Vitamin D, Diabetic Neuropathy and Depression in Women with Type 2 Diabetes

A recent study conducted at Loyola University highlighted the efficacy of Vitamin D supplementation in treating pain and depression in women with Type 2 Diabetes. In the news release, Todd Doyle, PhD, lead author and fellow at the Department of Psychiatry and Behavioral Neurosciences, Loyola University Chicago Stritch School of Medicine (SSOM), presented the research findings.

Study participants were given Vit. D supplementation of 50,000 IU every week for six months. The research focused on the effect of Vit. D supplementation on diabetic neuropathy and depression.

The pain experienced by Type 2 diabetics is most often due to neuropathy: nerve damage caused by diabetes and often described as shooting or burning pain in the legs and feet. In addition, sensory pain described as numbness and tingling may also be experienced in hands, fingers, feet and legs. People who have had diabetes for 25 years are more likely to experience neuropathy.

The experience of living with pain from neuropathy may cause clinical depression. Living with Type 2 Diabetes is also a factor in the diagnosis of depression.

The results of the study are as follows:

  • depression improved significantly following supplementation
  • at the start of the study, 61% of participants experienced burning or shooting pain in their legs and feet. 74% reported numbness and tingling in their hands, fingers and legs.
  • three and six months following Vit. D supplementation, participants reported a marked decrease in neuropathic and sensory pain

While the study looks very promising, Dr. Doyle admits that further research is needed. The National Institute of Nursing Research has provided funding for further study.

The typical over-the-counter Vit. D supplement contains 1000 IU Vit. D3 in 25 mcg. The 50,000 IU dosage used in the study is extremely difficult to meet using available over-the-counter supplements.

The current treatment for managing Type 2 Diabetes includes medication,  maintaining target blood sugar levels, eating a balanced diet and regular exercise. Fasting glucose levels for individuals with diabetes is 3.9 – 7.2 mmol/L. After meals, the level is less than 10 mmol/L.

If you are interested in the research findings and using Vit. D to alleviate symptoms of neuropathy and depression, talk it over with your doctor first.

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

What To Look For In A Foot Care Nurse

Who is a certified foot care nurse?

Only currently registered, licensed Registered Nurses, Registered Practical Nurses and Licensed Practical Nurses who have completed a certification course in Advanced Nursing Foot Care  can practice nursing foot care.  In Ontario, Canada, the public can access information on the College of Nurses of Ontario (CNO) website verifying the current standing of an RN or RPN to practice nursing in Ontario.  A certified foot care nurse should be able to produce a certificate of completion in Advanced Nursing Foot Care.  Don’t hesitate to ask to see it.

What services can I expect?

  • Obtain a medical/nursing history and be able to make correlations between medical conditions and medications as they apply to the overall health of the feet
  • Assessment of the feet
  • Toenail cleaning, clipping, filing
  • Removal of ingrown toenails
  •  Corn and callus reduction
  • Padding of tender areas
  • Foot massage
  • Assessment and recommendations for footwear
  • Assessment and recommendations for skin conditions such as tinea pedis and cellulitis

Who benefits from nursing foot care?

  • diabetics
  • people with rheumatoid arthritis
  • individuals with vision problems
  • individuals with mobility problems
  • anyone who is unable to self-treat conditions such as fungal and thickened toenails, corns, calluses, athlete’s foot (tinea pedis)

Payment and Coverage?

For Canadian veterans, nursing foot care is covered by the Department of Veterans Affairs (DVA).  Ask the foot care nurse if she/he is a DVA Provider.

There is a fee for service for certified nursing foot care services.  Some private insurance providers will cover a portion of the fee.  Nursing foot care services are an allowable income tax deduction.

Always obtain a receipt for payments made.  Make sure the foot care nurse includes their nursing license/registration number on the receipt.

Other Questions to Ask the Foot Care Nurse?

  1. How do you clean your instruments?  In Ontario, Canada, the Ministry of Health and Long-Term Care mandates that foot care instruments are to be sterilized by autoclave.  No other method of cleaning/disinfecting will thoroughly sterilize instruments.  Some foot care nurses still do not sterilize by autoclave.  Before the first visit, ask if their instruments are autoclaved.
  2. Frequency of visits?  Typically, visits are scheduled for every 6 weeks.  This may vary depending on individual clients.

Where to find a foot care nurse?

  • online – some certified foot care nurses have online listings, blogs
  • home healthcare agencies may provide certified nursing foot care as in-home visits or in clinics
  • your doctor may be able to make a referral
  • in Ontario, Canada, Community Care Access Centres (CCAC) have listings of certified foot care nurses
  • word of mouth

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

Why Athlete’s Foot Is Dangerous In Diabetes

Athlete’s Foot (tinea pedis) commonly occurs in diabetics.  Since the flaking and peeling skin symptomatic of this fungal infection can resemble large areas of dry skin, affected clients often mistake it for very dry skin.  At McDermott Footcare, monitoring the presence of Athlete’s Foot in diabetic clients is part of the routine, on-going assessment.

