Diabetic foot prevention care

Written by Li Hui Zhi
Endocrinology
Updated on September 23, 2024
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First of all, it's important to keep blood sugar under control. It's recommended that people with diabetes check their glycated hemoglobin every three months to see if their blood sugar levels meet the standards. Second, many patients suffer from diabetic foot due to severe diabetic peripheral neuropathy. Injuries such as stepping on a nail or accidental bumps may lead to infections. Therefore, it's suggested that patients with diabetes check their feet daily for any small wounds or ulcers, and if found, they should seek timely treatment from an endocrinology specialist. Third, using warm water for foot baths and treatments like local infrared lamp therapy are advised. It's important to ensure that the temperature is not too high, generally around 40 degrees Celsius, to avoid burning the skin.

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Gestational diabetes standards

Before addressing this question, let's first clarify another concept: if diabetes is diagnosed before pregnancy, this is referred to as pre-existing diabetes in pregnancy, which is different from gestational diabetes. Gestational diabetes refers to cases where there is no pre-existing diabetes diagnosis before pregnancy, but abnormal blood glucose levels are detected after becoming pregnant. Generally, a glucose screening test is conducted between the 24th and 28th weeks of pregnancy. Currently in China, there are two approaches: the one-step and the two-step methods. The one-step method involves a direct 75-gram oral glucose tolerance test. However, most of China uses the two-step method, which starts with a 50-gram glucose challenge test. If the blood glucose level one hour after eating is greater than or equal to 7.8 mmol/L, a 75-gram oral glucose tolerance test is recommended. For the 75-gram glucose test, the fasting blood glucose level should generally be less than or equal to 5.6 mmol/L, one hour post-glucose intake should be 10.3 mmol/L, two hours post-glucose should be 8.6 mmol/L, and three hours post-glucose should be 6.7 mmol/L. If two or more of these values exceed the diagnostic criteria, gestational diabetes can be diagnosed. If only one value is abnormal, impaired glucose tolerance can be diagnosed. It is recommended that anyone who experiences abnormal blood glucose levels during pregnancy undergo another 75-gram oral glucose tolerance test six months post-pregnancy to determine if blood glucose levels are still abnormal and whether treatment should continue.

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Can frequent urination be diabetes?

If the amount of urine increases, the first thing to consider is the possibility of diabetes. In this case, a routine urine test will reveal a significant increase in urinary glucose. If a blood test for blood glucose is performed, an increase in blood glucose will also be found. For this situation, it is necessary to go to the hospital's endocrinology department for hypoglycemic treatment in a timely manner. Secondly, diabetes insipidus should be considered, which also causes an increase in urine volume, and the patient will have obvious thirst. Routine urine tests find that blood sugar in the urine is not high, the specific gravity of urine will initially decrease, and the patient's daily urine output will exceed 2500 milliliters, even reaching more than 4000 milliliters.

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Gestational diabetes symptoms

Gestational diabetes shows several symptoms, the most typical being the "three more one less" syndrome, namely increased thirst, increased appetite, urination, and weight loss. The second common manifestation is fatigue, which is due to glucose not being utilized effectively in the body and being broken down too quickly, leading to insufficient energy replenishment. The third is unexplained frequent fungal infections, such as recurring candidal infections of the vulva and vagina, at which point blood sugar screening should be considered. The fourth symptom is pregnancy accompanied by excessive amniotic fluid or a large fetus. The fifth is glucose positivity in urine from two fasting morning samples.

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How to treat diabetic foot?

Diabetic foot is one of the most severe complications of diabetes. It is caused by a combination of factors including peripheral vascular disease and diabetic peripheral neuropathy associated with diabetes. In such cases, treatment can involve internal medicine, interventional vascular treatment, and surgical treatment cooperatively managed by multiple vascular departments. Early treatment focuses on controlling blood sugar, improving circulation, and nourishing nerves. If ulcerations and skin breakdown have already occurred in the foot, further debridement and anti-infection treatments are necessary. It is essential to conduct an ultrasound of the lower limb vessels to assess for any vascular narrowing. If severe vascular occlusion occurs, vascular surgery may be needed to restore blood flow. In cases of severe diabetic foot with infection, surgical debridement or even amputation may be necessary. Thus, it is crucial to control blood sugar well in the early stages of diabetes to prevent these complications and potentially avoid the onset of diabetic foot.

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Care for diabetic foot

The first fundamental step is monitoring blood glucose; good control of blood glucose levels is essential for the effective management of diabetic foot problems. Secondly, attention must be paid to the protection of the wound. It's crucial to keep the wound clean, perform regular cleaning and disinfection, and when necessary, debride necrotic tissue thoroughly. For instance, if there is a sinus tract or deep ulceration, it is essential to open the wound and ensure drainage, removing all necrotic tissue inside. Thirdly, footwear choice is critical for patients with diabetic foot; it is important to wear shoes that are loose fitting, moderately soft yet firm, and capable of evenly distributing pressure across the footbed. There are shoes specially designed for those with diabetic foot, and these can be custom-made. Other considerations include maintaining good blood pressure control and ensuring adequate nutrition to support wound healing, including sufficient protein intake, which plays a vital role in promoting wound repair.