Author Archive for Pat F. Bass III, MD, MS, MPH – Page 2

Hemoglobin A1c Levels

Hemoglobin A1c Levels

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What You Need To Know About Your Hemoglobin A1c Levels

  • Your hemoglobin A1c levels measure your average blood sugar over the last 2 to 3 months.
  • Hemoglobin A1c levels give you an idea of how your diabetes control is doing overall.

What You Need To Do About Your Hemoglobin A1c Levels

  • You need to check your hemoglobin A1c level at least twice a year, and more frequently if your blood sugar is poorly controlled.
  • Talk with your doctor about your hemoglobin A1c goal, but most will want a level of 7% or less.

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What Do My Hemoglobin A1c Levels Mean?

Your hemoglobin A1c level gives you an idea of how well your blood sugar has been controlled over the last several months. This test lets you know if your diabetes plan is working or not.

Hemoglobin A1c levels are a reliable method of assessing how well your blood sugar has been controlled. Elevated levels over long periods of time are associated with the long-term complications of diabetes. After reviewing your hemoglobin A1c levels,  your doctor will recommend changes in your treatment plan or tell you that your diabetes plan seem to be going well.

How Does the Hemoglobin A1c Test Work?

When you have excess blood sugar in your bloodstream it binds with hemoglobin or glycates. The more excess blood sugar the more hemoglobin gets glycated. As a result, the higher your hemoglobin A1c the more poorly controlled your diabetes.

Because the average hemoglobin cell lives for 120 days, your hemoglobin A1c level can reflect your blood glucose control over that time.

In a person without diabetes, the hemoglobin A1c level is about 5%. According to new standards, diabetes can be diagnosed when the hemoglobin A1c level reaches 6.5%.

How Often Should I Have My Hemoglobin A1c Level Checked?

Your doctor will likely check your hemoglobin A1c level either as a screening test or when you are first diagnosed with diabetes. If your diabetes is under good control, you should have a hemoglobin A1c level checked at least every six months. If your diabetes plan is not achieving optimal control, your doctor may check your hemoglobin A1c level more often.

Are There Any Limitations For Hemoglobin A1c Levels?

Some patients have other medical conditions that limit the use of hemoglobin A1c levels in monitoring their diabetes. The hemoglobin A1c level is unreliable in patients with sickle cell disease or sickle cell trait.

In these patients hemoglobin is slightly different and the tests to measure glycated hemoglobin overestimate the actual blood glucose over the last three months. Alternatively the fructosamine test can be use to measure diabetic control.

Estimated Average Glucose And Hemoglobin A1c Levels

Can I convert hemoglobin A1c levels to an average glucose? Hemoglobin A1c levels can be converted to an estimated average glucose or eAG result. The eAG is more familiar to patients who are testing regularly at home.

For example, a hemoglobin A1c level of 10% converts to an eAG of 240 mg/dL while a hemoglobin A-1 C level of 6% converts to an eAG of 126 mg/dL. The chart below converts hemoglobin A1c levels to eAG.

HbA1c eAG
% mg/dl mm/l
5 97 5.4
5.5 111 6.2
6 126 7.0
6.5 140 7.8
7 154 8.6
7.5 169 9.4
8 183 10.1
8.5 197 10.9
9 212 11.8
9.5 226 12.6
10 240 13.4
10.5 255 14.1
11 269 14.9
11.5 283 15.7
12 298 16.5

You can also use the following formula to calculate your eAG:

28.7 X A1C – 46.7 = eAG

Sources:

Nathan MD, David M; Kuenen MD, Judith; Borg MD, Rikke; Zheng PHD, Hui; Schoenfeld PHD, David; Heine MD, Robert J for the A1c-Derived Average Glucose (ADAG) Study Group. “Translating the A1c Assay Into Estimated Average Glucose Values.” Diabetes Care Aug 2008 31(8):1473-1478.

A1C. American Diabetes Association. Accessed: April 22, 2013. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c

A1c and the eAG. Lab Tests Online. Accessed: April 2, 2013. http://www.labtestsonline.org/understanding/analytes/a1c/test.html

If You Have Diabetes, Know Your Blood Sugar Numbers! National Diabetes Education Program. National Institute of Health. Accessed: April 22, 2013. http://www.ndep.nih.gov/diabetes/pubs/KnowNumbers_Eng.pdf

Would You Have Bariatric Surgery For Your Diabetes?