What does Athlete’s Foot look like?

The appearance of Athlete’s Foot was described in this earlier blog post (read here), but it bears repeating.

In its beginning stage, Athlete’s Foot shows up as flaky, scaly, peeling skin between the toes, most likely between the fourth and fifth toes.  There may also be  superficial cracking or fissures of the skin between the toes.  It may or may not be itchy.  It is odourless.  If there is a noticeable odour, this indicates a bacterial infection which is different from Athlete’s Foot but of equal concern.

The flaky, scaly area may spread down the soles of the foot.  As it spreads, the affected area often becomes reddened and may feel itchy or burning.  It may develop into moccasin-type Athlete’s Foot, covering an area that would typically be covered by a moccasin-type shoe.

Athlete’s Foot concerns for diabetics

Athlete’s Foot that remains untreated may cause abrasions, small cuts and bleeding in the skin.  This provides an opportunity to develop a bacterial infection known as cellulitis.

Cellulitis is a non-contagious bacterial infection that may occur secondary to Athlete’s Foot.  Diabetics are more prone to developing cellulitis because of a weakened immune system.  It is characterized by redness, swelling, warmth, tenderness and tightness of the skin in the affected area.  Oral antibiotics are prescribed as treatment.  If cellulitis does not respond well to antibiotic therapy, areas of blackened, necrotized or dead tissue may develop, which may result in amputation.

The circulatory system is weaker in people with diabetes.  Poor circulation causes weakening of the immune system, which causes increased risk of infection.  Any infection left untreated can be dangerous.  For a diabetic, the danger increases since unresolved infections in the feet and lower limbs are a leading cause of amputations.  That’s why even mild Athlete’s Foot becomes a concern.

Steps to prevent and treat Athlete’s Foot at home were addressed in a previous McDermott Footcare blog (read here).  It is important for everyone, but especially diabetics, to understand these steps for preventing the fungal infection.  For diabetics, the home remedies should be used as part of a comprehensive treatment plan which includes prescribed anti-fungal creams or ointment from your doctor.

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

Care of Corns and Calluses

Corns and calluses can cause much discomfort and frustration for clients seen by McDermott Footcare.  Clients often say that the pain caused by corns and calluses limits their participation in daily and social activities.

What is a corn?

A corn, or heloma, is a thickened area of dry skin that has a visible centre, or nucleus, at the area of greatest pressure.  It is caused by direct pressure from shoes upon a bony surface of the foot.  The centre, or nucleus, presses on nerve endings in the skin.  If it is large enough, it can be quite painful.

Soft corns form between toes, caused by direct pressure from neighbouring toes.
In this case, the skin between the toes is moist.

In the picture, two large, painful corns are visible – one on the ball of the foot underneath the third toe and one on the tip of the fourth toe.

What is a callus?

A callus (tyloma) is an area of hardened skin caused by shearing friction – a constant rubbing back and forth – over the heels, balls of the foot and along the sides of bony areas of the foot.  The hardened areas may be whitish, yellowish or brownish in colour.  The picture shows callus formation around the corn on the ball of the foot, on the area underneath the big toe, and on the side of the big toe.

Common Causes of Corns and Calluses

  • ill-fitting shoes are the biggest culprit – shoes that are too tight, too small, too big, too high, squish the toes, lack cushioning, have seams that rub against the foot
  • structural deformities of the foot such as hammertoes and bunions that rub against the inside of the shoe.  Part of the problem are shoes that don’t accommodate the deformity.
  • walking too much on the outside of the foot (oversupination)
  • walking too much on the inside of the foot (overpronation)

Preventing Corns and Calluses

  • wear supportive, well cushioned shoes that fit well.  Wear socks that absorb moisture.  For tips on buying shoes and socks, read here.
  • daily washing, exfoliating and moisturizing the feet
  • if overpronation or oversupination is a concern, a chiropodist or pedorthist can fit you with corrective orthotics

Home Remedies for Corns and Calluses

Home remedies for treating dry, cracked heels work well for getting rid of corns and calluses since both are caused by a build-up of dry skin.   Read 8 tips for dry, cracked heels here.

Avoid over-the-counter medicated corn and callus pads since the acid in these pads can irritate healthy skin around the affected area.  A u-shaped, unmedicated pad is fine for corns since it avoids putting direct pressure on the area. Using razor blades and other sharp objects to cut away corns or calluses is just plain unsafe…..enough said.

Corns and Calluses in Diabetics

Diabetics must be extra careful with corns and calluses.  Because of poor circulation and decreased nerve functioning in the feet, diabetics have an increased risk of infection from corns and calluses.  The same applies to anyone who is not diabetic but has poor circulation or decreased nerve sensitivity in the feet.   Self-care of corns, calluses and other foot problems could put you at risk for infections and trauma.  Seek out the care of a certified foot care nurse who is trained in diabetic foot care such as at McDermott Footcare.

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author