Diabetic and Pressure Ulcers

How Does Diabetes Affect My Body?

Diabetes causes your blood sugar levels to be higher than normal. Over time, high blood sugar levels may cause damage to blood vessels and nerves in your body. Damage to nerves means you may have burning pain or loss of feeling in part of your body (this is called diabetic neuropathy). Damage to blood vessels in your feet means your feet may not be getting a good supply of blood.

Why do I have to worry more about my feet?

People with diabetes often have trouble with their feet. Part of the problem is that of loss of feeling in your feet makes it hard for you to tell if you have a blister or a sore. If little sores aren’t taken care of, they can get worse and turn into ulcers (serious, deep sores). If these ulcers become infected, you may have to be admitted to the hospital. In very serious cases, a foot or part of the foot may have to be amputated (removed). This section will give you some tips on how to care for your feet.

How can I avoid problems with my feet?

Keep your blood sugars as close to normal as possible. Also, follow your doctor's advice on diet, exercise and medicine. Here are some other ways to protect your feet:

• Wash your feet every day with lukewarm water and mild soap. Test the water first with your hand or elbow to be sure it is not too hot.
• Dry your feet well, especially between the toes. Use a soft towel and pat gently; don't rub.
• Keep the skin of your feet smooth by applying a cream or lanolin lotion, especially on the heels. Don’t get the cream between your toes.
• Keep your feet dry by dusting them with a non-medicated powder before putting on shoes, socks or stockings.
• Check your feet every day. Use a mirror to look at the bottoms of your feet. Call your primary care doctor at the first sign of redness, sores, blisters, swelling, pain that doesn't go away, or numbness or tingling in your foot.
• Don't treat calluses, corns or bunions without talking to your doctor first.
• Cut toenails straight across - Don’t round the corners. It might help to soak your toenails in warm water to soften them before you cut them. Have your doctor or podiatrist trim your nails if you cannot see well or cannot use the trimmer safely.
• Don't let your feet get too hot or too cold. Never use hot pads or hot water bottles.
• Never use commercial corn or callus removers, foot pads or arch supports.
• Don't go barefoot!!

Pressure Ulcers

Pressure ulcers, also called bed sores, can cause serious problems for older adults and individuals with impaired mobility. There are ways to prevent and treat this common problem.

What is a pressure ulcer and how is it caused?

A pressure ulcer is an injury to the skin and the tissue underneath it. It is simply caused by too much pressure, rubbing or friction to an area of skin. Damage can range from discolored, unbroken skin to deep wounds down to muscle or bone.

Where do pressure ulcers form?

They form where skin and underlying tissue is pressed against bone by body weight or some other form of pressure. The location depends on one’s positioning and ability to move. Persons confined to bed usually develop ulcers on the lower back below the waist, on the skin over the hip bone and on the heels. Those in wheelchairs may have ulcers form on the skin over the buttocks, elbows and shoulder blades.

How can I prevent pressure ulcers on myself or a family member?

You should examine the areas of the body that are exposed to pressure and watch for reddened skin. Protect the skin from extreme dryness or moisture by applying moisturizers to the skin to keep skin from getting too dry and using pads to absorb wetness away from the skin. Clean the skin as soon as possible after soiling from urine or stool and applying creams or ointments to protect skin from urine, stool or drainage. Other strategies include: limiting pressure over bony parts by changing position at least every one to two hours; avoiding friction by lifting instead of dragging when moving; supporting the body and preventing contact of one body part against another with pillows or wedges; using a special mattress to reduce pressure; avoiding donut-shaped cushions when sitting and eating a well-balanced diet that provides adequate protein and calories. You may need to talk with your Primary Care Provider about nutritional supplements, vitamins and minerals if eating a normal diet is not possible

What does the treatment plan include?

Treatment of pressure ulcers focuses on many of the very same activities done to prevent them: for example, reducing or eliminating pressure from the sore and adequate nutrition to promote healing. Special care for the ulcer includes cleaning the sore, removing dead tissue and applying a bandage or dressing to protect the area while it heals. Ask your nurse for specific instructions on relieving pressure, changing positions safely, and for cleaning and dressing the ulcer. Hyperbaric oxygen treatment has not been shown to be effective.

Where can I get more information about pressure ulcers?

The National Pressure Ulcer Advisory Panel, www.npuap.org, 703-464-4849

Preventing Pressure Ulcers: A Patient’s Guide (ACHR Pub 92-0048). To order, call 800-358-9295; on-line edition at www.ncbi.nim.gov/books/NBK12258/ (Verified 03/2011)

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