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What You Need To Know- Diabetes Bariatric Surgery

  • Studies have demonstrated weight loss, improved glucose levels, and remission of diabetes in some patients.
  • Most studies have only looked at 2 years of postoperative data.

What You Need To Do- Diabetes Bariatric Surgery

  • Talk with your doctor to determine if you might be a good candidate for diabetes bariatric surgery.
  • Ask your doctor about the risks and benefits of surgical versus non-surgical treatment.

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Would you have bariatric surgery if it might improve or cure  your diabetes? More and more people are asking there insurance companies to do just that with more than 120,000 bariatric surgical cases per year in the U.S.

Diabetes Bariatric Surgery Questions

What sort of questions would you want to ask before undergoing diabetes bariatric surgery? This is a list of question you might want to discuss with your doctor before considering diabetes bariatric surgery:

  • How much weight might I be able to lose?
  • How long will it take me to lose weight?
  • What sort of changes will I need to make before surgery?
  • What will I be able to eat post-operatively.

What Is Diabetes Bariatric Surgery?

“Bariatric surgery” or weight loss surgery can help you lose weight. In general this is accomplished by making your stomach smaller. Other types of diabetes baraiatric surgery alter how your body absorbs food. No matter which type of surgery, decreased caloric intake will lead to weight loss.

What Are The Types Diabetes Bariatric Surgery?

There are several different types of weight loss surgery. The most common is the ‘gastric band’ where a band is placed around part of the stomach creating a small pouch. Your doctor can adjust the size of your stomach. This is the simplest weight loss surgery and involves the least amount of cutting, but is also associated with the least amount of weight loss.

In the gastric bypass procedure part of the stomach is removed to make a small pouch. This procedure is associated with the most weight loss, but can also cause some nutritional problems as your body may not absorb some nutrients as well after the operation.

A sleeve gastrectomy is a different surgical procedure, but is less likely to cause any of the complications associated with gastric bypass.

Diabetes Bariatric Surgery- Results

Bariatric surgery has demonstrated weight loss and improved diabetic control in patients in studies from 2 – 5 years following surgery.

In one study presented at the 29th Annual Meeting of the American Society for Metabolic and Bariatric Surgery, 67% of gastric bypass patients were in complete remission of their diabetes in the year following gastric bypass surgery. If patients were not on insulin and did not have reduced pancreatic function, the success rate jumped to 96%.  Many patients were off their diabetic medications within a couple of weeks.

In a Cleveland Clinic study, investigators compared gastric bypass, gastric sleeve, and intensive medical therapies and saw remission of diabetes in 42%, 37%, and 12%, respectively. Cleveland Clinic called bariatric surgery one of the “top medical innovations for 2013” and stated in the press release that “many diabetes experts now believe that weight-loss surgery should be offered much earlier as a reasonable treatment option for patients with poorly controlled diabetes —and not as a last resort.”

On the other hand, other scientists question whether or not bariatric surgery is as effective for diabetes. Investigators looked more than 4,000 patients with diabetes who underwent diabetes bariatric surgery, While 68% had a complete remission initially, more than one third of these patients ultimately redeveloped diabetes. Poor diabetic control before surgery, need for insulin before surgery, and longer time with diabetes were all predictors of redevelopment of diabetes.

 Diabetes Bariatric Surgery- Side Effects

Diabetes bariatric surgery is not without risk. While the surgery is generally associated with less than a 1% mortality rate, age greater than 65, BMI > 50, and more chronic medical problems increased the mortality rate. Additionally, when these procedures are preformed by surgeons and hospitals who do more than 100 cases per year, mortality was also lower. Additional potential complications include:

  • Bleeding
  • Wound infections
  • Blood clots
  • Heart and lung problems
  • Tears in your intestines causing leaks

 Diabetes Bariatric Surgery- What Would You Do

So what would you do? While some of the results seem impressive, there are real risks and a fair number of people ultimately redevelop diabetes. Please leave a rsponse- I would love to hear why you would or would not have diabetes bariatric surgery. Do you have other thoughts or concerns?

