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Diet For Diabetic Foot Patient

Systemic Nutritional Interventions For Treating Foot Ulcers In People With Diabetes

Systemic Nutritional Interventions For Treating Foot Ulcers In People With Diabetes

Systemic nutritional interventions for treating foot ulcers in people with diabetes Mater Misericordiae University Hospital, Department of Endocrinology, Dublin, Ireland Meave Anne Corcoran, Department of Endocrinology, Mater Misericordiae University Hospital, 30 Eccles Street, Dublin, Dublin 7, Ireland. [email protected] . Cited by (CrossRef): 0 articles Check for updates This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the effects of systemic nutritional interventions on the healing of foot ulcers in people with diabetes, in people of any age, in any care setting, with either type 1 or type 2 diabetes. A Diabetic foot ulcer (DFU) is a non-healing or poorly healing, partial or full thickness wound below the ankle, in an individual with diabetes ( Lavery 2008 ; Sanders 2011 ). Foot ulcers in people with diabetes are diagnosed by taking a history and a physical examination combined with monofilament testing for neuropathy and non-invasive testing for arterial insufficiency ( Armstrong 1998 ; Kruse 2006 ). People with diabetes may have either neuropathic, arterial or venous components to their ulcer, or a combination of all three ( Nelzen 1993 ). Neuropathy is a disease affecting nerves, with the symptoms dependent on whether motor, sensory or autonomic nerves are affected ( Marcovitch 2006 ). Long standing hyperglycaemia results in nerve damage associated with autonomic, sensory and motor neuropathy. All three categories of neuropathy can be found in people with diabetes: sensory neuropathy causes a loss of pain sensation; autonomic neuropathy can cause either anhydrosis (dry skin) or hyperhidrosis (excessive sweat), both of which affect skin quality; and motor neuropathy causes weakness of muscles and structural ch Continue reading >>

Nutrition In Patients With Diabetes

Nutrition In Patients With Diabetes

Background Diabetes is a chronic illness that requires a holistic approach in terms of care to prevent both acute and long-term complications. Nutritional management for diabetic patients has been evolving for 100 years as the pathophysiological basis of the complications incurred from diabetes becomes more explicit. Medical nutrition therapy is extremely important for diabetic patients and prediabetic patients so that adequate glycemic control can be achieved. One-on-one consultations with a registered dietician well-versed in diabetic nutrition are most preferable, as has been shown in studies performed in Pakistan [1] and Hungary, [2] which proved the utility of a dietician in improving dietary adherence. Nutrition counseling should be sensitive to the personal needs of the patient and how much effort the patient is willing to put in to making the change to eating appropriately. Medical nutrition therapy for diabetics can be divided into (1) dietary interventions and (2) physical activity. Lifestyle and dietary modifications form the cornerstone of therapy in type 2 diabetic patients (insulin resistance). In type 1 diabetic patients, who have an insulin deficiency, a balance between insulin and nutrition needs to be obtained for optimal glycemic control. [3] Continue reading >>

Nutrition 411: The Diabetic Foot Ulcer — Can Diet Make A Difference?

Nutrition 411: The Diabetic Foot Ulcer — Can Diet Make A Difference?

The statistics are shocking: 25.8 million Americans, or 8.3% of the population of the US, has been diagnosed with diabetes.1 Among the complications of the disease are diabetic foot ulcers (DFUs), which affect as many as 20% of patients with diabetes during their lifetime.2 DFUs can significantly impair a patient’s quality of life, require prolonged hospitalization, involve infection and gangrene, and may ultimately result in amputation. The National Pressure Ulcer Advisory Panel (NPUAP) has established evidence-based nutrition recommendations for the prevention and treatment of pressure ulcers. These guidelines focus on increasing micro- and macronutrients to promote wound healing.3 Unfortunately, no such guidelines exist for treating DFUs, and it is unclear if recommendations for pressure ulcers can be extrapolated to DFUs. However, it appears that nutrition does play an important role. A poor diet can result in altered immune function, malnutrition, and poor glycemic control, all of which are risk factors for poor healing.4,5 Achieving and maintaining a healthy body weight can help maximize wound healing because glycemic control can be negatively affected by obesity.6 Healthcare professionals (HCPs) should encourage patients with DFUs to consume a healthy diet that contains nutrient-dense foods. A registered dietitian (RD) skilled in medical nutrition therapy for diabetes can assess, treat, and monitor patients with DFUs to help them meet their complex nutritional needs. Immune Function and Malnutrition Compromised immune function is one factor associated with nonhealing wounds; it affects wound healing in a number of ways.4 Protein-energy malnutrition is associated with impaired immunocompetence, including depressed cell-mediated immunity and phagocyte dysfunction Continue reading >>

