Counseling patients with diabetes on lifestyle change during primary care office visits is motivated by good intentions. We as primary care doctors are interested in prevention, lifestyle changes can positively affect many patients with diabetes, and patients do best when engaged in managing their disease1. But it’s difficult to show with data that brief physician encounters are effective at producing any of these outcomes. Continue reading “Diabetes Management: Why Can’t We Do This with Lifestyle Alone?”
Simon J. Griffin, DM, is professor of general practice at the University of Cambridge, Group Leader in the MRC Epidemiology Unit and an assistant general practitioner at Lensfield Medical Practice in Cambridge, UK. He leads the Prevention of Diabetes and Related Metabolic Disorders Programme. Professor Griffin’s research interests include prevention and early detection of chronic conditions such as diabetes.
Haywan Chiu, DPM, is a practicing podiatrist in Albuquerque, New Mexico. He has a special interest in the diabetic foot. Haywan runs Diabetic Foot Guardian, an easily digestible resource for patients regarding feet and diabetes.
Callus Debridement Can Be Diagnostic
Calluses form when shear forces and pressure induce the epidermis to reinforce itself. In patients with diminished pain sensation such as in diabetic neuropathy, continued friction from shear forces and pressure evolves the callus into a blister, then a blood blister (figure 1). When I see a bloody foot callus, I know that at some point, there was a break in the dermis. I don’t know if it has healed on its own or if it has expanded into a full blown ulcer because I can’t see past the callus. In fact, some calluses can be so thick I can’t even see the blood underneath! The only way to find out what’s hiding is to debride the callus.