Diabetes and Nutrician

Dietetics is the science of managing food and nutrition to promote health. A relatively new profession, this field has gained importance with the realisation that inappropriate eating habits can lead to many major diseases and that quality of life depends on the quality of food we eat.

Dieticians or nutritionists help to promote good health through corrective eating habits, thus improving the quality of life. They assist people in planning meals depending upon their age, sickness or work routine, counsel and educate them about healthy eating- selection and preparation of food items according to the principles of nutrition and evaluate and make changes in their clients diet periodically.

Dietitians promote nutritious eating habits through education and research, as well as through overseeing the selection and preparation of food services for many different institutions and groups. They fix nutritional regimens for patients in a hospital, athletes in physical training camps, mountaineers on an expedition and so on.

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How does diabetes affect my body

When you digest food, your body changes most of the food you eat into glucose (a form of sugar). Insulin allows this glucose to enter all the cells of your body and be used as energy. When you have diabetes, your body doesn’t make enough insulin or can’t use it properly, so the glucose builds up in your blood instead of moving into the cells. Over time, too much glucose in the blood can damage the blood vessels and nerves in your body.

Damage to your nerves means that you may have burning pain or lose feeling in a part of your body this is called diabetic neuropathy. Damage to the blood vessels that some areas of your body (usually the feet) may not be getting a good supply of blood. 

 

People who have diabetes often have trouble with their feet. The loss of feeling in your feet can make it hard for you to tell if you have a blister or 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 go to the hospital or, in very serious cases, have a foot amputated (removed). This handout will give you some tips on how to care for your feet

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Footwear Recommendations for Effective Diabetic Foot care

Welcome to M.V Hospital for Diabetes

Reduction of  pressure, or off-loading is in essential aspect of diabetic wound care.  Foot pressures, shock and shear can be reduced with appropriately fitted footwear, insoles and socks. Total non-weight bearing, which allows the wound to be at rest, is the most ideal method of relieving pressures but it is hardly practical.  It is therefore necessary that care must be taken in selecting the most appropriate footwear as any inappropriately applied device may cause additional problems like exacerbation of postural instability, acute infection, deep ulcers accompanied by additional contraindications.   

 

The guidelines for selectiong the appropriate off-loading devices are:

The ability to effectively remove all pressures from the ulcer site. Cost effectiveness,  Ease of use,    Ability to address the characteristics of the diabetic ulceration. Ability to encourage patient adherence,Treatment and Wound Mangament

The primary goal in the treatment of diabetic foot ulcers is to obtain wound closure as expeditiously as possible.  The resolution of foot ulcers and decreasing the rate of recurrence can lower the probability of lower extremity amputation in patients with diabetes.  Orthotics are custorn made devices which serve to correct misalignments and relieve pressures in the foot. Studies have estabilished the efficacy of footwear related pressure relieving  and have concluded that in-shoe orghotics are of benefit. 

 

Principles of Protective footwear

Neuropathic diabetic patients with a history of foot ulceration have abnormally high pressures under the foot.  These have to be reduced to prevent further risk and damage to the foot.  One of the possible solutions is to use Protective or Therapeutic footwear consisting of custom made inserts.  These inserts generally incorporate force redistributing features. The main characteristics of protective foot wear can be summarized as shown:

Covering	To prevent injury from heat, objects, etc.
Padding	To lessen the effect of muscle-wasting and to give a soft surface for any hard, bony projections which can be felt.
Moulding	To increase the weight-bearing area and to take weight off the affected area.
Rigidity	To reduce the effect of sheaing stress, to stabilize the foot and correct mobile deformity.

Variety of Therapeutic Footwear

Effective footwear management and getting patients with diabetes to realize the importance of well-fitting shoe gear is a crucial component in the rehabilitation process of the diabetic patient.  Ill fitting shoes stimulate lesions, often placing patients who lack foot sensation at greater risk for complications.  Research has clearly shown that podiatrists and foot-care specialists can reduce foot complications by between 45% to 75% simply by developing and implementing a comprehensive and specialized foot care regimen that employs appropriate footwear as a critical component.

While discussing footwear selection, the podiatrists and foot-care specialists can reduce foot-care specialist should rely on the patients risk level to determine the allowable range of footwear. The patient with a high risk foot, as evidenced by a prior ulcer or amputation, Peirpheral Vascular Disease, insensitivity with structural deformity or Charcot foot, should be prescribed either custom moulded or extra depth footwear with tri-layered total contact insoles. Internal and external modifications may be added depending on bionechanics and pressure reduction needs.

 Patients at moderate risk, such as those with neuropathy or PVD without significant structural deformity, have to be given a pair of properly fitting footwear with soft soles, soft uppers and appropriate insoles.

Those at low risk without neuropathy of PVD may be prescribed a wider range of footwear which can be classified as general purpose comfort footwear but they should be re-evaluated every six months to keep track of any changes.

 

             

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