Diabetes and Foot care

Taking care of the feet is one of the most important things when you have diabetes, because foot problems account for about 20% of hospital admissions among diabetic patients. A diabetic foot ulcer is the most commonest cause of amputation of lower limbs in the world as well as in Sri Lanka.

Why do diabetics develop foot problems more often than others?

The disease process of diabetes itself affects the feet in many ways .

1. Diabetes can lead to nerve damage (neuropathy) causing loss of sensation to touch, pain and temperature. Hence you can never rely on pain to indicate when you are injured.
2. Diabetes affects blood vessels supplying the lower limbs by gradually blocking them and decreasing blood flow, so that fewer nutrients reach the legs for nourishment with less oxygen. This condition in the legs is known as Peripheral Vascular Disease or PVD.
3. Diabetics are more prone to secondary infections of traumatized skin and tissues and fight poorly against bacteria causing infections. Therefore it doesn’t take a long time for a warm spot on the leg to become a spreading cellulites involving the whole leg leading to an amputation!

How to take care of your feet if you are a diabetic

• Self-inspection of feet: is the most important thing to do. All diabetics should inspect their feet daily.Look for areas of blisters, cuts, cracks, calluses, corns, scratches, colour changes, swellings and a change of temperature, like a warm area.Look between nails for evidence of fungal infections. Check for ingrown toe nails, for evidence of fungal infections. If you have developed any of the above conditions, it is better to seek medical advice as soon as possible. It may be unwise or too late to wait for your next clinic date to get treatment. Inspect feet in good light and use a mirror to view the soles. If your eyesight is poor or if you are too obese to see your feet, get someone else to check your feet every day.
• Wash your feet daily: at least once a day and dry carefully. When washing your feet never use hot water as it could be too warm for you and your feet may not feel it. Dry your feet with a soft cloth paying special attention to areas between your toes. You can apply some moisturizing cream or ointment afterwards.
• Cut your toe nails straight across: Do not cut the corners of nails or ingrown toe nails. It is easier to cut nails after a shower or a bath, as the nails are softer
• Never self treat: In the case of corns, calluses and blisters improper treatment could lead to a limb threatening condition in a diabetic patient. Always avoid over the counter medication and home surgery.
• Try to avoid walking bare foot: the only time a diabetic is allowed to be bare foot is either in bed or in the shower.
• Be very careful with your footwear and socks: select comfortable, well fitting shoes with enough space for toes in their natural resting position. Always buy shoes in the afternoon, as it is known that feet swell towards the latter part of the day.
• Break new shoes gradually to avoid shoe cuts: check the inside of shoes for any sharp projections torn edges and ragged linings which can be rough on your skin.
• Exercising your feet: is a good idea for most diabetics as it improves the general circulation of blood and improves the general health of the patient by helping to control blood sugar.
• Avoid crossing legs: for a long period of time as it can affect an already reduced blood circulation to the feet . It can exert pressure on nerves too.
• Stop smoking: diabetes and smoking is a dangerous combinations, which can not only cost you your limb but also your life.

When you are a diabetic, your feet become more important than your face. Show your feet to the doctor at each visit. Make sure you remove socks at a clinical examination so that your doctor can see your feet.

So take care of your feet. Never assume that your feet are normal if you have diabetes. You are born with only one perfect pair and nothing on earth can give you an equally good spare if you neglect.

Diabetes and eye disease

People with diabetes are prone to certain eye complications. These conditions can cause severe impairment of vision or even cause blindness.

Eye Diseases in Diabetes:

Cataract

Clouding of the lens of the eye. Cataract develops at an earlier age in people with the disease.

Glaucoma

Increases the pressure of fluid inside the eye that leads to optic never damage and loss of vision. A person with the disease is nearly twice as likely to develop this condition compared to non- diseases.

Diabetic Retinopathy

This is the most common diabetic eye disease and a leading cause of blindness in adults. It is caused by changes in the blood vessels of the retina. Retina is the layer at the back of the eye that is sensitive to light. There are various stages of the diabetic retinopathy such as:

Background diabetic retinopathy

When blood vessels in the retina are damaged, they can leak fluid or bleed. This causes the retina to swell and form deposits called exudates.

Proliferative diabetic retinopathy

This is an advanced stage of diabetic retinopathy. As the retinopathy progresses the fine blood vessels in the retina get blocked. This triggers the formation of new blood vessels. The new vessels are very fragile and can bleed easily.

Screening for eye complications (Retinopathy)

Diabetic retinopathy is detected during a comprehensive eye examination that includes the following.

This eye chart test measures how well you see at a distance.