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Sources

1. Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. N Engl J Med 2012; 366:1567-1576

2. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obesity Surgery 2013; 23(1):93-102.

3. Top medical innovations for 2013- Cleveland Clinic

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Diabetes Problems and Question

How are you? I hope you are doing well!

I need you to answer one question for me:

Is there anything you want me to write a blog post about? Do you have a diabetes questions or problems you would like me to address on the website?

To be honest, a lot of the content on my blog comes directly from people asking me questions or emails I’ve recieved asking me to cover a certain topic.

Why?

Because you asked for them! The way I see it, there’s no point in writing for me. I should do all in my power to write for you. I want to focus my writing on your questions and diabetes problems.

Anyways – I’d love to hear your suggestions. I’ll do my best to answer as many questions in actual blog posts as I can, or maybe even in a video. I may not be able to get to all of them, but I’ll do my best.

What Everybody Ought To Know About Prediabetes

Prediabetes is an important medical condition because you are at higher risk for heart attacks and stroke. More importantly, if you take the steps outlined in this video, you may be able to prevent diabetes.  Learn what you need to know and do to take care of prediabetes.

What Is the Definition of Acanthosis Nigricans?

A brown to black hyperpigmentation of the skin. Acanthosis is commonly seen in skin folds such as under the arms or in the back of the neck.

Acantosis nigricans is commonly seen in obesity and can also mean that you have insulin resistance. Acanthosis nigricans may improve when insulin resistance improves.

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Do You Recognize These 11 Early Warning Signs of Borderline Diabetes?

What You Need To Know- Borderline Diabetes

  • Diabetes does not just develop overnight.
  • Borderline diabetes may have no symptoms at all, or you may experience 1 or more of the symptoms described below.
  • You can prevent diabetes if you identify borderline diabetes early.

What You Need To Do- Borderline Diabetes

  • If you have any of the symptoms described below then get checked out by your health care provider.
  • If you are in a high risk group than you also should be screen for prediabetes, even if you do not have symptoms.

I was stopped at a local function recently and the person I was speaking to told me she was recently diagnosed with borderline diabetes. My acquaintance was very concerned because she read and heard about many of the complications of diabetes; and she wanted to know what this meant for her.

She asked me things like “do I need to check my blood sugar all the time now,” “do I need to eat differently,” and “am I going to have to start taking medications?” While I discuss the answers to many of these particular questions in a previous post, I am always struck, in this day of the news coverage of obesity and the diabetes epidemic, how many people have not heard of borderline diabetes and its complications.

What Is Borderline Diabetes?

Actually, there is no medical diagnosis called “borderline diabetes.” Rather, borderline diabetes refers to a medical condition called prediabetes. This is when your blood glucose levels are higher than normal but not yet high enough to be diagnosed with type II diabetes. People with borderline diabetes or prediabetes are more likely to develop type II diabetes and may already have some of the signs or symptoms of diabetes.

Many times patients with borderline diabetes (prediabetes) will not have any signs or symptoms. The following signs and symptoms indicate you may have borderline diabetes (prediabetes) that you should get checked out:

1. Increased urination and  thirst. As your blood sugar rises your kidneys become overwhelmed and you begin to pass sugar in your urine. Your body takes fluid from normal tissues to help excrete the blood sugar from the body. This causes you to urinate more frequently and can lead to dehydration, and subsequently make you thirsty. As you drink more fluid you then subsequently will urinate more.

2. Hunger. With borderline diabetes (prediabetes) your body begins to become resistant to insulin. You become more hungry because sugar is not able to enter cells. This can also lead to hunger even after just eating.

 3. Dry mouth. This results primarily because increased urination and dehydration that result from elevated blood sugar levels as described above.

4. Tiredness. Fatigue in borderline diabetes (prediabetes) can be from a number of different causes. When your blood sugar is elevated your body is just not working properly. You do not use sugar appropriately, and a constant state of dehydration both contribute to the tiredness many borderline diabetics feal.

 5. Visual changes. Elevated blood sugar causes changes in the eye that can make it more difficult to see. In general, the lenses of the eye can become distorted and stiff- making it more difficult to focus. Over the long term there are a number of different complications to the high if diabetes is not well controlled.

