Maxy sez : Shoe Shopping With Diabetes

If you have diabetes, choosing the right shoes can help protect your feet from injury. Learn which styles could put you at risk for complications.
By Mary Elizabeth Dallas, HealthDay News
Medically Reviewed by Farrokh Sohrabi, MD
If you are living with diabetes, shopping for shoes is more than a matter of style. By following some simple guidelines to ensure a good, comfortable fit, you can prevent potentially serious foot problems.

Even minor foot problems, like calluses or blisters, can lead to serious diabetes-related complications. Diabetes can cause poor blood flow to your feet, making it more difficult for wounds to heal, sometimes resulting in infections and possibly amputation. Complicating matters, poorly controlled diabetes can also lead to nerve damage called peripheral neuropathy. This may cause you to lose sensation in your feet, so you may not feel potentially harmful cuts or blisters. To help protect your feet and overall health, it's important to know what to look for in diabetes shoes.

"It's all about prevention," said Katherine Dux, DPM, a podiatrist at Loyola University Medical Center in Maywood, Ill., who treats patients with diabetes. "Any friction in the shoe could lead to irritation and possible blister formation. This could lead to trouble down the road."

Before you shop for diabetes footwear, it's important to have your feet evaluated by a podiatrist to determine your risk for infections or complications, said Dr. Dux. Based on this assessment, the doctor can recommend exactly which types of shoes will be best for your feet.

What to Look For in Diabetes Footwear
Even if your diabetes is under control and your feet are healthy, there are a number of factors you should consider when selecting shoes. By looking for certain characteristics and avoiding others, you can protect against irritation, infections, ulcers, and potentially worse foot problems.

First, look for a shoe that has a large enclosed front, as well as a closed back and top. Shoes that expose your toes or heels increase your risk for injury and infection. You may love slip-on shoes, sandals, clogs, and mules, but they could trip you up when it comes to diabetes foot care.

Other good shoe features for a person with diabetes include:

Adjustable Closure. Look for shoes that have laces or Velcro. The built-in flexibility allows you to tighten or loosen your shoes depending on whether or not your foot is swelling.

Wide Toe. Steer clear of shoes with narrow or pointed toes. "It's best to stay with a shoe that has a wider toe box area as well as something with increased depth to the toe box," advises Christina Sigur, DPM, a podiatrist at Wake Forest Baptist Medical Center in Winston-Salem, N.C. Shoes with a round or wide toe box provide your feet with more room and are less likely to cause irritation.

Low Heel. Flats or shoes with heels less than two inches high are a better option than shoes with higher heels. Lower-heeled shoes reduce the amount of pressure applied to the ball of the foot.

Soft Material. Choose styles made from soft materials, such as leather, mesh or a pliable synthetic fabric. Since feet tend to swell throughout the day, these softer fabrics will give and allow for swelling. Breathable fabrics will also prevent the build up of moisture within the shoe, Dux added.

Cushioned Inner Sole. It’s important to choose footwear with a good amount of cushioning inside the shoe. This added support helps reduce foot pressure and the risk for developing foot ulcers, or sores, and other complications, Dr. Sigur noted.

Hard Outer Sole. Although the inside of your shoe should provide support with cushioning, the outer sole of any shoe you select should be hard. This will help protect your feet from rough or sharp objects and provide shock absorption.

When to Use Therapeutic Diabetes Shoes
For some people with diabetes, a podiatrist may recommend therapeutic shoes. "People with foot deformities, such a hammer toes and bunions, are at greater risk for irritation from ill-fitting shoes," Dux said.

Therapeutic shoes are advisable for anyone with diabetes who also has a history of any one of the following:

An amputation of any part of their foot or toe
Foot ulceration
Calluses that lead to an ulceration
Neuropathy or nerve damage
A foot deformity such hammer toes, bunions, flat feet, or high arches
Poor circulation in their lower extremities
At the Shoe Store
If it’s time for some new kicks, consider shopping later in the day. Since feet tend to swell throughout the day, Dux recommends visiting the shoe store in the afternoon or evening in order to get a more accurate sizing of your foot.

