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Foot problems

Discussion in 'Parents of Children with Type 1' started by Artgirl, Jul 6, 2016.

  1. Artgirl

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    I have been reading up on things to consider about when travelling with a teen with diabetes. There is a lot of mention about protecting feet around pools, oceans and wearing appropriate shoes to avoid blisters etc. Can wounds and infections be that difficult to heal in young children as well? I didn't think that i would have to worry about something like this already. Have your children had problems with wounds and healing?
    Thanks
     
  2. quiltinmom

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    I think this is a problem more likely to be seen in a person whose d isn't as well controlled. The feet are the furthest away from the heart, so circulation problems will be found in the feet first (and perhaps the retinas). Plus the slower healing (caused by the decreased circulation), as you mentioned. Plus if there's nerve damage from high blood sugars, a sore may not be felt, thus the need for visual inspection.

    I hear comments about foot sores mostly when the audience is older people who have type 2 d. But type 1s should keep an eye on their feet too. At d camp they always want the kids to inspect their feet. It's just a good habit to get into, but I doubt it's a huge problem for young people with well controlled diabetes. I guess my take on it is, causally watch for anything abnormal, but it's not worth worrying about.

    Fwiw, Ds has never had a foot sore that didn't heal as expected. A couple months ago he had a plantar wart frozen and it healed just fine, perhaps even faster than I expected.
     
  3. Christopher

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    This is one of my pet peeves so I had to reply. But I will control myself and just say that there is nothing you need to do differently on this vacation in terms of her feet. Children and teens with Type 1 diabetes should absolutely go barefoot in the summer. It's one of the fun parts of the warm weather. I think a better use of your time and energy is to change what you are reading. Not sure if it was on the Internet or a book but I suggest finding a more accurate source. I hope you and your daughter enjoy the trip.

    Here are some books that might be helpful to you:

    Type 1 Diabetes: A Guide for Children, Adolescents and Young Adults -- and Their Caregivers
    by Ragnar Hanas, M.D. Published by Marlowe & Company, New York,
    http://www.amazon.com/Type-Diabetes-.../dp/1569243964


    Understanding Diabetes (aka The Pink Panther book)
    by Dr. Peter Chase of the Barbara Davis Center at the University of Colorado.
    http://www.childrensdiabetesfdn.org/publications.html

    Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin
    by Gary Scheiner, Barry Goldstein
    http://www.amazon.com/Think-Like-Pan.../dp/1569244367

    Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace
    by Betty Page Brackenridge, MS, RD, CDE & Richard R. Rubin, PhD, CDE. Published by the American Diabetes Association, 2002. 250 pages. Softcover.
    http://www.amazon.com/Sweet-Kids-Bal.../dp/1580401244
     
    Last edited: Jul 7, 2016
  4. Megnyc

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    Both the American Academy of Orthopedic Surgeons and the American Podiatric Medical Association state that no one with diabetes (regardless of age or type) should ever walk barefoot (I learned this recently from a handout I received at an endo appointment). That said, I personally ran around barefoot as a kid including for hours upon hours each week in the spring/fall all over Central Park in NYC (including leaping off rocks) which is a generally dirty place. I think you have to use your judgement but really in a recently diagnosed teenager this isn't what I would be worried about while traveling. I never wore shoes at the beach or pool as a kid and I don't now. I also never wore flip flops in the showers at sleepaway camp for 7 weeks each summer (I'm horrified thinking about that now) and I have never had athlete's foot or any sort of fungal thing.

    As a kid I never had issues with wounds healing. As an adult, I have had one ulcer type thing on the top of my foot that took ages to heal but I am not 100% sure it was due to diabetes. My A1C was 5.8 at the time. I asked my endo (well the NP) at my last appointment if I should see a podiatrist regarding that ulcer which had healed and showed her a picture and she basically laughed and said I really shouldn't be concerned about my feet at 22 and gave me the pamphlet about walking barefoot.
     
