Diabetes Foot Care - Essay Example

The paper will be designed as a clinical paper and will have its aims of describing the significance of the topic chosen together with the literature review of the related literary sources. Diabetes foot care Significance It is stated, that foot ulcers and amputations often become the major reason for morbidity and emotional/ psychological stresses for people experiencing these problems in combination and as a result of the improper foot care during diabetes. The significance of the problem lies not only in the fact that its proper management will lead to the decrease in morbidity in general, but will allow to increase the quality of life for people with diabetes as well as to prevent amputations. It is essential to identify the main risks for the patients who currently don't have any foot ulcers, and to manage these risks as well as other factors when foot ulcers are already imminent. The significance of the risk identification is in the fact that it will prevent amputations, as well as allow effective preventive management for people with diabetes. For the patients who have diabetes for more than 10 years, especially among male patients with poor glucose control, are at risk of foot ulcers and should be properly controlled by physicians for the prevention of the undesirable consequences. Among the highest risks for foot ulcers the following can be named: peripheral neuropathy with loss of protective sensation; increased pressure (evidence-based) bony deformity nail pathology (depending on the severity) vascular diseases and possible histories of amputations. This is why the significance of the problem with foot care among patients with diabetes and understanding the risk factors with possible solutions for each specific problem will allow preventing serious medical intervention with the diabetes patients and giving them the chance for living quality life. Literature review A number of literary sources provide the specific guidelines for managing the foot problems with diabetes patients and should be reviewed for the aims of the present clinical course paper. Lavery et al (2007) have provided the results of their project in relation to the foot ulceration management among patients with diagnosed diabetes. The purpose of the project was to evaluate the effectiveness of the temperature monitoring instrument for reducing the incidence of foot ulceration among diabetes patients, who are at risk of the extremity complications. The investigation of the project has been performed through the group of 173 subjects, and it was stated that simple temperature monitoring, which can be performed even at home, has led to the positive results of better diabetes management and lower risks of ulcerations. The subjects of the investigation were working with the infrared skin thermometer, measuring the temperature of the skin foot every day. In case the difference in temperature was higher than the recommended one, the patients were asked to contact their nurse immediately. However, it is stated that through the existing limitations of the study, as well as the possible issues preventing the diabetes patient from measuring the temperature regularly, this method may appear less effective than stated in the project; however, the authors of the project are still sure that 'infrared temperature home monitoring in serving as an 'early warning sign', appears to be a simple and useful adjunct in the prevention of diabetic foot ulcerations'. (Lavery et al, 2007). It is necessary to understand, that foot self-care among diabetes patients is connected with certain cognitive and emotional factors, which Vileykite et al (2006) were investigating in their research. The aim of their research project was to develop and to validate a self-report instrument to assess patients' cognitive and emotional representations of neuropathy influencing foot self-care. They have come to the conclusion, that the development of instruments which would allow the patient assessing possible negative effects of neuropathy was useful, as well as it showed the way of better identification of the principal disease concepts; the instruments give the patient an opportunity to assess his attitudes towards the ulceration, the possibility of amputation and to address the problem of neuropathy from the viewpoint of each patient on the basis of the results acquired. 'Such an approach to illness emotion uncovers the differential effects of specific emotions on foot self-care: worry is a motivator of adherence, whereas anger hinders foot self-care actions. At the practical level, the PIN questionnaire identifies patients' characteristic misperceptions about neuropathy, their levels of understanding of neuropathy-related medical information, and their specific emotional responses, thereby providing clinicians and behavioral scientists with specific targets for designing more efficacious foot self-care interventions'. (Vileykite et al, 2006). In the research conducted by Colberg, Parson, Nunnold et al (2006), it is stated that 'in diabetic individuals increased shunting of circulation away from skin may exist, contributing to their greater risk of ulcerations and poor cutaneous healing.' (Colberg et al, 2006) The study was concentrated around the examination of the dorsal foot skin perfusion before and following an acute bout of moderate cycle ergometer exercise. It was found out, that local heating of the skin over 20-40 min caused maximal vasodilation. (Colberg et al, 2006) However, and even more important, it was found that cutaneous perfusion following 20 min of moderate exercise, 'in nondiabetic exercisers alone