Better Nutrition Boosts Diabetic Foot Outcomes

Better Nutrition Boosts Diabetic Foot Outcomes

The evidence documenting the role of nutrition in improving wound healing and neuropathy symptoms hasn’t been widely publicized, particularly among lower extremity healthcare practitioners. But getting that information to your diabetic patients could help save their feet. Practitioners who care for diabetic patients with neuropathy and an elevated risk of foot ulcers tend to agree on one thing: there is no one-treatment-fits-all solution. It takes a team of specialists working together, assessing patients one by one, to arrive at an effective treatment plan. And what lower extremity practitioners may not realize is that nutrition is a key part of that multidisciplinary equation. “What we don’t do well in medicine is evaluate nutritional status,” said David Armstrong, DPM, MD, PhD, professor of surgery and director of the Southern Arizona Limb Salvage Alliance at the University of Arizona in Tucson. “It is to our patients’ detriment that we don’t focus on this. If we ignore our feet, they’re going to go away. And by ignoring our nutrition, maybe we’re ignoring our feet. Whether we’ve taken it seriously in medical or nursing school, I think it’s important that we focus on it as we practice and in the research we do.” For patients with diabetes, evaluating nutritional status starts with evaluating blood glucose levels, which can affect both peripheral neuropathy and wound healing. But even blood sugar management requires more than a cookie-cutter approach, according to Wanda Howell, PhD, RD, university distinguished professor of nutrition science at the University of Arizona. “The emphasis for everybody on a team is to work with people, and follow up over the course of their management of diabetes to try to bring blood sugar within a reasonable ra Continue reading >>

With Proper Diet And Foot Care, Diabetes Patients Can Keep Feet Healthy

With Proper Diet And Foot Care, Diabetes Patients Can Keep Feet Healthy

With proper diet and foot care, diabetes patients can keep feet healthy Dr. Renu Joshi, chief of endocrinology with the PinnacleHealth System, said good diabetes control can help prevent neuropathy and foot problems. Submitted photo For John Lentz, a minor foot injury led to major surgery. The 71-year-old has had diabetes for 37 years. An accident in 1999 lead to an amputation, and the surgeries have snowballed from there. I stepped on a small nail that went into my shoe, said the Hampden Twp. resident, recalling the accident. It hit between my second and third toe and got infected. Doctors couldnt save it. Since that first amputation, Lentz has had about 25 operations, including the loss of all toes and his right leg above his knee. According to Dr. Renu Joshi, chief of endocrinology with the PinnacleHealth System , diabetic foot disease is the No. 1 cause of foot disease in the country. Because of their high blood sugars, diabetics have poor circulation in both large and small blood vessels. Without proper blood supply to the feet, if you get ulcers, they wont heal, Joshi said. Plus, the high sugars cause bacteria, so you get infections. Diabetes also causes neuropathy, or nerve damage: They lose sensation to their extremities, especially their feet, said Dr. Allan Grossman, podiatrist at Harrisburg Foot & Ankle Centers locations in Lower Paxton and Hampden townships. They have no protective sense. Literally, they could break their foot, ankle or leg and not even know it. Without proper blood-sugar control, 70 percent to 80 percent of diabetics develop neuropathy after 10 to 15 years and after 20 years it jumps to 100 percent, Joshi said. Prevention, agreed the experts, is the best way to protect diabetic feet. Number one, two, three and four is good diabetes care, s Continue reading >>

