Tips for diabetes care: Keep your feet healthy with exercise

Author: Yang Li, The Fifth Medical Center, PLA General Hospital

Reviewer: Shen Lijun, deputy chief physician of the Fifth Medical Center of the General Hospital of the Chinese People's Liberation Army

Diabetes, the "sweet trap" of modern life, poses a huge threat to the vascular health of countless patients. Long-term high blood sugar erodes the patient's blood vessel wall, resulting in decreased vascular elasticity, stenosis of the lumen, and even thrombosis. What is particularly serious is that diabetic foot, as one of the serious complications of diabetes, is even more shocking. Due to neuropathy and vascular lesions caused by high blood sugar, the patient's foot sensation is reduced, and the response to pain, cold and heat stimuli becomes dull. At the same time, the stenosis and occlusion of the blood vessels in the feet make the blood supply insufficient. Once injured, it is difficult to heal and it is very easy to cause infection. However, diabetic patients often have low immunity. Once infected, it may spread rapidly, leading to tissue necrosis, and even requiring amputation to save life. This not only brings great physical pain to patients, but also seriously affects their quality of life and ability to participate in society.

Exercise can promote blood circulation, enhance blood vessel elasticity, and improve microcirculation, thus helping to prevent and reduce damage to blood vessels caused by diabetes. At the same time, exercise can also improve insulin sensitivity, promote blood sugar metabolism, and help control blood sugar levels. For patients with diabetic foot, moderate exercise can also enhance the strength and endurance of foot muscles, improve the foot's resistance to pressure and trauma, and reduce the risk of injury and infection. Therefore, reasonable exercise and proper foot care are essential for the health of diabetic patients.

Figure 1 Copyright image, no permission to reprint

1. What should diabetic patients pay special attention to when exercising?

1. Avoid exercise after insulin injection and before meals to prevent hypoglycemia.

2. It is not advisable to exercise when insulin is most effective, and patients should have a detailed understanding of the insulin they use.

3. The intensity of exercise should be based on one's ability. Start with low-intensity exercise, proceed step by step, and persist.

4. The main exercise method is aerobic exercise, such as Tai Chi, walking, climbing stairs, cycling, swimming, dancing or Yangko for the elderly.

5. The best time to exercise is 1 to 2 hours after a meal, not at dusk or at night, to prevent nocturnal hypoglycemia.

6. Choose appropriate shoes, socks and jackets.

7. It is advisable to be accompanied by someone when exercising. If you go out for exercise alone, you should carry a diabetes first aid card with you.

8. Carry candy with you so that you can replenish sugar in time when you experience symptoms of hypoglycemia such as dizziness and sweating.

9. If you experience any discomfort during exercise (such as palpitations, dizziness, shortness of breath, etc.), you should stop exercising and rest immediately.

2. How should diabetic patients take good care of their feet?

1. Foot soaking: Soak your feet in warm water at about 37℃ (below 40℃) for 5 to 10 minutes every night. Do not soak your feet for a long time. Use a thermometer to measure the water temperature before soaking your feet (if there is no thermometer, use the inside of your wrist or ask a family member to test the water temperature for you. The water temperature should not be too hot to feel hot). Avoid burns.

Figure 2 Copyright image, no permission to reprint

2. Taboos of foot soaking: Foot soaking is contraindicated in the following situations: damaged foot skin, history of coronary heart disease, heart failure, cerebral apoplexy, varicose veins of the lower limbs, simultaneous existence of neurological and ischemic lesions, tinea pedis and blackening of calluses, etc.

3. Towel selection: After soaking your feet, use a soft, absorbent, light-colored towel to dry them. People with dry skin can apply moisturizer, avoiding the spaces between the toes.

4. Daily inspection: Check the soles of feet and between toes every day for damage, blisters, tinea pedis, onychomycosis, calluses or corns. If there are any abnormalities, go to the diabetic foot specialist clinic for treatment.

5. About fungal infection: Patients with fungal infection will experience whitening, damage, and itching of the skin between the toes. They need to use antifungal drugs under the guidance of a doctor and are not allowed to take drugs privately. Shoes and socks should be exposed to the sun after washing.

6. Daily care: Use moisturizer for dry skin and urea cream for cracked skin.

7. About massage: Foot massage should be done once a day in the morning, noon and evening for 10 minutes each time. Massage from bottom to top with gentle movements to improve foot microcirculation.

8. About exercise: Exercise regularly. Bedridden patients can practice the "bicycle" movement in bed to improve circulation and prevent muscle atrophy.

9. About shoes: It is recommended to buy shoes in the afternoon, try them on with both feet at the same time, wear socks to try on shoes, and put on shoes slowly. Choose shoes of suitable size, round toe, non-slip, and good breathability. The sole should not be too thin, and the inside of the shoe should be 1 to 2 cm longer than the foot itself (it is better to put a little finger in the back of the shoe). Before wearing shoes, check whether there are rough seams or foreign objects in the shoes. Do not wear sandals with exposed toes, do not wear shoes barefoot, do not walk barefoot, and do not walk with only socks.

10. About the choice of socks: Choose light-colored, undamaged cotton socks. The sock openings should not be too loose or too tight. Change the socks every day. If necessary, use 5-toe socks.

11. About cutting toenails: Be sure to cut the toenails into a flat “—” shape.

12. If you have peripheral neuropathy or vascular disease: Do not use heating equipment such as hot water bottles, electric blankets, foot warmers, etc. Do not use fire, cupping, or moxibustion to prevent burns. Do not smoke.