 6. Itching. Dry itchy skin is not uncommon in patients with elevated blood sugars. Additionally, itching is common in the genital areas and lower legs. This is often due to dry skin that results from the previously mentioned dehydrated state that occurs in borderline diabetes (prediabetes).

 7. Weight changes. Significant weight changes are more common in type I compared to type II diabetics. However, if you have lost weight or if you feel hungry all the time you should let your doctor know and get tested for borderline diabetes (prediabetes).

 8. Rash. Acanthosis nigricans is a brown to black hyper pigmentation of the skin. This is a benign condition that is commonly seen in obese patients that have insulin resistance. When your blood sugar gets under better control the rash may improve.

 9. Numbness in the hands and feet. High blood sugar levels over long periods of time can damage your nervous system. This can result in decrease in sensation and feelings of numbness and tingling in the hands and feet. This is also known as neuropathy. Decreased sensation in the feet can also contribute to frequent injury and development of diabetic foot ulcers.

10. Poor healing. A number of different factors contribute to poor wound healing in patients with elevated blood sugars. These range from decreased immune response to decreased function of the actual cells that heal the body. If you frequently have wounds that scene to take a long time to heal you need to be checked for borderline diabetes (prediabetes).

11. Sexual dysfunction. While some sexual dysfunction is common in increases as you get older, sexual dysfunction is more common with elevated blood sugars. This is generally not a symptom of borderline diabetes (prediabetes) because the high blood sugar sugar levels leading to nervous and cardiovascular changes generally take many years to develop. However, elevated blood sugar levels can lead to dryness in the genital area making sex uncomfortable.

What Do I Do If I Have Symptoms of Borderline Diabetes (Prediabetes)?

If you’re experiencing any of the signs of borderline diabetes (prediabetes), let your healthcare provider know.

 There are many things that you can do if you have borderline diabetes so that you can prevent diabetes in the long-term.

Sources:

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What Is Diabetes?

What Is Diabetes

You or a loved one may have recently been diagnosed, but can you really answer the question “What Is Diabetes?”

In general, diabetes is your body’s inability to naturally store and use glucose, the body’s main fuel, appropriately. As a result the sugar level in your blood increases. This condition is also referred to as diabetes mellitus.

What Is Diabetes- Glucose And Insulin

Most food contain sugar or glucose that is released into the blood stream as part of digestion when we eat. Once glucose is in the blood stream a hormone called insulin helps glucose go into different organs that need it. The insulin is produced in an organ called the pancreas.

There are 2 main types of diabetes- type 1 diabetes and type 2 diabetes. Type 1 is most commonly diagnosed in childhood, while type 2 is diagnosed in later life. In type 2 diabetes, your pancreas produces insulin, but the organs do not respond to it. Type 2 diabeteics are often called insulin resistant. In type 1 diabetics, the pancreas does not produce insulin.

What Is Diabetes- Who Will Take Care Of My Diabetes?

If you have not before, you will now see several different types of health care providers. Your diabetes team could include several of the following:

Physician– your diabetes doctor may be a primary care physician or it might be a specialist called an endocrinologist.

Diabetes nurse or diabetes educator– this healthcare professional teaches you how to better manage your diabetes. Your diabetes educator will help you develop a plan based on all the different things that your other health care professionals reccomend. For example, your doctor may reccomend that you begin an insulin treatment regimen. Your diabeteic educator will make sure that you know and understand all of the different steps to do this.

Dietician- a dietician will help you plan healthy eating habits to help get your diabetes under good control. Your dietician can also help you plan for eating out and times where sticking toyour special diet may be hard- like holidays.

Pharmacist- you are likely on at least one new medicine since being diagnosed with diabetes. Your local pharmacist can help you make sure that your diabetes medication do not interact with any medications given to you by other doctors.

Counselor A new diabetes diagnosis can be really hard on you or yuor family. Sometimes an experienced counselor to help with mental health issues is needed.

What Is Diabetes- Will I Need Medication

This will depend on which type of diabetes you have ben diagnosed with, but probably yes.

Anyone with type 1 diabetes will need to take insulin everyday. If you are diagnosed with type 2 diabetes than your doctor may give you a trial of diet and exercise. If you have symptoms of diabetes, your doctoe will probably start you on medication

What Is Diabetes- Will I Need Tests?