1. Visual acuity test
2. Dilated eye exam
• Drops are placed in your eyes to widen or dilate the pupils.
• This allows your Doctor to see more of the inside of your eyes where the blood vessels and the nerves are found.
• Your doctor uses a special instrument called an ophthalmoscope, a slit lamp and sometimes a retinal camera, to examine your retina and optic nerve for signs of damage such as leaking of blood vessels, retinal swellings, damaged nerve tissues and other eye problems.
3. Checking for eye pressure (glaucoma)

Diabetes Footwear and Orthotics

Proper footwear is an important part of overall foot care and podiatric treatment for people with diabetes, even for those in the earliest stages of the disease. Proper footwear should be worn when a person has diabetes. Footwear for diabetes has many benefits over the ordinary shoes for diabetics. This special footwear have enough room to fit the toes, are non-slip and provide soft and cushioned insoles. If there is any evidence of neuropathy, or lack of sensation, wearing the right footwear is crucial.

The excessive pressure and friction from the wrong kind of shoes or from ill fitting shoes can lead to blisters, calluses, corns or ulcers, not only in the insensitive foot, but also in feet with no evidence of neuropathy. By wearing special footwear, many patients can prevent such serious diabetic foot complications. It is also important for patients to learn how to select the right type of shoe in the right size, so that future problems can be prevented.

Benefits of specialized footwear and orthotics for diabetics

• Relieve areas of excessive pressure:

Any area where there is excessive pressure on the foot can lead to skin lesions, calluses, corns or foot ulcers. Footwear for Diabetics helps to relieve these high pressure areas, and therefore reduce the occurrence of diabetes related foot problems.

• Reduce shock and shear:

Special footwear reduces the overall pressure on the sole and shock to the bottom of the foot.

•  Stabilize and support deformities:

 Deformities resulting from conditions such as charcot involvement, bunions, loss of fatty tissue, hammer toes and amputations need to be stabilized to relieve pain and avoid further damage. Also the custom made footwear decreases progression of the deformity.

• Improve healing by offloaded footwear:

By wearing offloaded insoles, people who have corns or foot ulcers can improve the healing process.

• Custom made footwear for people with foot deformities:

Custom made footwear limits the motion of certain joints in the foot, that can often decrease inflammation, relieve pain, and result in a more stable and functional foot. People who are with foot deformities and the people with amputations of the lower limbs should wear custom made footwear which are made to fit the shape and size of the affected foot.

• Orthotics support and stability to the affected foot:

 Orthotics are devices that are worn to correct foot problems non-surgically. They include silicon gel insoles, heel cushions, toe separators, metatarsal pads, toe protectors and arch supporters. Orthotics should be properly selected according to the type of foot deformities.

Diabetes and Diet

Since diabetes is a degenerative disease, it is important to take control measures of blood sugar level from the onset of the disease. Diabetics are greatly assisted by regular physical activities and proper dietary control, in addition to their medications.

As diabetes affects almost all organs in one’s body, maintaining regular physical activities and a proper diet plan is very important in controlling blood sugar levels in day to day life and it helps to prevent or delay the long term complications of diabetes affecting the organs.

There are no such diabetic diets. Every individual with diabetes should be aware of the foods that are suitable for them and the recommended quantities which suit his or her medical conditions.

Some of the important tips of dietary control in diabetics are given below.

• Do not skip or delay your meals.
• Get recommended portions for main meals and add healthy snacks in between.
• Add plenty of green leafy vegetables, more fruits, nuts and grains into your diet.
• Take a snack or a drink (without sugar) before starting your exercise regimen or workout.
• Reduce intake of fatty foods and salty foods.
• Avoid consuming alcohol.
• Be aware about the suitable foods to manage your sugar levels during sick days.
• Be aware about when your blood sugar drops below the healthy range and adjust your meals accordingly if you face such situations more often.

Foods that can be taken more often are:

• Green vegetables – Including cabbage, leeks, beans, drumsticks, bitter gourd, lettuce, gotukola, mukunawenna, kankun and green leaves etc.
• Fiber rich foods – kohila, keselmuwa, snake gourd etc.
• Grains – green gram, grams, cowpea, cashew nuts etc.
• Low fat or non-fat dairy products – yoghurt, low fat butter, skimmed or partially skimmed milk.
• Fruits – papaya, green apple, water melon, guava, avocado, lemon, ambaralla, bael fruits, nelli etc.
• Complex starchy foods – brown rice, parboiled rice, basmati rice, brown bread, whole meal bread, attar flour, oat meal and root vegetables etc.
• Fish and fish oils – small fish like hurulla, salaya and sprats give more nutritional benefits to diabetics.