exhibits a greater responsiveness to local heating, suggesting that it is negatively affected by both diabetes and inactivity, independent of NO production in the skin.' (Colberg et al, 2006) The authors of this research also made a conclusion in relation to endothelium-dependent dilation in skin vasculature; according to the information found in the research, endothelium-dependent dilation in skin vasculature is enhanced by moderate exercise training, while the effect cab ne reversed by detraining. (Colberg et al, 2006) It is suggested in the study, that exercise may define the responsiveness of the cutaneous endothelium, while the differences in the stimulated infusion increments those diabetic patients who were subject to exercises, and those who were sedentary, were no longer evident. In its turn, the rise in NO helps to suggest that the combination of local heating and cutaneous perfusion is more likely to be mediated through a non NO-mechanism. (Colberg et al, 2006) Moghtaderi (2006) has performed a research related to the screening instruments of neuropathy with the diabetic patients. It was concluded, that 'the accuracy of MNSI scoring makes it a useful screening test for diabetic neuropathy in taking a decision regarding which patients should be referred to a neurologist for electrophysiological studies'. (Moghtaderi, 2006) The study was conducted during the two years among 176 patients with the type 2 diabetes. In connection with the problem of diabetes foot ulceration and foot self-care, it is essential to have closer look at the issue of neuropathic pain with diabetes patients, researched in the study by Stacey (2005). 'Neuropathic pain can be thought of as pain that arises from abnormal nervous system physiology, at times completely removed from ongoing tissue damage or inflammation. In contrast, other more familiar types of pain, such as acute postoperative pain, typically arise from activation of peripheral nociceptors'. (Stacey, 2005) The writer pays special attention to the use of various kinds of treatment for the neuropathic pain. Among the suggested means of treating neuropathic pain the writer described the action of topical treatments (among them are 5% lidocaine patch, ketamine gel and capsaicin, which work locally and give minimal systemic effect). 'Lidocaine, like other local anesthetics, seems to act through inhibition of voltage-gated sodium channels. Capsaicin is thought to elevate the pain threshold in areas to which it is applied through depletion of substance P from the membranes of type C nociceptive fibers'. (Stacey, 2005) Special attention should be paid to the description of the use of rational multipharmacy to the treatment of neuropathic pain, as the means of active diabetes foot-care, with its possible positive impact on the ulceration and amputation prevention. However, the principal limitation of the present study is in the instrument of the pain evaluation with diabetes patients; it is stated, that statistically significant results don't always correlate with the clinically significant results, as measuring the level of pain according to the specially designed scale, and evaluating pain on the basis of the evaluation provided by the patient orally are different. In considering the possibility of applying polypharmacy in prevention of ulcerations and general foot care management with diabetic patients, it is necessary to account the factors as previous medication and reaction to previous medicines, sleep disturbance, health status, as well as chronic nature of pain is to be considered. (Stacey, 2005) The author of the project also described the means and meanings of interventional treatments, admitting that neuopathic pain still remains to be a challenge for the practicing clinicians for its complexity and the wide range of symptoms and factors to be accounted during the development of the therapy. 'TCAs, in selected patients, may be useful for treating chronic pain that coexists with depression. Also, both gabapentin and TCAs may be helpful for patients with a coexisting sleep disturbance. Many of the available medications (except for the lidocaine patch) should be used with caution in elderly patients because of the risk of falls and cognitive impairment'. (Stacey, 2005) Thus, in the foot care among diabetic patients, the range of studies is wide, and touches various aspects of foot care. It is essential to take into account all the factors and aspects described for the creation of the general preventive management structure, which will work for the decrease of complications and prevention of ulcerations and amputations among the patients with diagnosed diabetes. References Colberg, S.R., Parson, H.K., Nunnold, T., Holton, R., and Vinik I. (2006). 'Effect of a single bout of prior moderate exercise on cutaneous perfusion in type 2 diabetes'. Diabetes Care, 29 (10): 2316-2318 Lavery, L., Higgins, K., Lanctot, D., Constantinides, G. et al. (2007). 'Preventing diabetic foot ulcer recurrence in high-risk patients: use of temperature monitoring as a self-assessment tool'. Diabetes Care, 30 (2): 14-20 Moghtaderi, A. (2006). 'Medical devices: Michigan neuropathy screening instrument offers a reliable test for diabetic neuropathy'. Medical Devices & Surgical Technology Week, p. 25 Stacey, B.R. (2005). 'Management of peripheral neuropathic pain'. Am J Phys Med Rehabil, 84: S4-S16 Vileikyte, L., Gonzalez, Jeffrey S., Leventhal, H., Peyrot, M. et al. (2006). 'Patient interpretation of neuropathy (PIN) questionnaire: An instrument for assessment of cognitive and emotional factors associated with foot self-care'. Diabetes Care, 29 (12): 2617-2624 Read More