  5. Lakeman

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    I think its a good discussion to have. diabetics can both have neuropathy where they don't feel wounds as well or slow healing where wounds don't heal so well. Both happen in poorly controlled diabetes. I think going barefoot in safer situations is a good thing and walking barefoot is good for the feet. That being said it is a great idea to get into the habit of always doing a foot check after walking around barefoot and at each shower/bath. I tell my kids not to walk around barefoot in situations where it has no benefit - like at the mall while trying on shoes. My daughter was buying some sandals and wanted to walk from one department to another barefoot rather than put her shoes back on. If we break a glass in the house I clean it up and have her stay back.
     
  6. Christopher

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    The OP's child has been dx less than 8 months. She has nothing to worry about with her daughters feet.

    Yes, I agree with you that it is a good thing to be aware of in general but in this specific case I don't think it is relevant. Unless the OP has seen signs of wounds not healing properly or signs of neuropathy, which she did not mention.
     
  7. Christopher

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    This is the kind of over-generalized, blanket statement "advice" that drives me crazy. Ack.

    #freethefeet :wink:
     
    Last edited: Jul 7, 2016
  8. rgcainmd

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    My daughter spends well over half of her waking moments barefoot. I don't give this a second thought because she's not a poorly-controlled Type 2 diabetic. Period.
     
  9. Mimikins

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    When I'm at home, I'm barefoot (I am a weirdo who watches Netflix while walking around my house, so I might be walking 6-9 miles a day barefoot). When I go outside (especially in extreme hot or cold), I wear appropriate shoes. I've lost count on how many times I would quickly run outside barefoot to get the mail during a summer day and would slightly injure my feet while walking/sprinting across the hot pavement.

    I might be overly cautious about my feet. On top of my diabetes, I have a super strong family history of peripheral neuropathy (my mother, maternal grandmother, and at least one maternal uncle have it, and none of them have diabetes), so it benefits me in the long-term to adopt foot habits that will prevent ulceration early on. The only shoes that I have really given up on wearing are sandals (they offer no protection against injury and often offer no support for the amount of physical activity I do) and anything with more than an inch heel (again because I walk a ton). Typically I wear some form of a casual sneaker that covers most of my foot (I really like Sketcher's GoWalk series).

    I'm more concerned about nail salons and diabetes than walking barefoot. I have a family member who is a type 2 diabetic (and like me has fugly callused feet), and the endo recommended that he get a pedicure. Um... did the endo really recommend that he expose his feet to all sorts of bacteria and other nasties (are they reusing tools, using disposable tools, or using an autoclave? how good are their foot basins sanitized? etc.) all while increasing the chances that he has his foot cut while the calluses are removed (thus providing a perfect entry way for those little nasties into the body)? I thought most nail salons would also refuse to do a pedicure if you're diabetic (huge liability issues?).
     
  10. Christopher

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    First, a disclaimer: I have never gotten a pedicure in my life. So I may be way off base here, but how in the world would a nail salon know that a customer had diabetes???? Secondly, I don't think there would be ANY concern on the salon's part about liability issues. How a person does or does not take care of themselves after they leave the salon has no bearing on the salon itself.

    In your particular case, with a family hx of PN and you having Type 1 diabetes for 3 years, it probably makes sense, in a general way, to keep an eye on your feet (that sounded weird). But I still believe that in the specific case of the OP, she should do nothing different on this trip with her daughter than she would normally do, using common sense.
     
  11. forHisglory

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    My son had an inflamed spot on his foot (we thought splinter) at his endo appt last year. His endo is also a Type 1. With urgency I was told to get him to the pedetrician to have it examined promptly because of the diabetes. I felt like a complete and utter failure....until the ped told me it was not urgent because his diabetes was under control and the small foreign body was already encapsulated. Then, I glanced down at our discharge sheet and his diagnosis says, "Encapsulated FB, extremity. Uncontrolled Type 1 diabetes." Talk about confusing.
     
    Last edited: Jul 8, 2016
  12. Christopher

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    I think this story shows that even Endo's can have misguided thoughts about foot care and Type 1 diabetes.

