By Ann S. Williams, Ph.D., RN, CDE
Listen to Living with Diabetes and Visual Impairment—Reducing Risks Audio
Complications resulting from diabetes are highly preventable, but make no mistake, diabetes is a very serious condition with severe consequences if not managed carefully. Taking the steps necessary to reduce the risks associated with having diabetes means preventing diabetes emergencies—both low blood glucose levels, possibly with loss of consciousness, and high blood glucose levels, possibly with DKA (diabetic ketoacidosis) or HHNS (hyperglycemic hyperosmolar nonketotic syndrome). Reducing risk also means preventing long-term complications, the most common being heart disease, stroke, kidney failure, visual impairment, damage to nerves in the internal organs, nerve damage in the feet and hands, and impaired circulation in the feet, which can potentially lead to infection and amputation.
Avoiding these complications begins with careful monitoring of your blood glucose, blood pressure, and cholesterol, along with keeping accurate records of monitoring done at home and lab tests done by your doctor. If you smoke, stop. And remember to keep up with your regular medical appointments so that your doctor can monitor your diabetes and check for early signs of complications. In addition, prevention of problems includes planning ahead for sick days, considering diabetes management when traveling, and being prepared for unforeseen disasters, such as hurricanes, floods, fires, and power outages.
For the most part, diabetes patients with visual impairments reduce risks in the same ways that fully sighted people do; the only difference is a reliance on vision loss adaptations such as large print record logs and talking monitoring equipment. The one area in which special adaptive skills are necessary is foot care.
Best Foot Forward
Avoiding infection is paramount when dealing with diabetes, and feet are especially vulnerable because of the daily punishment we inflict upon them. They must be protected with well-fitted shoes, kept clean and dried thoroughly after baths and showers, and, for many people, the skin must be softened with lotions to avoid cracking. This care is the same for people with vision loss as it is for fully sighted people. Other tasks can present more of a challenge.
Small cuts on the foot can become easily infected, so people with diabetes need to cut toenails very carefully. With visual impairment, it may be easier to accidentally cut the toes, especially if the nerves to the feet are damaged and the feet are numb. Therefore, foot care specialists strongly recommend that people with visual impairment have their toenails cut by a podiatrist, which has the added advantage of giving the person frequent expert foot inspection. Medicare and most health insurance cover cutting of toenails for people with diabetes and visual impairment.
Daily Foot Inspection
All people with diabetes should inspect their feet daily, looking for blisters, cuts, scratches, corns, calluses, and any change from the previous day. For fully sighted people, this is usually done by looking at the top, sides, and bottom of the feet, and between the toes. People with reliable low vision can use a lighted magnifying mirror to inspect their feet.
If you cannot rely on your vision to see problems on your feet, you can make use of your other senses, such as your sense of smell. When you remove your shoes and socks, notice the smell of your feet. An exceptionally bad smell on the feet is often associated with an infection. Sometimes the smell of the feet changes before any other sign of an infection is present.
You can also rely on your sense of touch. Follow these steps to do a tactile foot inspection:
- Sit and lift a bare foot to your lap, or stand and place your foot on a chair.
- Using the balls of your fingers and thumbs, search your feet for irregularities of texture and differences in the shape of your toes and feet from the way they felt the previous day.
- Beginning with the large toe, feel the sides, top, and bottom of the toe, then the space between the large toe and the next toe.
- Continue feeling the remaining toes.
- Move your hand to the outside edge of the foot, the heel, and the inside edge of the foot.
- Feel the entire surface of the top of the foot and the sole of the foot.
- Finally, turn your hand over. The back of the hand is more highly sensitive to temperature changes. You can use it to find any spots that are unusually warm, which may indicate an inflammation.
- Feel the entire top and bottom surfaces of your foot and toes, and the sides of your foot with the back of your hand.
- Repeat this entire process with your other foot.
If your foot inspection turns up anything unusual, call your podiatrist or doctor right away! Small problems unattended can turn into big problems, so be sure to take care of small cuts, blisters, corns, and calluses while they are still small and easy to heal.