies I needed. Now that I have joined the Better Care Program I do not ever have to worry about running out of supplies of prescriptions. Thank God for AmMed Direct!

- Audrey Washington