Understanding How Your Diet Affects Diabetic Foot Pain

Understanding How Your Diet Affects Diabetic Foot Pain

Our talented and compassionate doctors all have clinical appointments at the Mt Sinai School of Medicine or are part of the Mt. Sinai Beth Israel Faculty practice. As the official podiatrists for the NYC Triathlon, Hamptons Marathon, Bridgehampton Half and NY Lizards, we know the needs and concerns of runners, triathletes, and other athletes. Dr. Geldwert is now seeing patients at Manhattan Orthopedic and Sports Medicine at 57 West 57th Street on Wednesdays between 8:30am and 12:30pm At the Center for Podiatric Care and Sports Medicine, our only goal is to get you walking, running, biking, hiking, or whatever you enjoy- without pain. Understanding How Your Diet Affects Diabetic Foot Pain Posted by Jenn F. on Monday, July 10th, 2017 Foot pain is a reality for many people with diabetes, but it doesnt have to be that way, according to the NYC foot and ankle specialists at The Center For Podiatric Care and Sports Medicine. Fortunately, some of the most natural treatments also happen to be some of the most successful at the long-term management of diabetic foot pain, says Dr. Josef J. Geldwert. Today, we explore the types of diabetic foot pain and the role your diet plays in alleviating the symptoms. Food is a diabetics best weapon against inflammation and high blood sugar. Image Source: Pixabay user jill111. Individuals with diabetes may suffer from: Peripheral Neuropathy : Aburning, tingling, and/or numbness of the hands, feet, and lower legs due to peripheral nerve damage. Neuropathy develops in response to chronic inflammation of the nerves and constant exposure to high blood glucose levels. Plantar Fasciitis : Inflammation and damage to the connective tissue running from the heel along the arch of the foot, which results in a stabbing pain (particularly after periods o Continue reading >>

Nutrition And Wound Care

Nutrition And Wound Care

Today’s Dietitian Vol. 11 No. 8 P. 12 Diabetes educators routinely talk to patients with diabetes about daily foot care, but what role do nutrition professionals play in preventing and treating wounds in these individuals? According to the American Diabetes Association (ADA), the disease affects nearly 8% of the U.S. population, and its prevalence increased 13.5% from 2005 to 2007. Optimum diabetes management has been shown to minimize the risk of complications such as retinopathy, nephropathy, neuropathy, ischemic heart disease, cerebrovascular disease, and peripheral arterial disease. About 60% to 70% of people with diabetes have some type of nervous system damage that can include impaired sensation in the extremities. More than 60% of all nontraumatic lower limb amputations are performed on people with diabetes, a rate 10 times higher than for people without diabetes, according to the ADA. The circulation and nerve damage that often occur in diabetes combine to make wound healing more problematic, leading many physicians to categorize diabetic foot wounds as the most common chronic wounds in the world. Even more frightening for people with diabetes, one half of amputees die within 18 months, and 80% won’t survive five years, according to a 2008 Diabetes Forecast article. According to Nancy Collins, PhD, RD, LD/N, FAPWCA, founder and executive director of RD411.com and a recognized authority on nutrition and wound care, there are no evidence-based nutrition therapy guidelines for diabetic wound care. But we can extrapolate appropriate therapy using research and guidelines for other types of wounds, especially pressure ulcers. The National Pressure Ulcer Advisory Panel (NPUAP) released a white paper on the role of nutrition in pressure ulcer prevention and treatmen Continue reading >>