And don’t forget to bring your socks. Experts recommend that people with diabetes wear socks to decrease the friction in shoes and soak up extra moisture to prevent infections. To ensure a proper fit, it's important to always try on shoes with the socks you intend to wear with them.

Finally, ask a trained sales professional to measure both of your feet. One foot is typically larger than the other. You’ll want to determine which one is longer and base your shoe size off of that foot to get the best fit.

Other Ways to Protect Your Feet
Consider Fit, Not Fashion. The type of shoes you wear should have less to do with fashion and have everything to do with proper fit. "Shoes should feel comfortable from the moment you put them on,'" Dux said. "There is no true break-in period for shoes." Dux adds that shoes should never feel tight, rub, or cause irritation.

Inspect Your Feet Daily. It's important to routinely remove your shoes and inspect your feet for problems or signs of irritation, such as redness or marks along the top, sides, or sole. This is particularly true when wearing new shoes. "Any areas of redness or marks that do not resolve in 10 to 15 minutes could be an indication that the shoes need to be addressed or adjusted," Dux noted.

Visit a Podiatrist Regularly. People with diabetes who do not have any foot problems should still be evaluated by a podiatrist annually. Anyone diagnosed with peripheral neuropathy — or those with a history of calluses or foot ulcers — should be reassessed more frequently, according to experts.


Know When to Buy New Shoes. Whether or not to replace a pair of shoes depends on how often you wear them. For everyday shoes, however, Sigur says a good rule of thumb is to change them at least once a year since the interior cushioning of the shoe wears down over time.

Maxy sez :How to Stabilize Your Blood Sugar

Keeping blood sugar under control is key for good management of type 2 diabetes. Here’s how to navigate this sometimes complicated course of diabetes care.
By Madeline R. Vann, MPH                Medically Reviewed by Justin Laube, MD
Blood sugar testing tools can help you track how diet, exercise, and other lifestyle changes are affecting your blood sugar levels.B. Boissonnet/Alamy
Life with type 2 diabetes can sometimes seem like an hourly or even minute-by-minute effort to stabilize your blood sugar. All of the recommendations and drugs you’ve been given as part of your type 2 diabetes treatment plan are intended to help you reach — and keep — healthy blood sugar levels most of the time. But doctors are learning that to control type 2 diabetes well, better information about why blood sugar matters and how to manage it is essential.

The Facts About Diabetes and Blood Sugar
As the American Diabetes Association (ADA) explains, your body needs sugar (glucose) for fuel, and there’s a fairly complicated process that makes it possible for your body to use that sugar. Insulin, which is made by the pancreas, is the hormone that enables the cells in your body to take advantage of sugar.

Type 2 diabetes occurs when your body isn’t able to remove sugar from your blood. This can happen if your body stops being sensitive to insulin or if it starts to respond in a delayed or exaggerated way to changes in your blood sugar.

Diabetes is signaled by an elevated blood sugar level of more than 126 milligrams per deciliter (mg/dL) for a fasting blood test, or more than 200 mg/dL at any time during the day. It can also be indicated by a hemoglobin A1C level of 6.5 percent or higher, a measure of the percentage of blood sugar attached to hemoglobin in the blood during the past two to three months. (Hemoglobin is a protein in red blood cells that transports oxygen throughout the body. So an A1C of 6.5 means that 6.5 percent of your red blood cells have sugar attached to them.)

Unchecked high blood sugar gradually damages the blood vessels in your body. Over the long term, this slow, progressive harm can lead to a dangerous loss of sensation in your legs and feet, a loss of eyesight and kidney function, and an increased risk for heart disease and stroke.

Both high and low blood sugar are health threats. "Having low blood sugar can lead to hypoglycemia, which puts people at risk for confusion and loss of consciousness, so it can be life threatening. Fluctuations in the opposite direction, or high blood sugar, can cause fatigue and dehydration," explains endocrinologist Laure Sayyed Kassem, MD, an assistant professor of medicine at Case Western Reserve University School of Medicine in Cleveland. "Good diabetes control can help reduce the risks for heart attacks, strokes, visual deficits, kidney disease, and peripheral artery disease.”