    As for the discharge sheet, often times doctors will use the term "uncontrolled", I assume because the body is not controlling it? Additionally, I don't know if there is a specific definition, or set of parameters that equate to "controlled" Type 1 diabetes. Is it a certain A1c? Is it a certain percentage of time with in range bg readings? I think it would be very hard to define. There are some days when I feel like we have good "control" and she is in range more often than not. Other days when things are totally FUBAR and I would say she is "uncontrolled".
     
  13. Snowflake

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    I've seen that notation on discharge sheets when my daughter has gone in for non-T1 medical issues or procedures. During one urgent care visit, a nurse told us that notation was used for any diabetic with an A1C over 7.0. I don't know if this is a national standard, or just used by that particular hospital network.

    I HATE seeing this line on the discharge instructions. It's like a slap in the face to bring her in for something unrelated like a stomach bug or strep throat -- often after spending a couple of sleepless nights doing nothing but fight highs and lows and ketones -- and then having a computer program pass judgment on efforts that our endocrinologist is perfectly happy with.
     
  14. Christopher

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    I hear what you are saying but don't let it get to you. YOU know how hard you work to manage this disease. YOU know that you do everything you can to keep your child happy and healthy. All the rest doesn't matter. :smile:
     
  15. forHisglory

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    Snowflake, I don't think the nurse is correct. Ours always says that whether we are below 7.0 or above. It must mean because (like Christopher suggested) the pancreas doesn't function correctly. The term control is irrelevant anyhow. Sure, our children are in range one minute and in 30 min it could be a different story. People mean well, but when they ask me if our son's diabetes is under control I just smile and say, "Well, we have our ups and downs." :/

    The notation bothers me too. It should be replaced with simply Type 1 Diabetes.
     
  16. sarahspins

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    I've seen it on paperwork myself with an A1C much closer to 6..... in some ways, it's both a blessing and a curse. Good because being "uncontrolled" according to insurance records make access to some stuff much easier (like less hassle to get/keep a Dexcom). It's a curse because it's darn frustrating not to get that "validation" for your hard work.

    Control is a BS term... I really don't worry about what the paperwork says now, but it definitely used to bother me to see it.

    However, back to the OP's question, I consider my feet "normal" after almost 16 years with this... I don't treat my feet special, and I walk around barefoot all the time. If I had any neuropathy or PAD I would probably reconsider this, but currently I don't, and I don't really expect that to change in the near future. I use all kinds of things on my feet that say not to use if you have diabetes (I adore my amope pedi perfect, for example). Cuts/scrapes/etc all heal just fine for me. I have several times over the past year stubbed my toe on something with enough force to split my skin open (usually happens when I'm carrying laundry and one of my kids leaves something on the floor I wasn't expecting to be there, and it usually hurts super bad and leaves me yelling profanity and clutching my foot on the floor - just like anyone else would) and those have all "healed" within about a week with the exception of when I actually split my toenail too and that had to fall off - that took a few weeks, but the "cut" part had long since healed by that point, the nail just needed more time for the new nail to grow in before the old one fell off.

    One of my kids on the other hand, stepped on something and ended up developing a huge abscess on the bottom of her foot - it was SUPER gross, and she's not diabetic. So, sometimes stuff just happens and diabetes isn't to blame. I am sure if she did have T1 though, that would have been the FIRST thing her doctor said though :(
     
  17. rgcainmd

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    With or without diabetes, my daughter (Type 1) and myself (Type 3) make sure any salon at which we get a mani- and/or pedi- (which only happens when there is a wedding, graduation, prom, or funeral) uses clean instruments. "Sterile" (or some semblance thereof) actually only occurs in the OR.

    Same applies with body piercings (me: total of 3 ear piercings plus non-septal nose piercing), (my daughter: 4 total ear piercings, no other body piercing until she turns 16, and only allowed at Jori Zan's, a body piercing establishment where the procedures are as hygienic as they come). The same applies to tatts (me: will likely stop at the one I have; my daughter: none until she turns 18).

    That is to say that I use common sense when it comes to needles, period. Both with or without Type 1, both before and after diagnosis. No "extra" special precautions when it comes to D regarding needles and bare feet. It goes without saying that the presence of peripheral neuropathy would alter this picture.
     