Diabetes Diet And Exercise

Diabetes Diet And Exercise

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. Interventions aimed at increasing exercise combined with diet have been shown to decrease the incidence of type 2 diabetes mellitus in high-risk groups (people with impaired glucose tolerance or the metabolic syndrome).[1]However, there are no high-quality data on the efficacy of dietary intervention for the prevention of type 2 diabetes.[2]Exercise appears to improve glycated haemoglobin at six and twelve months in people with type 2 diabetes.[3] Nutritional advice and information are essential for the effective management of type 1 diabetes. Exercise reduces mortality in type 1 diabetes and can reduce HbA1c by 0.7% in type 2 diabetes.[4] See also the separate Healthy Diet and Enjoyable Eating article. The goals of dietary advice are: To maintain or improve health through the use of appropriate and healthy food choices. To achieve and maintain optimal metabolic and physiological outcomes, including: Reduction of risk for microvascular disease by achieving near normal glycaemia without undue risk of hypoglycaemia. Reduction of risk of macrovascular disease, including management of body weight, dyslipidaemia and hypertension. To optimise outcomes in diabetic nephropathy and in any other associated disorder. Eat three meals a day. Avoid skipping meals and space breakfast, lunch and evening meal out over the day. At each meal include starchy carbohydrate foods - eg, bread, pasta, chapatis, potatoes, yam, noodles, rice and cereals. Eat more slowly absorbed (l Continue reading >>

Diabetic Ulcers Treatment & Management

Diabetic Ulcers Treatment & Management

LYRICA is contraindicated in patients with known hypersensitivity to pregabalin or any of its other components. Angioedema and hypersensitivity reactions have occurred in patients receiving pregabalin therapy. There have been postmarketing reports of hypersensitivity in patients shortly after initiation of treatment with LYRICA. Adverse reactions included skin redness, blisters, hives, rash, dyspnea, and wheezing. Discontinue LYRICA immediately in patients with these symptoms. There have been postmarketing reports of angioedema in patients during initial and chronic treatment with LYRICA. Specific symptoms included swelling of the face, mouth (tongue, lips, and gums), and neck (throat and larynx). There were reports of life-threatening angioedema with respiratory compromise requiring emergency treatment. Discontinue LYRICA immediately in patients with these symptoms. Antiepileptic drugs (AEDs) including LYRICA increase the risk of suicidal thoughts or behavior in patients taking AEDs for any indication. Monitor patients treated with any AED for any indication for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. Pooled analyses showed clinical trial patients taking an AED had approximately twice the risk of suicidal thoughts or behavior than placebo-treated patients. The estimated incidence rate of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% among 16,029 placebo-treated patients, representing an increase of approximately one patient for every 530 patients treated with an AED. The most common adverse reactions across all LYRICA clinical trials are dizziness, somnolence, dry mouth, edema, blurred vision, weight gain, constipation, euphoric mood, balance Continue reading >>

Nutritional Supplementation For Diabetic Foot Ulcers: The First Rct.

Nutritional Supplementation For Diabetic Foot Ulcers: The First Rct.

Abstract OBJECTIVE: To determine if oral nutritional supplementation improved wound healing in malnourished patients with diabetic foot ulcers when compared with a placebo. METHOD: This prospective randomised controlled double-blind trial involved patients aged over 60 with diabetes mellitus and a Wagner grade I-II foot ulcer of over four weeks' duration. Patients received either 400 ml (400 kcal) oral nutritional supplementation (n = 26) or 400 ml placebo (n = 27) daily for six months. Patients were followed monthly for six months and after one and two years. RESULTS: A third of the patients were classified as having protein-energy malnutrition at inclusion, with no difference between the two groups. Critical leg ischaemia was more common in the intervention group than in the placebo group (p = 0.008). Nine patients in the intervention group (35%) and four in the placebo group (15%) dropped out of the study (not significant). Of those who completed the study, the wound had healed at six months in eight out of 23 patients (41%) (placebo) and in seven out of 17 (35%) (intervention) (not significant). Twenty-four per cent of patients with protein-energy malnutrition at inclusion had healed at six months compared with 50% of those without it (not significant). CONCLUSION: This is the first study to evaluate the possible benefits of nutritional supplementation on diabetic foot ulcers. A third of patients were malnourished. We encountered several methodological problems and were unable to demonstrate an improved wound healing rate in these patients. Continue reading >>

