Diabetic Foot Care

As published in the Bothell/Kenmore Reporter, Capitol Hill Times, Kirkland Reporter, Northgate Journal and South Seattle Beacon

One out of four people with diabetes will have at least one foot ulcer in their lifetime. Two out of three non-traumatic amputations performed in the U.S.A. are on a person with diabetes. That’s the bad news.

The good news is that the majority of these amputations can be prevented. If you have had diabetes for more than six years, you may have lost some feeling in your feet. Since you may not feel your feet well, you can reduce your risk for ulcers and infections with regular foot inspections, which include:

  • Looking at the bottom of your feet daily for calluses, blisters, swelling, bleeding or ingrown toenails.
  • See your At-Risk Foot Specialist or primary care provider for any of these concerns
  • Controlling blood glucose
  • Maintaining normal blood pressure
  • Lowering bad cholesterol

Taking these measures can prevent foot problems that can cascade into serious infections ending in toe, foot or leg amputation, according to May Chang, ARNP (Advanced Registered Nurse Practitioner). Chang is the At-Risk Foot Specialist for the Foot and Ankle Clinic at Pacific Medical Centers. She sees patients regularly at many of our clinics.

Given that about 23 million people, roughly 15 percent of the United States population, have diabetes, a significant number of Americans need to be following a foot care plan that includes daily self foot exams. Foot problems usually are not evident in the first years after a person is diagnosed with diabetes. “It’s when blood sugar is uncontrolled for about seven years that we begin to see nerve damage in the feet,” said Chang. She explained that neuropathy or nerve damage is a common side effect of poorly controlled blood sugar that can result in a loss of feeling in the feet.

Many times a person with diabetes doesn’t realize that they have lost feeling in their feet and consequently may not realize when their feet are wounded. Chang explained why daily foot inspections are so important. “If you have lost feeling in your feet and are not wearing protective shoes when you get up to walk from the couch to the bathroom, you can step on a small sharp object that punctures your skin. Without looking at your feet, the injury can go unnoticed. A simple cut can quickly advance to become an infection if left untreated. The infection can then potentially reach bone. By then a surgical intervention may be needed,” she said.

While there are many foot clinics in the community, not many are staffed by someone like Chang who is a nurse practitioner trained in more than foot health. During the first visit Chang takes time to learn about each patient’s background history and overall health status, identify major risk factors, and then works with each patient to reduce risks and preserve foot function.

“I understand that patients can sometimes be overwhelmed by medical health advice. My goal is to meet each patient where they are at and gradually build on their knowledge base. Patients who have a high-risk foot are recommended to receive toenail care from an At-Risk Foot Specialist or a medical provider periodically. At these regular visits, I help patients identify deteriorating foot health and correct problems in its early stages. My job is to help patients keep their feet so they can continue to participate in life’s activities,” she said. Chang will coordinate care with each patient’s primary care provider to refer patients to endocrinologists, vascular specialists, neurologists, and diabetic educators as needed. It’s all part of the comprehensive approach PacMed clinicians take in treating patients with diabetes.

Pacific Medical Centers takes great pride in caring for their patients who have diabetes. The National Committee for Quality Assurance (NCQA) has recognized Pacific Medical Centers for consistently providing a high level of diabetes care for patients. To achieve this, PacMed submitted patient data to be audited against established criteria in 10 categories, such as HbA1c and blood pressure. While a passing score is 75 out of 100 points, PacMed scored a near perfect 95 points. The American Diabetes Association (ADA) and the NCQA have recognized over 30 individual physicians at Pacific Medical Centers for providing excellent diabetes care. These physicians are in the Diabetes Physician Recognition Program (DPRP) and are a part of an elite group of physicians that is publicly recognized for its skill in providing the highest-level diabetes care. You can see a complete list of our NCQA diabetes recognized physicians here.

May Chang is a certified Advanced Registered Nurse Practitioner. May received her education and training at the University of Washington. Click here for more information about May Chang, ARNP, PacMed's At-Risk Foot Specialist.

May L. Chang, ARNP

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