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In general, weight loss can be achieved using a balanced diet that neither avoids nor focuses heavily on one food group. Puede disfrutar de sus comidas mientras hace pequenos ajustes a las cantidades de alimentos en su plato. Daily foot care is essential to the self-management of diabetes, and pharmacists can recommend OTC products and techniques to prevent and treat infections. Pharmacists can have a significant impact on increasing awareness and educating patients with diabetes on the importance of routine foot care and screenings. There are a host of OTC dermatological products formulated for foot care to meet the specific needs of patients with diabetes.
As one of the most accessible health care professionals, the pharmacist can improve the quality of life of patients with diabetes by counseling them on foot care. The Michigan Podiatric Medical Association and Oakland Regional Hospital have joined to host a FREE health expo with special guest the American Diabetes Association to educate the public on the signs, causes, treatments and general information on diabetes.
Event details may change at any time, always check with the event organizer when planning to attend this event or purchase tickets. We're generating custom event recommendations for you based on DIABETES HEALTH EXPO right now! Pressures (bedsores), insect bites, immobility or trauma can also cause non-healing wounds. Typically, a wound that does not respond to normal medical care within 30 days is considered a chronic wound.
Medically advanced treatments at the Wound Care Program include debridement, dressing selection, special shoes, and patient education. The Wound Care Program is designed to complement the physician’s services and is committed to the treatment of chronic or non-healing wounds. Patients must make an appointment and are typically referred by their primary care physician. A customized treatment plan is developed for the therapies best suited to address the patient’s needs. After a treatment plan has been initiated, you will visit the hospital on a regular basis for specialized treatments and documentation of the progress of your healing. Please contact a member of our staff with any other questions you may have regarding your therapy.
Wound CareLibrary For more information about wounds, including care and treatment, download the brochures (PDF) below.
When you need to find a doctor for yourself or your family, our FREE Direct Doctors Plus physician referral service can help. Manatee Memorial Hospital is a Joint Commission-accredited hospital that is committed to providing high quality and safe care to our patients. Manatee Memorial Hospital is owned and operated by a subsidiary of Universal Health Services, Inc. Note:The information on this website is provided as general health guidelines and may not be applicable to your particular health condition. The information, content and artwork provided by this Web site is intended for non-commercial use by the reader. Manatee Memorial Hospital offers a wide range of high quality services to residents of Manatee County and surrounding area. Whether you are getting ready for a procedure at Manatee Memorial Hospital or planning to visit a patient, get the information you'll need to make your trip more pleasant. Stay up to date with the latest news and events at Manatee Memorial Hospital, including health fairs, classes and seminars. Diabetes can affect the skin in a number of ways that can make a person feel less than comfortable.
Dryness commonly leads to other skin problems such as itching (and often scratching), cracking, and peeling.
Itchy skin is usually related to dryness, but it can also be related to poor circulation, especially in the legs and feet. When blood glucose levels are high, a person with diabetes is more susceptible to infection.
Ecthyma has many features similar to those of impetigo and can in fact result from untreated impetigo.
Folliculitis is inflammation of the hair follicle that is characterized by the formation of a pustule (a small pimple or blister containing pus) or a group of pustules. The chances of getting folliculitis may be lessened by using clean or new razors to shave, exposing areas of the skin that are typically covered, such as the back, to the air, and wearing loose, cool clothing. When the lesions are large, painful, and fluctuant (they can be shifted and compressed), draining them via surgery is usually the best option. Infectious gangrene is a serious condition that usually develops on the hands or feet at the site of an injury such as a laceration, needle puncture, or surgical incision.
Since the mortality rate (death rate) for infectious gangrene is high, it is important that it is diagnosed early and treated aggressively. High blood glucose levels can also predispose people with diabetes to developing common fungal skin infections from organisms such as Tinea and Candida. Fungal infections can occur just about anywhere, including the feet (Tinea pedis), the hands (Tinea manuum), the body (Tinea corporis), and the groin (Tinea cruris). Candidiasis of the skin tends to occur in folds of skin such as the underarms, groin, under the breasts, and between the buttocks. The following skin conditions are strongly associated with having diabetes, but they can occur in people who don’t have diabetes as well. There is no cure for this condition, but it may improve with weight loss, topical bleaches, or a class of drugs known as keratolytics. Treatment of vitiligo is necessary only in people who have severe cases or who are considerably distressed by the condition.
A number of factors make people with diabetes more likely to develop foot ulcers than those without diabetes.
Peripheral vascular disease is another factor that can contribute to the formation of foot ulcers in people with diabetes. Although there is no effective treatment for these conditions, they generally resolve on their own within six months to two years. Be sure to use mild or hypoallergenic varieties of products that come in contact with the skin, such as soaps, lotions, washes, and creams.