Diabetic Wound Care: 3 Foods For Improved Blood Flow

Diabetic Wound Care: 3 Foods For Improved Blood Flow

Ginger can help improve circulation while adding flavor to tea, rice and other foods. Many people may not realize it, but blood flow is an important factor in the wound healing process. Diabetics often suffer from poor circulation, and this can result in a loss of sensation in the extremities. In such cases, someone may not notice if he or she has a lesion on the foot, and by not properly caring for the wound can experience infection that becomes gangrenous and requires amputation. Even for those without diabetes, good circulation is essential for the wound site to receive an ample amount of vitamins, nutrients and protective white blood cells. Exercising regularly is important to maintaining healthy circulation, as is being mindful of the foods you eat. Some fruits, vegetables, spices and other edibles are great for improving blood flow, and they can be integrated into the meals you eat everyday in tasty ways. Take a look at these circulation-boosting foods and how to incorporate them into your diet: Ginger Many Americans know of ginger as the flavoring in a large number of Asian dishes as well as in holiday cookies. The root of the ginger plant has been ground up and used as a popular spice for thousands of years, and it has also been utilized for its medicinal purposes. The ancient Chinese used ginger for nausea, diarrhea and other digestive issues, according to the University of Maryland Medical Center. More recently, it has been found to help maintain healthy blood pressure levels, which is particularly important for people with diabetes and for wound healing. To incorporate ginger into your diet, add it to: Tea: Grate a teaspoon or two of fresh ginger root into your tea with lemon juice and honey to taste. Rice: Add grated ginger to the water before boiling and ad Continue reading >>

Diabetic Wound Healing Through Nutrition And Glycemic Control

Diabetic Wound Healing Through Nutrition And Glycemic Control

Diabetes has quickly become one of the most complex health challenges of the 21st century. In 2010, a total of 10.9 million US residents ages 65 years and older were reported to be living with diabetes.1 Currently, it is the seventh-leading cause of death in the US, totaling 4.6 million deaths in 2011 (with healthcare expenditures reaching more than $471 billion.)2 A condition that increases one’s risk for heart disease and stroke, diabetes is also the leading cause of kidney failure, new cases of blindness among adults, and non-traumatic lower-limb amputations. Approximately 15% of individuals who live with diabetes develop a foot ulcer, and 84% of this population will end up with lower-leg amputations.3 Several factors can disrupt wound healing. Without proper nutrition, a normal wound can rapidly become a chronic, infected wound. However, it is possible for wound care providers to reduce the huge economic burden and life-threatening complications of diabetes by implementing timely, easy-to-use interventions. Comprehensive diet and nutrition management have been shown to promote optimal glycemic control and facilitate wound prevention and healing. As such, all healthcare professionals should know how to adequately manage blood glucose levels to support wound healing in patients living with diabetes. This article explains how uncontrolled blood sugar impairs wound healing and offers practical nutrition recommendations and guidelines that promote healing, as well as simple suggestions to prevent further complications and comorbidities. Effect of Diabetes Diabetes often causes slow-healing wounds that can worsen rapidly — with elevated blood glucose levels serving as the initial barrier to healing. Thus, achieving optimal glycemic control is imperative. Hyperglycemia Continue reading >>

Nutrition Can Aid In Healing Diabetic Foot Ulcers

Nutrition Can Aid In Healing Diabetic Foot Ulcers

Nutrition can aid in healing diabetic foot ulcers Please provide your email address to receive an email when new articles are posted on this topic. Receive an email when new articles are posted on this topic. In this issue, Susan Weiner, MS, RDN, CDE, CDN, talks with nutrition and wound care expert Nancy Collins, PhD, RDN, LD, NWCC, FAND, about the role of nutrition in prevention and treatment of diabetic foot ulcers. Nutrition is a critical component of healing diabetic foot ulcers, particularly as it relates to immune function, malnutrition, glycemic control, and weight loss and weight maintenance. Diabetes educators should include nutrition assessment and intervention as key components of the overall diabetes treatment plan to help patients with diabetic foot ulcers maximize their nutritional status and promote wound healing. Nutrition is not often the first thing clinicians think of when dealing with diabetic foot ulcers. How important is it, and exactly what role does nutrition play? Collins: Nutrition does indeed play an important role in the prevention and treatment of diabetic foot ulcers. A poor diet can result in altered immune function, malnutrition and poor glycemic control, all of which are risk factors for poor healing. Malnutrition and nutrient deficiencies can impair collagen synthesis, prolong inflammation, decrease phagocytosis causing dysfunction of B and T cells, and decrease the mechanical strength of the skin. Once a patient has a wound, achieving and maintaining a healthy body weight can help maximize wound healing because obesity can negatively affect glycemic control. Often just losing extra weight can help with glucose control and, in turn, wound healing. Of course, weight loss proves very challenging for most patients. This is where referral Continue reading >>

