• Choose a category
• All
• Classic-Fiction

If diabetes causes the blood vessels in the legs to narrow, you can have cramps, cold feet, pain when you walk or climb stairs, and skin sores that don’t heal. Eventually, the lack of circulation can lead to death of tissue (gangrene; see page 601) in the feet and legs, which may require amputation. The feet are especially prone to injury, so it is important to take good care of them (see next page). If any cut fails to heal within 10 days, see your doctor immediately. Any sore or ulcer must be examined promptly by your doctor.

Insulin

Many different types of insulin are available for people with diabetes, and the type of insulin and the schedule that your doctor prescribes will depend on many factors, including your age and the severity of your diabetes. The insulin most frequently prescribed is identical to human insulin, produced in bacteria or yeast. Insulin can currently only be injected or infused, although studies are under way to determine the effectiveness and safety of insulin formulations that can be inhaled, eaten, or absorbed through the skin or mucous membranes. Several modified versions of human insulin are available that produce effects rapidly or over a longer time.

The best control is usually achieved by giving yourself injections once or twice a day of a long-acting insulin and injections of a rapidly acting insulin at mealtimes. Your doctor will show you how to inject the insulin just under the skin of your thigh, arm, or abdomen. Most people learn to do this expertly within a few days. (If you have a child with diabetes, you will need to administer the injections until the child is about 10.) Always make sure that you obtain the same type and strength of insulin each time you renew your prescription.

Taking Care of Your Feet

If you have diabetes, you are at risk of damage to the nerves and blood vessels in your feet, which can reduce their sense of feeling and limit the circulation of blood to them. If you don’t have feeling in your feet, you can injure them and not realize it. In addition, the reduced flow of blood to the feet can make injuries heal slowly or not at all, which can cause the tissue to die (a condition called gangrene). In severe cases, amputation is necessary to save the rest of the foot and leg. The following steps can help you avoid these serious but common complications of diabetes:

• Inspect your feet every day for scratches, cuts, blisters, ingrown toenails, or warts on the soles (called plantar warts; see page 1060); using a mirror can help you see the bottoms of your feet better. If you notice anything unusual, see your doctor right away.

• Immediately report to your doctor any signs of infection, burning, tingling, or numbness in your feet.

• Do not cut or treat corns or calluses yourself. Have a doctor remove them.

• Make sure your doctor examines your feet at each visit.

• Wash your feet every day and dry them well, especially between the toes.

• Shake out your shoes before putting them on to make sure there aren’t any pebbles or other objects that could cause a cut or blister.

• Wear comfortable, well-cushioned shoes that do not pinch at the toes or scrape at the heel. Try wearing shoes that are a half size larger than you normally wear. Never wear shoes with high heels.

• Break in new shoes slowly.

• Change your socks every day. Wear socks that wick away moisture. Smooth your socks or panty hose over your feet carefully, leaving no lumps that could cause chafing or blisters.

• Put a moisturizer on your feet nightly if your skin is dry.

• Never walk barefoot, even in your own home.

• Don’t smoke. Smoking reduces blood flow to your feet.

• To prevent ingrown toenails and infections, be extra careful when you trim your toenails. Cut your nails straight across from side to side (ask your doctor to show you how). If you have numbness in your feet, you should not trim your own nails.

• To prevent scalding, do not test the water temperature in your bath with your feet.

• Have a podiatrist examine