Yes. Whether you have type 1 or type 2 diabetes you are going to have to monitor your blood sugar. Depending on how recently you have been diagnosed, your doctor will liekly ask you to test your blood sugar anywhere from 1 to 4 times per day. Type 2 diabeteics generally test less often than type 1s. You use a blood glucose meter to do this.

Your doctor will also get a test to see how well your blood sugar has been controlled over the last several months. This test is called hemoglobin A1C or HbA1c.

No matter what type of diabetes you have, you will see a bunch of different doctors and ger a bunch of different tests. We are here to try to help make that journey easier.

Sources:

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). Accessed February 8, 2013. Diabetes Overview

How Prediabetes Is Different From Diabetes

How Prediabetes Is Different From Diabetes

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What You Need To Know & Do About Pre Diabetes

What You Need To Know About Pre Diabetes

  • Your blood sugar is too igh, but not yet high enough to cal diabetes..
  • You will not have symptoms, so you need to be tested..

What You Need To Do About Pre Diabetes

  • Losing weight (10% of your current body weight) is the best treatment.
  • Your doctor may prescribe medication.

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If you have prediabetes you are not alone. More than 41 million American also have prediabetes. In prediabetes your blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. In prediabetes, your body does not respond to insulin as it should. With prediabetes you are at an increased risk for developing diabetes in the next 10 years. Your doctor may also refer to prediabetes as impaired fasting glucose., or impaired glucose tolerance

How Is Prediabetes Diagnosed?
Basically, your blood sugar is higher than normal, but not yet elevated enough to make a diagnosis of diabetes.

A normal fasting blood glucose is 100 mg/dl. In prediabetes your blood sugar is between 100 and 125 mg/dl. Once your blood glucose is 126 mg/dl or above, you have a diagnosis of diabetes. Alternatively, your doctor may perform an oral dose tolerance test to diagnose prediabetes. Most people with prediabetes do not have symptoms of diabetes. Some patients with prediabetes have patches of dark skin on the back of the neck called acanthosis nigricans.

Should I Be Tested For Prediabetes?
You should be tested for prediabetes if you:

  • Are obese or overweight
  • Have a sedentary lifestyle
  • Have high blood pressure
  • Increased cholesterol
  • Have a close family member with diabetes
  • Have a history of gestational diabetes
  • Are in an ethnic group (African American, Hispanic, American Indian) with an increased risk for diabetes

Why Is Making a Diagnosis of Prediabetes Important?
Because you are at an increased risk for developing diabetes in the future, it is important to know if you have prediabetes. Even in prediabetes you have an increased risk of developing heart disease compare to someone without prediabetes.

What Is the Treatment For Prediabetes?
You can do something about prediabetes. Just because you have prediabetes does not mean you will automatically develop diabetes. Improving your lifestyle will decrease your risk and improve how your body uses insulin to lower your blood sugar. It is recommended that you:

  • Lose 5-10% of your body weight
  • Be physically active for 30 or more minutes most days of the week
  • Quit smoking
  • Get more Fiber
  • Decrease fast food
  • Eat more fruits and vegetables

Your doctor also may start you on a treatment such as metformin.

More Info

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Have You Gotten Your Flu Shot?

I have never understood it, but I see many people who choose not to get flu shots despite knowing better.

Patients will tell me “I never get sick from the flu.” I will then tell them that past wellness is not necessarily indicative of future wellness and that the benefits for flu prevention significantly outweigh the risks. It is also still relatively common for people to to say “the flu shot gave me the flu.” While this is not technically possible for the flu injection, some patients do experience a low grade fever and achiness. Significant side effects from the flu shot are exceedingly rare. Finally, some patients just say, “I’ll get treated if I develop symptoms.”

What do you think about the flu shot? Do you have any other reasons for not wanting to get the flu shot? Do you have any words of encouragement for others not wanting to get the flu shot?

Take Action- Talk with your health care provider about the flu shot– it could be one of the best things you do for your health this year..