Foods & Wound Healing

Foods & Wound Healing

People with diabetes do not heal as efficiently as people with normal blood sugar levels. Certain foods can also help keep your blood sugar optimal. Protein helps to repair tissue: Fish Shellfish Eggs (egg whites have protein and no cholesterol) Cheese (low fat is better for your heart) Poultry Lean meat Nut butters (peanut butter, almond butter, cashew butter, etc.) Carbohydrates give you energy: Starch (bread – whole grains are best – cereal, noodles, rice, barley, kasha) Starchy vegetables (sweet or white potatoes, corn, peas, beans) Non-starchy vegetables (broccoli, green beans, asparagus, salad greens) Fruit Milk (drinking milk, soymilk or yogurt) Fat allows you to absorb your fat soluble vitamins – A, D, E, K: Oil (olive and canola oil are best for your heart) Nuts (are good for your heart and health) Avocado (is good for your heart) Margarine (pick one without trans fat) Butter (use more sparingly) The following vitamins are excellent to heal wounds most efficiently: Vitamin C – foods with high levels: Peppers (especially red) Kiwi fruit Tomatoes Citrus fruits (oranges, grapefruits) Broccoli Vitamin A – foods with high levels: Orange colored fruits/vegetables Dark green leafy vegetables Vitamin E – foods with high levels: Whole grains Wheat germ Dark leafy green vegetables Eggs** Nuts and seeds Vitamin B – foods with high levels: Whole grains (wheat and oats) Fish and seafood Poultry and meat Eggs** Zinc – foods with high levels: Oysters (very high) Protein Beans ** Egg yolks contain vitamins and cholesterol while egg whites contain protein The goal of Destination Diabetes is to be a useful and credible resource for the more than 20 million children and adults who have diabetes in the U.S. and their families. Destination Diabetes provides informat Continue reading >>

With Proper Diet And Foot Care, Diabetes Patients Can Keep Feet Healthy

With Proper Diet And Foot Care, Diabetes Patients Can Keep Feet Healthy

With proper diet and foot care, diabetes patients can keep feet healthy Dr. Renu Joshi, chief of endocrinology with the PinnacleHealth System, said good diabetes control can help prevent neuropathy and foot problems. Submitted photo For John Lentz, a minor foot injury led to major surgery. The 71-year-old has had diabetes for 37 years. An accident in 1999 lead to an amputation, and the surgeries have snowballed from there. I stepped on a small nail that went into my shoe, said the Hampden Twp. resident, recalling the accident. It hit between my second and third toe and got infected. Doctors couldnt save it. Since that first amputation, Lentz has had about 25 operations, including the loss of all toes and his right leg above his knee. According to Dr. Renu Joshi, chief of endocrinology with the PinnacleHealth System , diabetic foot disease is the No. 1 cause of foot disease in the country. Because of their high blood sugars, diabetics have poor circulation in both large and small blood vessels. Without proper blood supply to the feet, if you get ulcers, they wont heal, Joshi said. Plus, the high sugars cause bacteria, so you get infections. Diabetes also causes neuropathy, or nerve damage: They lose sensation to their extremities, especially their feet, said Dr. Allan Grossman, podiatrist at Harrisburg Foot & Ankle Centers locations in Lower Paxton and Hampden townships. They have no protective sense. Literally, they could break their foot, ankle or leg and not even know it. Without proper blood-sugar control, 70 percent to 80 percent of diabetics develop neuropathy after 10 to 15 years and after 20 years it jumps to 100 percent, Joshi said. Prevention, agreed the experts, is the best way to protect diabetic feet. Number one, two, three and four is good diabetes care, s Continue reading >>

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