Strategies to Stabilize Blood Sugar
Getting your blood sugar to healthy levels may take trial and error, but there are steps to help you achieve it.

“Having a daily routine is critical for good diabetes control," Dr. Kassem says. "That means following your meal plan, exercising regularly, being consistent with blood sugar testing, and following up regularly with your doctor." Tracking carbohydrates is particularly important. “Big variations in carbohydrate intake from day to day can lead to fluctuations in blood sugars,” she adds. For example, when you consume excess carbohydrates, the body digests them like sugar and sends them straight to the bloodstream, increasing the risk of blood sugar spikes.

Follow these specific strategies to help control blood sugar:
Exercise :  A regular exercise program has been shown to help manage blood sugar levels over time, and taking a varied approach to fitness is good for diabetes and health in general. Participants in a 12-week program who exercised for an hour three times a week using both aerobic and resistance training had improved diabetes management, according to research published in February 2015 in the Journal of Sports Medicine and Physical Fitness. So mix it up with strength training, aerobic workouts, and any other activities you enjoy.

Weight : Loss If you’re overweight, it will be easier to stabilize blood sugar more effectively if you lose even a few pounds. “For most people with diabetes, losing just 5 or 10 pounds can make a difference in diabetes control or the need for medication,” says endocrinologist Joseph Aloi, MD, section chief and professor of endocrinology and metabolism at Wake Forest Baptist Health in Winston-Salem, North Carolina.

Diet:  Many people with diabetes achieve better control over their blood sugar by limiting the kinds of foods that can cause blood sugar to spike. For example, your doctor might recommend cutting back on carbohydrates and eating more lean protein, fruits, and vegetables. Fiber can be so helpful that sprinkling even a small amount of a fiber supplement onto a meal that otherwise might spike blood sugar can help stabilize it, Dr. Aloi says, because fiber slows down the body's digestive process.

Drinking :  Wisely Alcohol can cause an immediate rise in blood sugar and then a drop a few hours later. It’s best to stick to moderate amounts and have some solid food with your beverage.

Medication:  Your doctor may recommend different types of medication at different times during your diabetes treatment. Treatment options include the following:

Biguanides, the drug class that includes metformin, help your body use insulin more effectively and may also reduce the amount of blood sugar made by the liver.
Sulfonylureas cause certain cells in your pancreas to make more insulin, though low blood sugar (hypoglycemia) is a possible side effect.
Meglitinides, a class of drugs that includes repaglinide, cause your pancreas to make more insulin, with hypoglycemia as a possible side effect.
Thiazolidinediones, a class that includes pioglitazone, may help insulin work better.
Alpha-glucosidase inhibitors, a class including acarbose, stop the body from breaking down starches and may be used to prevent a spike in blood sugar after a meal.
DPP-4 inhibitors allow GLP-1, a gut-based hormone naturally found in the body, to last longer and help stabilize blood sugar levels.
SGLT2 inhibitors cause excess glucose to be eliminated in the urine.
Insulin may be necessary to help your body use blood sugar more effectively.
Asking More Questions:  Don’t be shy about asking your doctor or diabetes educator about how to interpret blood sugar numbers, or for clearer instructions to help stabilize blood sugar. “You should know what your medications are for and what your goals are,” Aloi says. Strategies to stabilize blood sugar are most effective when you understand how they work and how to use them. And the answers may be as close as your phone. When Australian researchers offered telephone counseling to 94 adults with type 2 diabetes, they found it improved diabetes management, according to a study published in September 2014 in the Internal Medicine Journal.

Blood Sugar Testing Options
Specific recommendations for testing blood sugar depend on your type of treatment. "If it’s oral treatment, stagger the tests because this gives us a better idea of blood sugars through the day. It allows us to tailor medication better. But people on insulin have to be tested at regular times every day,” Kassem explains.