Learn More

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Diabetic Foot Care- 11 Tips To Improve Your Diabetic Foot Care

Incorporating These Diabetic Foot Care Tips Will Prevent Complications

Diabetic foot care is very important because you are more likely to have foot problems because you have diabetes. Diabetes damages the nerves and makes it less likely that you will feel pain. As a result, you are more likely to injure your foot or not notice a problem until the foot has been damaged.When your doctor does a foot evaluation as part of your diabetic foot care they will look for signs of:

  • poor circulation
  • nerve damage (decreased sensation of the foot)
  • skin changes
  • deformities of the foot and toes

 

Specific Diabetic Foot Care Tips

These 11 tips will help you improve your diabetic foot care:

Piede diabetico1. Check Your Feet Daily. Because diabetes decreases sensitivity in your feet, you may not realize that you have an ulcer or abrasion. Make sure you examine all aspects of your foot-  start on top and then look at the  sides, soles, heels, and between the toes. Make checking your feet part of your daily diabetic foot care plan.

2. Don’t Go Barefoot. One of the easiest diabetic foot care tips is to avoid going barefoot, even indoors. Because you may have poor vision and decreased sensation in your feet, you are at greater risk of injury. It is very easy to stub your toe or step on something and cut your foot.

Wearing shoes all the time will protect your feet from developing a diabetic foot problem. Make sure your shoes do not have any rough edges that could cause irritation and also wear socks for extra protection. Wear comfortable fitting shoes that are not tight on your feet. Make sure you choose shoes that are made of a breathable material such as leather or canvas. Finally, changing shoes or taking them off after several hours decrease pressure and chances of developing an ulcer.

3. Watch For Calluses. If you have calluses or corns, talk with your doctor about appropriate diabetic foot care. Do not just take a file or treat the corn yourself.

Diabetic Foot Care- Calluses

Diabetic Foot Care- Calluses

4. Wash Your Feet Daily. Using a mild soap and lukewarm water, you should wash your feet daily. Hot water and strong soaps can damage your foot. Drying your feet is also an important part of your routine diabetic foot care. If you don not dry well, you may develop infections in moist areas like between your toes. If your feet are dry and cracked, use lotion to moisturize your feet, but avoid any areas of cracked skin.

5. Get An Annual Foot Exam. The final piece of your diabetic foot care plan is to get a yearly exam by your doctor. During this exam your doctor will test to see if you have lost any sensation and look for any problems.

6. Quit Smoking. Smoking increases your risk of heart attack and stroke as well as lead to vascular problems that result in decreased blood flow.

7. Ask For Foot Exams. Your foot exam is am important part of your diabetic plan. This exam should be part of your regular healthcare visits, but can sometimes get left out, especially if you have a number of medical problems. You should have a diabetic foot care visit at least once per year- more often if you have any complaints or problems with your feet.

Diabetic Foot Care- Wear Shoes

Diabetic Foot Care- Wear Shoes

8. Choose Shoes and Socks Wisely. Shoes should be comfortable, not too tight or too loose, and broken in slowly to prevent blisters. Your diabetic foot care plan should always include socks- cotton and loose fitting. Certain patients may also benefit from specialized, custom shoes. Patients with abnormally shaped feet or those with ulcers are most likely to benefit. Additionally, special insoles can decrease pressure on the soles and bottom of the feet.

9. Protect Your Feet From Temperature Extremes. Never walk barefoot- whether at the beach or in the mountains. Before putting your feet in water make sure you test the temperature, much like you would do when bathing a baby. Do not use heating pads, electric blankets, or hot water bottles as you can quickly burn your feet.

10. Keep Your Circulation Going. Wiggling your toes increases blood flow to the feet. Doing this several times per day while flexing your ankle back and forth keeps blood flowing to your foot/ ankle area. You can also sit with your legs straight and make circles with your feet to promote blood flow in the foot/ ankle area. Ask your significant other for or treat yourself to a foot massage- his also increases blood flow to your feet. Additionally you want to avoid crossing your legs as this decrease blood flow to the heart.

11. Use Foot Cream. This will help keep your feet soft and smooth. Cracks on the skin increase your risk for infection. If you have a cut or skin damage, make sure you get treatment right away.

Source

NIDDK. Prevent diabetes problems: Keep your feet and skin healthy. Accessed January 30, 2013.

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