Wearing shoes that fit is very important, since ill-fitting footwear is a major cause of foot ulcers. People who have lost the protective sensation in their feet due to neuropathy or those who have peripheral vascular disease, foot deformities, calluses, ulcers, or other special circumstances should discuss getting customized shoes with their physician. A large part of keeping your skin healthy involves maintaining practices that are good for your whole body, such as eating a balanced diet, drinking plenty of water, managing stress, and controlling your blood glucose level. Disclaimer Statements: Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. These can prevent complications such as foot ulcers, which if left untreated can ultimately lead to amputation.
These include antimicrobial lotions, skin moisturizers, antifungal and callus treatments, powders, and alcoholfree foot sanitizers. When trimming toenails, cut them straight across, and round the edges slightly with an emery board. To prevent drying and cracking of the skin, use lotion on the tops and bottoms of the feet but not between the toes.
To promote good circulation to the lower limbs when seated, prop your feet up and avoid standing in one position for long periods of time. Adhere to your prescribed medication schedule and monitor blood glucose routinely to ensure glycemic control.
Do not attempt to remove corns or calluses without seeking the advice of your primary health care provider. Immediately report any sores or skin changes, such as blisters, cuts, or soreness, to your primary health care provider.
Quit smoking, because it accelerates damage to blood vessels, especially the small blood vessels. Doctor and expert presentations will include diabetes care and issues, available support and diet.


The Wound Care Program at Manatee Memorial Hospital uses advanced approaches to aid the healing process of chronic wounds that don’t heal through conventional methods. Some non-healing wounds are associated with complications from diabetes or other vascular-related disorders such as inadequate blood circulation and poorly functioning veins. At the appointment, physicians identify the wound and the health status of the patient to determine what treatment is necessary to heal the chronic wound.
Wound size and depth are documented at the initial visit, and again at each subsequent visit.
You will also be fully instructed on how to manage your wounds at home between visits, as well as how to protect your wound from further injury. Your individual health status and any required medical treatments can only be properly addressed by a professional healthcare provider of your choice. In fact, as many as a third of people with diabetes will have a skin condition at some point in their lifetime. When the blood glucose level is high, the body attempts to remove excess glucose from the blood by increasing urination. This is typically due to atherosclerosis, a disease in which fatty plaques are deposited in the arteries. This is believed to be why there’s a higher incidence of certain bacterial infections among people with diabetes and why these infections tend to be more serious than in the general population. Impetigo is a common, contagious, superficial skin infection that starts out as fluid- or pus-filled blisters or pimples that rupture to form erosions on the skin. The main difference is that ecthyma goes into the deeper layers of the skin, forming ulcerations, which then become covered with thick crusts. The use of oral antibiotic medicine, coupled with topical antibiotics such as bacitracin, antibacterial soaps, and good hygiene, is typically sufficient to clear the infection within a week.
Folliculitis, furunculosis, and carbuncles are all infections that arise in the hair follicles. Lesions usually improve on their own, but they heal faster with the use of antibiotic washes and creams. In these cases, the person should receive antibiotics until all evidence of inflammation has disappeared. Two of the more serious and complicated bacterial infections that occur in people with diabetes include cellulitis and infectious gangrene. It is important that the health-care provider take a culture to determine what organism is causing the infection so that the right antibiotic is used. Tinea pedis, or athlete’s foot, usually occurs in the web spaces between the toes or on the soles of the feet.
This condition begins with pustules on a red base that eventually result in softened, thickened areas of skin.
Applying antifungal creams two to three times daily for approximately two to four weeks should clear the infection.
This condition is characterized by the formation of velvety, brownish, thickened areas of skin in the groin, underarms, under the breasts, and in the creases of the neck.
Vitiligo is a skin disorder that causes white spots or large areas of depigmentation to occur on various areas of the body.
Treatment involves the use of steroids or chemical agents called psoralens that are either placed directly on the skin or taken orally.
A common skin disorder of unknown cause, granuloma annulare manifests as skin-colored or pinkish groups of bumps, or papules, that may be arranged in rings.
This common skin condition is characterized by depressed, irregularly round or oval, light brown, shallow lesions. This is an uncommon condition in which blisters occur on the hands and feet and sometimes also the legs and forearms.
Foot ulcers are a serious problem that can ultimately lead to amputation if left untreated.
Because of the decreased blood circulation to the feet in this condition, there is an impaired delivery of oxygen, nutrients, and antibiotics. This condition occurs in about 0.3% of people with diabetes and is three times more common in women than in men. Although topical steroids may halt progression of active lesions, it is very difficult to completely cure the affected areas. Digital sclerosis is a condition in which the skin on the hands becomes thickened and waxy and may develop multiple, pebble-like growths. Products with additives such as fragrances or coloring can irritate the skin or cause an allergic reaction.
