The diabetic patient must ever keep in mind his propensity for infection. Keeping the number of infections at a minimum is largely dependent upon the individual’s personal hygienic habits. Personal hygiene in the diabetic patient refers primarily to cleanliness. Careful and frequent cleansing of the skin should be emphasized. Immediate attention to all skin abrasions will often prevent serious sequelae.
George Thorn and Peter Forsham in Hormonal Disturbance also explain that the nails should be kept clean, but the cuticle should not be cute. All areas of pruritus should be kept clean, dry, and free from irritation. Good oral hygiene is
helpful in reducing tooth infection and in delaying the onset of the tooth decay. The lower extremities with their attendant vascular changes require a more special type of attention.Care of Feet. In patients with diabetes mellitus, arterial changes progress more rapidly than in nondiabetic persons. Among the vessels frequently affected are those of the extremities. Care and attention to the feet may prevent long periods of disability. Every patient with diabetes should be given careful instruction in this matter. Simple rules include:
1. Cleanliness: Was feet with warm, not hot or cold water and a
bland soap each morning. Dry thoroughly but gently between the toes. Then rub feet gently with rubbing alcohol. If the skin is dry, use lanolin or cocoa butter two or three times weekly.2. Wear clean hose, loosely fitting and without seams or wrinkles.
3. Insert lamb’s wool between overlapping toes.
4. Avoid injuries to feet.
5. Cut toenails cleanly and straight across with scissors and nail clippers, never with a knife and only after a foot bath.
6. In cold weather fleece-lined “stadium boots” are ideal footwear, being warm, nontraumatic, and inexpensive.
Pointed shoes and loose-fitting heels are dangerous and should be avoided. Corns are caused by ill-fitting shoes. Properly fitting shoes are most important, and protective pads are helpful. Corns should be treated only by an accredited chiropodist or surgeon. Epidemophytosis is best treated with cleanliness and appropriate mediated powder such as calcium propionate or undecylenic acid preparations. Special exercises and measures for improving the circulation of the feet are an invaluable adjunct in many elderly patients.