Foods not to be taken regularly or foods to avoid are:

• Sugar added snacks.
• Instant foods and drinks.
• Malted milk.
• High fat food like ghee, butter, cheese etc.
• Food containing simple sugars – Including table sugar, honey, ice cream, jams cordials, puddings, treacle, jaggery, raisings, sultanas, cakes, pastries and short eats etc.

The Above mentioned should be avoided in general. But the recommendations may be changed according to the medical conditions, body weight and physical activity levels of the individual.

It is advisable to discuss your medical conditions, food preferences, food availability, accessibility, preparation and your physical activity level with your Dietician or Nutritionist and get a personalized diet plan for you.

Laboratory Services

The staff of the Ceylinco health laboratory are dedicated to providing a high quality analytical medical diagnostic service to meet our customer expectations. We are commited to practicing sound Professional and ethical values in our laboratory service.

The entire staff of the Ceylinco Health Care Service laboratory endeavours to achieve the highest level of customer satisfaction, and contained improvement of the service to meet the local and international quality control standards. (Participates in international quality control programs e.g.: Bio –Red Laboratories EQAS USA.)

Our range of laboratory tests includes routine and special laboratory investigations done on blood, urine, stools and other body fluids. The uniqueness of our service is that most reports are issued on the same day.

E.g.: HbA1C Analysis a special test done to check Diabetes and the report is available in two hours time.

The following investigations are done in our laboratory:

• Fasting Blood sugar
• Blood Urea
• Creatinine
• Total Cholesterol
• Uric Acid
• Lipid Profile
• Liver Profile
• Full Blood Count
• ALT(SGPT)
• AST(SGOT)
• Gamma GT
• Alkaline Phosphatase
• Total Protein
• Serum Triglycerides
• HIV
• Glycosylated Haemoglobin(HbA1C)
• Urine Microalbumin
• Urine Full Report
• Stool for Occult Blood
• Pap Smears for cytology

Pharmacy & Diabetes Shop

The Diabetes shop at the Ceylinco Diabetes Centre is stocked with all diabetes related items including:

• Medicines
• Glucometers
• Sugar substitutes and diabetic food items
• Dressing items

Pharmacy of the diabetes shop provides all of your pharmaceutical needs and is managed by a qualified professional pharmacist.

MEMORY CLINIC (Dementia)

Memory impairment may be the early sign of a disorder called dementia among the elderly. Dementia means a progressive decline in the ability to remember, to think and to reason. There are several diseases that may cause dementia and your doctor will be the one to differentiate Alzheimer’s disease from other types of dementia. However, you should know what the sign and symptoms of dementia are, so that you will know when to consult the doctor. Early intervention will help to manage the disease better.

Screening tool for Dementia

Check the boxes that describe the problem you have.

    Memory loss (Forget appointment, cannot recall recent events or conversations)
    Misplacing objects & thinking someone has stolen them.
    Disorientation (get confused in unfamiliar places, do not know the time or year, could not find your way home)
    Speaking (forget the names of simple, well known objects, use inappropriate words, repeat words & statements)
    Loss of interest in hobbies and personal activities, avoid activities you used to enjoy.
    Recognizing friends, co-workers or family members (forget who are grandchildren, think friends are strangers)
    Performing complex tasks (keep check book, count money, use the telephone)
    Troublesome behaviour (aggressiveness)
    Poor personal hygiene (forget to brush teeth, dress slowly or in inappropriate clothing, forget to take a bath)

If you have ticked any of the above boxes, there is a possibility that you may be at risk of developing dementia or other medical problems.

Please contact +94112490290 for further details.

Mens Clinic

Male sexual dysfunction is common, yet rarely discussed. Stress, anxiety and depression are some of its psychological causes. Impotence and similar difficulties may even be due to systemic disease.

Common problem faced by men:

• Sexual problem
• Reduced sexual desire
• Difficulties in achieving and maintaining an erection
• Problem with rapid or delayed orgasm
• Structural abnormalities of the penis
• Difficulties when passing urine
• Prostate problem

The Men’s clinic at the Ceylinco Healthcare Centre addresses urological problems and specializes in the treatment of male sexual dysfunction. This Clinic is equipped with the best facilities, medical team and services. The non-hospital environment will make you feel at home and your privacy will be maintained at all times by our highly qualified friendly staff.

Our services include:

• A clinical review by a qualified specialist in sexual Dysfunction and a urologist
• Adequate time for each person to discuss problems with experienced doctors
• Appropriate investigations of related symptoms
• Detection of associated infirmities and appropriate advice
• Suitable treatment for sexual problems e.g. Erectile problems

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