Reactions to oral drugs may take the form of itching, rashes, or wheals, while reactions to insulin may appear as bumps, rashes, or depressions in the areas where insulin is injected. Since people with diabetes may not heal as well as others, it is important to give immediate attention even to cuts and wounds that seem minor. This means the feet should be inspected daily for cuts, sores, or other forms of irritation. People with risk factors for developing a foot ulcer, such as neuropathy, foot deformities, calluses, or a history of foot ulcers, should have their feet inspected by a doctor more often, preferably every one to six months. People who have not lost the protective sensation in their feet can choose off-the-shelf shoes. Good diabetes management is especially important, since many skin conditions are related to complications resulting from high blood glucose. Patients with kidney disease (especially patients on dialysis) face many emotional and social stressors. When counseling patients with diabetes, pharmacists should seize the opportunity to remind them about the value of receiving an annual foot exam and establishing a daily foot care routine, which should include cleaning and inspecting for injuries, cuts, scrapes, or skin changes. This can lead to poor circulation, which is a major risk factor for foot infections and, ultimately, amputations. Up to 15 percent of the estimated 17 million Americans with diabetes may suffer from chronic wounds, most commonly non-healing foot sores, which can lead to amputation. Remember: There is no adequate substitution for a personal consultation with your physician.
While some conditions may appear uniquely in people with diabetes, others are simply more common in people with diabetes. Fungal infections, which can be more common when a person has high blood glucose, can also be very itchy. The following are some of the more common bacterial infections in people who have diabetes.
Sweat and other conditions that cause moisture on the skin (such as high temperatures and humid weather), the shaving of hairy regions such as the underarms and legs, and the blockage of hairy areas by clothing, bandages, or casts or by lying or sitting in one spot for a long period of time can all increase the risk of an infection in the hair follicles. The nodules usually enlarge, become painful, and rupture after several days, forming abscesses (swollen areas containing pus). Simple furunculosis is treated by the local application of antibiotic creams and warm, moist compresses, which relieve discomfort and promote drainage. After the lesion is drained, the area should be covered with a thin layer of antibiotic ointment and a sterile dressing. Cellulitis is an infection that spreads through the deeper layers of the skin as well as the fat layer directly underneath the skin.
Once oral or intravenous antibiotics are started, the average time for healing is 12 days, with a range of 5—25 days. The condition generally begins as cellulitis, which is followed by fever and other generalized symptoms as the infection rapidly spreads. Lesions are itchy and may develop vesicles (sacs filled with air or fluid) or may simply be red and scaly. Keeping the affected areas dry, and using medicated powders in skin folds to reduce friction and moisture are also helpful measures. About 30% of people with vitiligo have a family history of the condition, and it is more common in people with Type 1 diabetes than Type 2 diabetes.
The most popular treatment, known as PUVA, uses oral psoralens in combination with phototherapy sessions, in which the person is exposed to ultraviolet light, specifically ultraviolet A.
There are several subtypes of granuloma annulare; the one associated with diabetes is called disseminated, or generalized, granuloma annulare, in which lesions are widespread over the body. Lesions may vary in number from few to many and are usually found on both legs but are not symmetrically distributed.


The blisters are unrelated to trauma or infection; they develop spontaneously and may become quite large.
Ulcers often begin as a result of minor trauma, such as irritation from ill-fitting shoes that goes unnoticed or untreated. Almost all people with diabetes who develop typical foot ulcers have neuropathy that affects their motor, sensory, or autonomic nerves. Lesions tend to form on the fronts and sides of the lower legs, although they may also occur on the face, arms, and trunk.
Scleredema audoltorum is a similar condition that affects the back and sides of the neck, with the possibility of painless swelling spreading to the face, shoulders, and upper torso. Keep areas of the skin that are susceptible to infections, such as the underarms, groin, area under the breasts, neck, web spaces of the feet and hands, and inner thighs clean and dry. If you suspect you are allergic to one of your diabetes drugs, inform your health-care provider.
Injuries to the skin should be kept covered and inspected on a regular basis to make sure they are not worsening. If a person notices a blister, cut, scratch, sore or other form of irritation, he should be sure to notify his health-care provider immediately.
By sticking with healthy habits and keeping an eye on your skin, you can avoid many common ailments and be happy with the skin you’re in. Consult appropriate health-care professionals before taking action based on this information. For me, there is no greater happiness than partnering with these patients in their health and emotional content.
Keeping appointments and following directions are critical to attaining a positive healing outcome. The good news is that a fair number of these conditions are treatable or can be prevented by maintaining blood glucose control and taking good daily care of your skin.
