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Preventing and Controlling Diabetic Foot Problems

Preventing and Controlling Diabetic Foot Problems

by Joan Hultgren, RD, LDN, CDE

What types of foot problems are more likely seen with diabetes?

  1. Neuropathy (Nerve damage)

Neuropathy is one of the most common foot problems associated with diabetes.

Symptoms can include tingling, pain, burning, stinging and foot weakness. Over time, the nerve damage can lower the ability to feel temperature changes and pain. Without knowing it, burns, cuts or broken skin can occur. Items on the ground can get lodged in the foot and lead to complications.

Additionally the nerve damage can change the shape of the foot. Special shoes designed with wider and higher toe boxes can allow deformed feet from being further damaged.

  1. Callouses

Foot callouses can occur more often and build up faster with diabetes. Callouses, if not trimmed, thicken and turn into open sores (foot ulcers). To avoid burns and infections from doing home foot “surgery” and using over the counter remedies, it is best to have callouses safely removed by a podiatrist.

  1. Skin changes:

    Dry, peeling and cracked skin may occur because the nerves that control the oil and moisture in the foot are no longer working. Healthy skin is one of the ways the body is able to fight infection. Keep feet clean and use lotion.

  2. Poor Circulation:

    Diabetes causes the blood vessels of the feet and legs to narrow and harden making it difficult to fight infection and heal adequately. Feeling may be compromised, leading to difficulty in determining hot and cold sensations.

  3. Foot ulcers:

    Ulcers can form from poorly fitting shoes. They most often occur on the ball of the foot or on the bottom of the big toe. They may or may not hurt. It is extremely important that the ulcer is examined by a health care provider. X-rays may be needed to determine if the infection has reached the bone. Keeping pressure off the foot is key to healing. The foot needs to be cared for long after the ulcer heals.

  4. Amputation:

    Rates are higher with diabetes due to nerve damage and peripheral artery disease, both of which reduce blood flow. Complications requiring amputation can be greatly reduced by controlling blood glucose and blood pressure, and by not smoking.

What can be done to prevent any problems?

  • Work with your doctors and certified diabetes educators to keep blood glucose levels and blood pressure under control.
    • Additional medications, weight loss and exercise will all help.
  • Check feet daily for blisters, redness and cracked skin. Call your healthcare provider immediately if the area looks red, is swollen or worse than the day before.
  • Moisturize the feet with lotion, but limit the amount of lotion in between toes to avoid infection.
  • Wash feet daily, but avoid soaking as this can further dry the feet.
  • Avoid walking barefoot!
  • Walk to improve circulation.
  • Find ways to stop smoking! This will greatly improve circulation.
  • Make an appointment with a podiatrist for foot inspections, nail care, foot appliances and shoes to help limit complications.


Written by : Joan Hultgren RD LDN CDE (Certified Diabetes Educator)

Program Coordinator Pentucket Medical Associates
November 2014

Fruits and Veggies


Lowers blood pressure, helps with weight loss, prevents some cancers, promotes healthy hair, vision, nerves and skin, aids in proper digestion… and more!

What is it that can do all that?? Fruits and Vegetables!!!

Vegetables that top the list with higher amounts of vitamins, minerals, antioxidants and other compounds include:

  • Dark Green ones like leafy kale, spinach and collard green;
  • Bright orange/red choices including tomatoes, radicchio, sweet potato and pumpkin;

Fruits with high scores include:

  • Berries
    • blueberries
    • strawberries
    • blackberries
  • Citrus, especially oranges
  • Melon
    • cantaloupe
    • watermelon
  • Kiwi
  • Apricots

All others certainly provide good amounts of nutrients and should be a part of your daily menu.

What to look for when shopping:

Buy fresh or frozen without additional sauces, cheeses, oils or salt. Canned, packed in their own juice or without salt can also be used. Bagged fruits and vegetables can be economical, but you should always carefully inspect the produce and buy those without bruising, brown spots or wrinkled skin. Wash all well before putting away.