From self-tests to lab tests, from daily testing to testing every few months, these different blood sugar tests can give you a more complete picture of your diabetes and how to go about managing it best:

Testing Strips and Glucose Monitors These are fingertip blood sample tests you can do at home. Depending on the status of the diabetes and your doctor’s recommendations, you may need to test multiple times a day to keep tabs on your blood sugar levels. Get to know your condition better by keeping a diary of your meals and activities and the blood sugar levels that result.

Use these self-check blood sugar testing tools to find out how your body responds to changes in your diet, exercise, and overall health. There are many brands of monitors, each with their own lancets and testing strips, so talk to your doctor about which design is best for you and about how often you should be checking your blood sugar levels at home.

Lab Work Your doctor will often order lab-drawn blood sugar tests as part of your regular office visits to monitor how well you’re managing diabetes and other chronic health conditions.

A1C Tests This is a lab-drawn blood test that provides your doctor with information about how your blood sugar control has been over the past three months. Every time your A1C drops by a point, you cut the risk of diabetes complications by about 30 percent, Aloi says.

Responding to High or Low Blood Sugar Levels
As you learn more about living with diabetes and monitoring your blood sugar levels, you’ll experience times when your blood sugar levels are too high or too low. But don’t panic over these results, Aloi says. The complications of diabetes are caused by poor blood sugar control over the long term — typically not by the occasional short-lived elevations in your blood sugar levels. Still, it's important to be aware of the long-term effects of blood sugar that’s too high (hyperglycemia) or too low (hypoglycemia), and how it’s treated.

Hyperglycemia
Blood sugar levels that are too high for too long are considered hyperglycemia. If your blood sugar is more than 240 mg/dL, you should also check for ketones in your urine before you take steps to lower your blood sugar, according to the ADA. Rarely, someone with type 2 diabetes will develop diabetic ketoacidosis (DKA), a serious condition characterized by high blood sugar, low insulin and the presence of moderate to high ketone levels. DKA is a medical emergency and requires urgent medical care.

Ways to treat hyperglycemia include the following:
Exercise. Physical activity is a good way to bring down blood sugar. Aloi points out that 10 minutes of exercise used to be the recommendation for children with type 1 diabetes as a way to stabilize blood sugar before insulin was commonly available. But if you have high levels of ketones in your urine, hold off on exercise because it may make that situation worse. Let your doctor know if your blood sugar or ketone levels are too high for an extended period of time.

Change your diet. High blood sugar can result from eating too much or eating the wrong foods. If you’ve strayed from your diabetes diet, get back to eating healthy as your doctor recommends. Making your very next meal high in protein and fiber should help. Whatever you do, don’t fast.

Aloi notes that many people with diabetes get frustrated over their somewhat unpredictable response to food and decide not to eat in an attempt to lower blood sugar levels. Fasting causes stress, which can actually cause your blood sugar levels to go up or stay up.

Adjust your medication. Blood sugar that’s too high may call for a medication change, but only with your doctor’s advisement. Talk to your doctor about what to do in response to high blood sugar levels before you alter your medication plan.

Hypoglycemia
For many people, low blood sugar can lead to dizziness and feeling ill, and it can be extremely dangerous if it results in loss of consciousness, according to the ADA. You need about 15 grams of carbohydrates to bring your blood sugar levels up. Many people carry glucose tablets with them just in case, but 4 ounces of juice or soda, four or five crackers, or a tablespoon of honey will also do the job. Test your blood sugar again in about 20 minutes to make sure it’s back to more acceptable levels.

If you have episodes of low blood sugar, wear a medical identification bracelet or necklace in case you’re unable to treat yourself.

Some people find a formula that works well to stabilize their blood sugar and they can depend on it, day after day. For others, blood sugar levels can seem like a moving target. If this sounds like you, build a partnership with your diabetes care team — including your primary care provider, endocrinologist, nutritionist — and together you can find strategies for better blood sugar control that work for you.