Dry skin can also be caused by neuropathy (damage to the nerves) by affecting the nerves that control the sweat glands. The best way to moisturize is to apply lotion or cream right after showering and patting the skin dry. Minor breaks in the skin may lead to an impetigo infection, or it may arise as the result of an existing skin problem, such as atopic dermatitis, contact dermatitis, psoriasis, ulcers, traumatic wounds, burns, or insect bites.
Since lesions (areas of damaged tissue) are deeper in ecthyma, they usually take a longer time to close, and they may heal with some degree of scarring. A carbuncle or furuncle with a significant amount of redness or swelling or an associated fever should be treated with a systemic antibiotic (one that affects the entire body), since one of the risks of these lesions is an infection of the bloodstream. People who develop cellulitis usually have an open wound that acts as an entry point for bacteria, although occasionally, the skin infection originates from a bacterial infection of the blood. The area then becomes dusky blue in color, and blisters appear and rupture, forming areas of black skin. Infections that don’t respond to topical treatment may be treated with oral antifungal medicines.
Acanthosis nigricans is common in people who are obese, but it may also be associated with certain forms of cancer as well as endocrine disorders such as polycystic ovarian syndrome (PCOS), acromegaly, Cushing syndrome, and diabetes. Vitiligo progresses slowly over the years, commonly affecting the backs of the hands, the face, and body folds such as the underarms and groin. The use of steroid creams or ointments or steroid injections is sometimes used to treat lesions. Because these lesions do not itch, hurt, or open up, they are often overlooked and not reported to the health-care provider.
However, they are usually not painful and typically heal without scarring in several weeks. Approximately 15% of people with diabetes develop a foot ulcer at some point in their lifetime.
The most common locations for ulcers to develop are the weight-bearing areas of the foot such as the heel and the ball of the foot and sites subject to pressure such as the toes or ankles.
Neuropathy in the motor nerves causes weakness, thinning, and limitation in the movement of certain muscles in the foot, leading to deformities in the normal foot shape such as atypically high arches, claw toes (all toes except the big toe bend toward the floor) and hammer toes (the longest toe bends toward the floor at the middle toe joint).
Treatment for a foot ulcer may include oral or intravenous antibiotics to control the infection, as well as dressings and salves with lubricating, protective, antibiotic, or cleansing properties. Unfortunately, not even the normalization of blood glucose levels is sufficient to control this skin condition in many cases.
If necessary, use antichafing powders or creams and choose proper clothing that allows air to circulate.
The hands and feet should be inspected daily for the presence of cuts or scrapes, since these parts of the body may have decreased sensation due to neuropathy, and wounds may therefore go unnoticed. The width of the shoe should accommodate the ball of the foot, and the toes should not be cramped. According to the 2010 ADA Standards of Medical Care, all patients with diabetes should receive an annual comprehensive foot exam. In these cases, neuropathy causes a decrease or absence of sweating that may lead to dry, cracked skin. This infection most often arises on the face, arms, legs, buttocks, hands, and skin folds such as the underarms and groin. A carbuncle is a larger, painful, more serious lesion with a deeper base, generally occurring at the nape of the neck, on the back, or on the thighs. This can spread bacterial infection to many of the body’s organs, including the heart, brain, and kidneys. To help prevent athlete’s foot, it is always a good idea to wear slippers or shoes of some sort in public areas such as locker rooms. Neuropathy of the sensory nerves results in loss of protective sensation to pain, pressure, and heat. Taking care of the ulcer and following up with health-care providers is very important for preventing complications that could eventually lead to an amputation.
Dryness and itching can be self-treated, but more serious conditions should be brought to the attention of a doctor. Selecting a store with a certified pedorthist on staff is a good idea, since this person will know the subtle differences between various styles. Skin that is severely dry may require application of heavy-duty emollients 2—3 times a day.
The lesions feel hard to the touch, and there is no clear line between skin that is infected and skin that isn’t infected. Tinea manuum is characterized by papules (small, raised pimples or swellings), vesicles, or scaling, typically on the dominant hand, and is associated with touching athlete’s foot lesions. People with sensory neuropathy may therefore not be aware of cuts, abrasions, and calluses that can lead to ulcers. It may then become depressed and turn a brownish-yellow color, except for the border, which remains red. People who live in hot, humid areas should change their clothing once it becomes wet from perspiration. This condition usually affects the face and extremities, and sometimes it also occurs on the trunk.
Tinea corporis, or ringworm, presents as multiple red or pinkish circular lesions with a distinct, scaly border. Depending on the amount of sensory neuropathy, people may even be unaware of major traumas to their feet, such as occur from stepping on pins, glass, and other sharp objects.
Affected areas may lack sensation because of the destruction of some nerves and nerve endings. Neuropathy of the autonomic nerves can lead to warm, excessively dry feet that are prone to skin damage. Tinea cruris, or jock itch, results in red to brownish, scaly, itchy lesions that cover the groin and sometimes extend to the pubic region and upper thighs.



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