How to include them:

  • Plan to have at least one fruit and one vegetable as part of every meal or snack.
  • Enjoy them fresh or cooked (roasted, baked, steamed or grilled) as is or add them to your favorite dishes.
  • Add frozen, fresh or no salt added canned vegetables to:
    • soups
    • casseroles
    • sandwiches
    • breakfast egg dishes
    • meatloaf
    • vegetable stir fry
    • crock pot meals
    • tomato sauces


  • Baked on meat, fish or poultry
    • onions
    • peppers
    • mushrooms
    • apple
    • apricots
    • oranges
    • lemon
    • lime
  • Kabobs
    • fruit
    • veggies and meat, fish or poultry, grilled
  • Vegetable or fruit salsa
  • Stuffed vegetables
    • peppers
    • mushrooms
    • tomatoes
    • squashes
  • Fruit salad or smoothies
  • Fruit added to salads, gelatin or in a dessert

Hot Days and Diabetes

Diabetes can be challenging to control on a day with comfortable temperatures, but as the temperatures and humidity rise, it can be downright dangerous if the body gets dehydrated. The quick loss of fluid can increase thirst, decrease urine output, result in dark urine, dizziness, excessive sweating, muscle cramping, cool/clammy skin, nausea and vomiting headaches and rapid heartbeat. If left untreated severe dehydration causes confusion, weakness, organ failure and coma.

Those with high blood glucose (sugar) to begin with are more likely to see even higher numbers as the blood becomes more concentrated.


Drink extra non calorie, preferable decaffeinated fluids like water and non calorie flavored seltzer or water throughout the day. Avoid sweetened drinks and large amounts of caffeine! These can be more dehydrating.

Check blood glucose (sugar) numbers more often.

Avoid exercise and strenuous activity in hot weather. Do chores in the morning or later evening as temperatures cool.

Recognize the symptoms of dehydration and act quickly. Delayed treatment can difficult to treat.

Should fever, nausea and vomiting occur it is important to treat as soon as possible. Medications can be given to control symptoms. Drink small, frequent amounts of clear liquids (apple juice, regular gingerale, regular Jell-O, clear soups are all examples of fluids that replace the carbohydrates normally supplied by food)

Emergency services should be called if extreme tiredness, confusion, uncontrolled fever, nausea and vomiting can’t be controlled. Call immediately if seizures occur.


Just as the body struggles with hot temperatures, glucose meters, strips and insulin should be protected from the high heat. All products need to be stored in a cooler with an ice pack if in a hot car.

Insulin that is being used can be kept at room temperature for 28 to 42 days (depending upon the product) from when it is opened. If the location is hotter than room temperature, then instead store in a cooler or refrigerator.


Brought to you by the Diabetes Educators –

Joan Hultgren RD LDN CDE; Kelly Sinclair MS RD LDN CDE ; Marcia Sikorski RD LDN CDE


Simple Ways to Cut Calories

ways to cut calories

“Slow hands” with the salad dressing, mayonnaise and sauces:

  • 2 tablespoons of regular Ranch-type salad dressing contains close to 140 calories
  • ½ cup Alfredo sauce contains up to 300 calories
  • ½ cup of red pasta type sauce adds about 80 calories

While light versions can reduce total calories, be aware that they can still contain a lot of calories in a small portion. Measuring cups and spoons might be a helpful tool!

Be picky with your proteins!

  • -Sausages, pepperoni, hot dogs, spare ribs, bacon and bologna are all high-fat, high-protein foods and contain upwards of 300 calories for a 2 ounce serving, or about the size of a small sausage link.

Better choices to save calories would include chicken, fish, turkey, lean beef, Canadian bacon and ham. Consider too, plant proteins like kidney beans, lentils and soy based products.

Skip (slow down) the snacking!

  • -The average “snacker” puts away 300-600 calories per snack.

Typically, snack foods chosen are often high in calories, hydrogenated (bad) fats and sodium. The body will work better if given a 3-4 hour break from food. Breaks allow the stomach and the brain to signal each other better. Include them if you are truly feeling hunger or if a meal is delayed to prevent overeating at the next meal. Choose lean protein, raw vegetables, small amounts of nuts or a small piece of fruit.

Push away the pasta and rice!

  • 1 cup of cooked rice or pasta (about a cereal bowl filled halfway), without oil or sauces added sets you back up to 250 calories.

Use 100% whole grain versions to add fiber. Additionally toss in vegetables like onions, peppers, mushrooms, broccoli to increase volume and help control calories.


Shy away from shoveling your food!

  • Try the “4 bite rule

Usually, the first and last bites of food are the tastiest. Eat slowly, taking time to enjoy the texture and taste of the food. The decreased stress and improvements in brain-stomach messaging help cut total calories over time.

Sip wisely!

  • Flavored coffees can add up to over 500 calories for 24 ounces.

Start by ordering smaller sizes; consider asking for less syrup; add less cream, milk and sugar. Look for coffee and tea that is flavored without added calories.