Diabetes ABCs

Diabetes ABCs: W

Wound Care
By Eileen B. Wyner, NP
Bulfinch Medical Group


Wound care refers to the treatment of chronic skin irritations that can be common and chronic in people with poorly controlled diabetes. Chronic skin breakdown or ulcers may occur for many reasons:  trauma; blisters, corns or bunions caused by poorly fitting shoes. Treatment of these lesions requires specialized care by specifically trained personnel such as podiatrists, surgeons, and certified wound nurse specialists who work in conjunction with the patient to ensure good healing.

Diabetes ABCs

Diabetes ABCs: U

Ulcer (foot)


A foot ulcer is a deep open wound, usually on the bottom of the foot that can be  slow or difficult to heal.  If you’ve lost feeling in your feet from neuropathy you might not feel it if you have a cut or blister.  Continuing to walk on even a minor injury can irritate the skin, causing it to break down and develop into an ulcer.  This is a serious condition and immediate medical care is required to prevent the spread of infection.  The good news is by taking good care of your feet you can prevent foot ulcers from developing in the first place.  Check your feet every day for blisters, cuts and sores and call your health care provider if you notice anything that isn’t healing right.  Always wear comfortable, well-fitting shoes and avoid going barefoot.

(Content reviewed by MGH Diabetes Center)

(Summer) Safety First

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen W

Summer has arrived in a fashion that will be hard to forget. That’s what life in New England is all about:  blink and the weather will change.  I really love summer, weather and all. It’s a time where I slow down the daily pace, enjoy the long hours of daylight, and remember being a kid where my only responsibility was reading the 7 books required from the Boston Latin School Summer Reading List. Well, adulthood has a few more responsibilities and I want to give you some pointers that will hopefully keep this summer healthy and happy for you and yours. 

 Managing your Diabetes can get a little tricky with the advent of heat and humidity, so a little pre-planning can help ensure you’re able to enjoy this magical season completely.  Remember, extreme heat can lead to heat exhaustion and heat stroke, both of which can be serious medical conditions requiring urgent medical attention.  Symptoms of heat exhaustion include dizziness, extreme sweating, muscle cramps, and clammy skin. This is best treated with cool fluids in a cool location and close monitoring of your glucose levels. Heat stroke is much more serious and characterized by a dangerous rise in your body temperature along with decreased ability to perspire. This potentially life threatening condition always requires urgent medical attention. 

  • It’s so important to stay well hydrated. The best choices are water and sugar free liquids.  Caffeinated beverages can actually cause dehydration so drink those sparingly. It’s also a good idea to use caution when drinking alcohol. Small amounts of diluted sports drink may be necessary if you’re exercising in the heat. It’s best to develop a plan with your health care provider to determine if you need additional fluids.
  • Exercise is important to maintain all year round, but extra caution is required with the heat, humidity, and bright sun. Outdoor exercise is best done before and after the high sun and heat of the day. However, with very hot temperatures and elevated heat indexes, outdoor exercise may need to be postponed. Indoor activity should be done in air conditioned facilities.  If you don’t have access to a gym you can try walking around the mall, or up and down all of the aisles of the store while doing your food shopping.
  • The sun isn’t always your friend. ALWAYS wear sunscreen during any outside activity, not just when you’re at the beach. The sun’s rays are strong and present, even when the sky is hazy, and you have to protect your skin. It’s also important to use the sunscreen correctly. Dermatologists recommend using a shot glass worth of lotion for the whole body. Reapplication is needed every 3 hours or so, especially after swimming or sweating. Another way to help to protect you from the sun and heat is to wear a wide brimmed hat and light colored, light weight loose clothes that will help to deflect the sun.
  • Your blood sugar control may be affected by the heat. Your appetite may fall off or you may be eating those special treats of summer: corn on the cob, potato salad, and lots of berries. All these things are fine in moderation, but may make your blood sugars a little erratic. You also have to be really careful about your supplies and medications. Your glucometer, test strips, oral medications, and insulin are all extremely heat and sunlight sensitive. Prolonged exposure to extremes of weather will cause malfunction and possible inactivation of your medications. This could be life threatening. Always store these things in moderate temperatures and use a well insulated gel pack for travel or any weather related storage. NEVER use a freeze pack for your insulin: it will freeze, not cool, your insulin and it will be deactivated.
  • NO bare feet. EVER. Good foot care is always in season. Always wear socks when doing heavy exercise, walking, and hiking as they will help to absorb moisture and protect the skin from breaking down. Change your socks frequently if they get too sweaty and always make sure your shoes fit well. Wear closed toe shoes with outdoor work like lawn mowing or painting to provide extra protection in the event of an accident. I ask all my patients, regardless of their medical conditions, to always wear water shoes or beach shoes when at the beach, in the ocean, and even poolside. It is very common to get a cut or abrasion from debris in the water or on the shoreline and this could be very serious for anyone, and especially so for people with Diabetes.  Avoid flip flops as the rubber piece that separates the toes can cause friction and lead to skin breakdown.