  18. Artgirl

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    Thank you all for your input, some very helpful information here. A quick question, there was a mention about circulation, I find my daughter has poor circulation, hands and feet often cold. I asked her Endo and the response was that her BG control is very good and its most likely not related to Diabetes, but I find that hard to believe as she was never like this before being diagnosed with Type 1. Do you find your children have poor circulation as well? Also don't circulation issues stem fron the heart? How is this all connected to Type 1?
     
  19. Mimikins

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    Circulation issues may not necessarily stem from the heart, but instead they often go together. For example, one of the more common reasons for circulation issues (especially among older adults) is atherosclerosis, or the formation of plaques (made up of layers of fibrous connective tissue and fat) within the wall of a vessel. The condition is exacerbated by diseases like diabetes (uncontrolled diabetes can impair wound healing, and how atherosclerosis initially begins is due to damage of the tunica intima layer of a vessel), high cholesterol (particularly high LDL cholesterol), smoking (because it increases the risk of endothelial damage), high blood pressure, and family history of heart disease. What's important to remember is that if atherosclerosis is occurring in a peripheral artery, then it could also be occurring in a coronary artery (an artery that feeds the muscle cells of the heart), and if a coronary artery becomes blocked then you're in really big doo-doo (heart attack).

    Many different disease processes can cause poor circulation (atherosclerosis, Raynaud's disease and phenomenon, vasculitis, Buerger Disease, etc.). The big concern for diabetes is that poor circulation in extremities like the feet often cause impaired wound healing (the white blood cells and other cells necessarily for healing to occur cannot effectively get to where the damage is), which increases the chances of infection. High blood sugar levels can also impair wound healing and promote bacterial growth (this is why one of the symptoms of diabetes is frequent urinary tract and yeast infections). It becomes a big concern when peripheral neuropathy is also factored in (which can be caused by high blood sugar levels), because then one will be unable to feel when damage to an extremity is occurring (you could step on a rusty nail and not feel it and as a result have it penetrating your foot for days) or when a wound within that extremity is becoming infected. With poor circulation there's also the risk of necrosis within that extremity (necrosis occurs because the cells within that extremity are not getting adequate oxygen, which causes them to do a high amount of anaerobic metabolism, which then disrupts the sodium-potassium pump within the cellular membrane, it then causes sodium to not be pumped out of the cell and will increase the amount of water within the cell, which ultimately causes the cell to burst).

    My pathology professor noted that the big concern with type one diabetes is microvascular complications (complications affecting the tiny blood vessels in organs like the eyes and kidneys), while type two diabetes tends to cause more macrovascular complications (complications affecting relatively larger vessels like the peripheral and coronary arteries). I am not entirely certain of the pathology behind this, but I would assume it's because of the highly fluctuating and extreme BG levels seen in a type 1 making it super easy to damage those little vessels. With type 2 diabetes, the BG levels may be slightly elevated for longer periods (type 2 diabetes is often considered a silent disease, because you can go years with hyperglycemia without experiencing any symptoms, while that high BG can cause damage to the body), and many type 2 diabetics also experience metabolic syndrome (insulin resistance combined with high blood pressure and high cholesterol levels), which increases their chances of developing vascular diseases like atherosclerosis.

    Whew. That was a lot. I'm really happy I saved my pathology final exam study guide and my arterial insufficiency path chart. ;)
     
  20. Christopher

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    Professor Mimikins :)wink:) did a great job in her post, so I only have one thing to add. I know you are relatively newly dx and it is easy to think that every issue your child has is related to Type 1. But it's not. Oftentimes, those issues have nothing to do with Type 1. If you are worried about your daughters circulation or heart, have it checked out by a medical professional. Put your mind at ease so you can stop worrying. Life is very short and time goes by very quickly. Before you know it your daughter will be packing up for college or leaving home. Worrying just takes time away from enjoying her while she is still at home. I know it is easier said than done and I have spent way too much of the last 8 years worrying too. But it's just not worth it. Take care :smile:
     

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