Sunday, February 13, 2011

Diabetic Patients Need All We Can Give

It cannot be said enough, that everything that can be done must be done to prevent a diabetic patient from losing a limb. Here are some of the techniques that FAANT uses in this battle.

1. Vascular testing
With this exam, we are testing the blood flow status of the lower extremities, or the "plumbing" part of the legs. This non painful test applies pressure cuffs at different intervals to the feet and legs and gives us a picture of the amount of blood making its way to the toes. This study should be performed every one to two years to catch changes in blood flow that can occur in diabetic patients and enables us to treat this change aggressively. A dramatic loss in blood flow to the feet can lead to amputation.

2. Xray exams
Plain ol' xrays can play a significant role in protecting those diabetic feet. We are looking for changes like severe arthritis, breakdown of joints, infection, bone spurs and anything that can put your feet in jeopardy that can't be seen outside the skin.

3. Neurologic exam
Three things can be tested easily in the office: Light touch, vibration and proprioception (big word for you know where you are in space). Testing for these 3 things will give us a basic idea of what you feel and what you don't feel. And guess what...80% of the time, you don't feel what you think you do.

4. Bio-engineered tissue and grafts
When there is an ulcer, technology has given us the ability to get it healed quickly with bio-engineered tissue like Apligraf, Dermagraft and Theraskin. These products, when placed on a healthy wound, reduce the healing time dramatically.

5. Shoes, boots and stuff
To keep those feet healthy, we will often prescribe diabetic shoes with protective inserts to reduce pressure and possibility of ulcers. At times, it might be necessary to use walking boots, total contact casts, post op shoes and offloading pads to reduce pressure and save those feet.

6. Good old fashion exam
Actually examing your feet for signs of change or worsening. This is our single best tool. When we see things change, we must act to prevent further change that can lead to amputation. If a new callus pops up, we must stop it from ever forming again. Sometimes this is impossible, but there are so many things that can be done to keep that callus from becoming an ulcer. And don't think that those bunions and hammertoes goes unnoticed. They must be watched on a regular basis and sometimes surgically corrected to save those tootsies.

As we continue to strive to save more and more lower extremities, all of these things are nothing if you as a diabetic patient do not do your part. You must maintain control of your blood sugar, take your mediations as prescribed and check your feet every single day.

Wednesday, February 9, 2011

New Guidelines for Exercise in Type 2 Diabetes

New guidelines were published in late 2010 that stress the crucial role that physical activity plays in the management of Type 2 diabetes. Exercise is important and you should not let foot pain slow down your exercise program. The physicians at Foot and Ankle Associates of North Texas, in Grapevine, Texas, encourage our diabetics to exercise and can help you reach your goals with better shoe gear, functional foot orthotics and even physical therapy to get you on the road to better diabetes control! Do not use foot pain as an excuse not to exercise, contact us and get started today! The guideline are crystal clear on the importance of regular, vigorous exercise!

Developed by a panel of 9 experts, the new guidelines are published concurrently in the December issue of Medicine & Science in Sports & Exercise and Diabetes Care.

"High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently," the expert panel writes, "but it is now well established that participation in regular physical activity improves blood glucose control and can prevent or delay Type 2 diabetes mellitus, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life."

Most of the benefits of exercise are realized through acute and long-term improvements in insulin action, accomplished with both aerobic and resistance training, the experts write.

For people who already have Type 2 diabetes, the new guidelines recommend at least 150 minutes per week of moderate to vigorous aerobic exercise spread out at least 3 days during the week, with no more than 2 consecutive days between bouts of aerobic activity. These recommendations take into account the needs of those whose diabetes may limit vigorous exercise.

Sheri R. Colberg, PhD, writing chair, professor of exercise science at Old Dominion University, adjunct professor of internal medicine at Eastern Virginia Medical School, Norfolk, Virginia, and regular Diabetes In Control contributor, stated that, "Most people with Type 2 diabetes do not have sufficient aerobic capacity to undertake sustained vigorous activity for that weekly duration, and they may have orthopedic or other health limitations." "For this reason, the ADA [American Diabetes Association] and ACSM [American College of Sports Medicine] call for a regimen of moderate-to-vigorous activity and make no recommendation for a lesser amount of vigorous activity."

The panel specifically recommends that such moderate exercise correspond to approximately 40% to 60% of maximal aerobic capacity and states that for most people with Type 2 diabetes, brisk walking is a moderate-intensity exercise.

The expert panel also recommends that resistance training be part of the exercise regimen. This should be done at least twice a week -- ideally 3 times a week -- on nonconsecutive days. The panel also recommends that people just beginning to do weight training be supervised by a qualified exercise trainer "to ensure optimal benefits to blood glucose control, blood pressure, lipids, and cardiovascular risk and to minimize injury risk."

Regular use of a pedometer is also encouraged. In a meta-analysis of 8 randomized controlled trials and 18 observational studies, people who used pedometers increased their physical activity by 27% over baseline. Having a goal, such as taking 10,000 steps per day, was an important predictor of increased physical activity, according to the expert panel.

Finally, the new guidelines emphasize that exercise must be done regularly to have continued benefits and should include regular training of varying types.

Physicians should prescribe exercise, Dr. Colberg said in a statement. "Many physicians appear unwilling or cautious about prescribing exercise to individuals with Type 2 diabetes for a variety of reasons, such as excessive body weight or the presence of health-related complications. However, the majority of people with Type 2 diabetes can exercise safely, as long as certain precautions are taken. The presence of diabetes complications should not be used as an excuse to avoid participation in physical activity."

The physicians at Foot and Ankle Associates of North Texas encourage our diabetics to exercise and can help you reach your goals with better shoe gear, functional foot orthotics and even physical therapy to get you on the road to better diabetes control! Do not use foot pain as an excuse not to exercise, contact us and get started today!