I hope that this list will help you and your families have a wonderful summer.  Now if you’ll excuse me, I have to go and start working on my self-appointed summer reading list.  Happy summer to all!



Caring for Your Built-in Transport System

By Eileen B. Wyner, NP
Bulfinch Medical Group

I was just wondering…how many times a day do you think abEileen Wout your feet?  I’m willing to guess that you don’t think about our built-in transport system much at all. Our feet carry us around every day and it’s easy to take them for granted. Sometimes we’re good to them and wear comfortable sneakers; other times we force them into pointy high heels because they look so stylish. A person living with Diabetes needs to be more attentive to our natural transportation and so I’d like to share some points about foot care.

Diabetes can lead to many different types of foot complications including calluses, fungal infections and poorly healing ulcers that can lead to bacterial infections and amputation—these conditions can happen as a long term complication of Diabetes and may be more severe if blood sugars aren’t well controlled.   Neuropathy, a frequent complication for people living with Diabetes, occurs when blood sugars are poorly controlled over time and there is damage to the nerve fibers. Symptoms of neuropathy can include the sensation of tingling in the feet, decreased sensation to temperature and altered sensation to pain.  Peripheral vascular disease or PVD occurs when there is damage to the lower extremity blood vessels, while poor circulation can cause pain and contributes to poorly healing injuries. Both of these conditions may not be completely preventable but they are manageable and your self-care is an important part of this. You may want to see a vascular specialist if your symptoms are severe, and it’s very important to stop smoking if you are currently.

There are many steps that you can take to keep your feet healthy. It’s very important to self examine your feet each time you get out of the shower or bath. You may not feel things as you did in the past and you may have an injury to your foot that you didn’t feel when it happened.  Doing a self exam, you can see the injury and begin to take care of it. Check for signs of ingrown toenails, blisters, and calluses. Seek medical attention for any suspicious injuries and see a podiatrist twice a year for a full foot exam (they can also assist in caring for complications). If you are cutting your own toenails it’s important not to cut them too closely to the toe to avoid ingrown nails. Also, it’s best not to file the heels or calluses on your own as it’s easy to get abrasions that can lead to infection.  Keep your skin moist by using a skin cream on the foot (but not between the toes).  It’s fine to get pedicures, but there are a few “rules”:

  1. Avoid pedicures if you have poorly controlled blood sugars.
  2. If there is any question about how clean the salon is, DON’T GO THERE.
  3. Bring your own cuticle tools to any pedicure and manicure and clean them well yourself.
  4. Tell the technician that you have Diabetes and do not want your nails and cuticles cut too short.
  5. Do NOT have any calluses or corns filed down. See the podiatrist for this.

Another important step in keeping your feet healthy is keeping your blood sugars and A1C in good control. This will decrease the risk of infection and may help to improve pain of neuropathy.  Review your medications and diet with your healthcare team if you are having problems keeping up with either.  Be sure your shoes fit very well to avoid any blisters, ingrown toenails, or pain. Shoes and boots for the bad weather are equally as important to ensure sure your feet stay dry, especially inNew England snowy winters and rainy springs.

I always get the funniest looks when I talk to my patients about going barefoot.  People tell me they have carpet at home or only walk on the grass. I visibly cringe at that point. Tiny little particles in carpet, grass, beach sand and the ocean are all potential culprits for injury that can cause serious infections.  Remember, you may have decreased sensation in your feet so the splinter that would have made you howl 5 years ago can go undetected until a more serious problem presents itself. At the very least, socks with treads are essential for around the house, and beach shoes are a must for the beach and pools both indoor and out.

So tonight, take off your shoes, wiggle your toes and think of all the ways you can show appreciation for your built in transportation system. Give yourself a foot massage, prop them up on the couch, and treat yourself to reruns of Everybody Loves Raymond.  And tomorrow, set up an appointment with the podiatrist. Your feet will smile.