Generally the initial source of diabetes supplies and diabetes testing supplies will vary depending on the country you are in.  In most developing countries, the doctor that sees you for your diabetes will also dispense the medicines as well as the testing and monitoring materials for diabetes.  Developed countries, however, have a tendency to separate prescribing and dispensing functions.  Thus the doctor will see you and advise you on your diabetes, and he will write a prescription for you to fill at the local or nearby pharmacy.  This second practice does tend to make the cost of your treatment much higher as both the doctor and the pharmacist will have to make a profit.

While the initial costs of consultations and diabetes supplies may be affordable, the fact that this is an ongoing process (your diabetes is not going to get cured) ultimately can create a sizeable dent in your pocket.  Many a time the long-term cost of diabetes supplies and diabetes testing supplies will force one to re-evaluate and adjust one’s spending on other essential items in the monthly budget, especially if one is not covered by insurance.

Because of this need to economize, there have sprung up a great deal of pharmacies, both online and offline, that deal with diabetic supplies as well as diabetic testing supplies, and offer cheap prices, claiming lower overheads allow them to do so.

It is important to ensure that what you are getting is the real thing.  While diabetic testing supplies are rarely fake,  because the technology needed to produce these is more complicated, diabetes supplies can be fake.  What looks like real Diamicron or Glucophage, for example (to quote the two more popular diabetic drugs), could easily be corn starch tablets wrapped convincingly in a genuine-looking blister strip.

It is thus crucial that your supplier is trustworthy and real.  Ensure that your supplier does not operate from a P.O. Box.  One way to test that your supplier is real is to ask for a contact number (usually a 1-800 number) that you can call and test.  Ask relevant questions to ensure that your supplier knows about your order and is knowledgeable about details of your medicines.  Ensure that your supplier has an address near you, as the shipping costs can be quite high, and if your supplier ships from overseas, your order may be held in customs because of laws banning the import of medications without an approved license.

Certain diabetic supplies need to be kept in a cold chain that cannot be broken.  For example, insulin needs to be kept at a certain cold temperature all throughout transport.  Any break in this chain will render the insulin useless.  Check that your diabetes supplies company can observe this cold chain.

Thus when one refers to foot care in diabetics, one has to be aware of possible complications that can come on in the feet as a result of the disease, and take steps toward preventing them from occurring and if they have occurred, to limit the worsening of this problem.

1. Examine your feet daily.  Are there areas of numbness or coldness?  Are there any cracks in the skin, infected oozy or pussy areas, especially in the soles or the toes?  If there are any, get medical help as soon as possible.  Infected areas can worsen, and spread either to involve the whole limb or inwards to affect the bone, causing chronic osteomyelitis, a chronic bone infection which is difficult and often virtually impossible to cure.

2. Keep the skin of your feet smooth, free of cracks and mildly moisturised.  Dry cracked skin can allow the entry of organisms and infection. 

3.  Ensure that your toenails are well trimmed and cut square at the edge to prevent damage to the nail folds. 

4. Ensure that you do not wear shoes that are too tight that will predispose to fungal infections in between the toes because of the humid environment.

5. Thickened skin, corns and calluses need to be taken care of well.  Often one tends to file down corns carelessly, resulting in injury and subsequent infection.  Or one uses corn plasters that cause maceration of the skin and allow infection to set in.

6. Wear well fitting thick absorbent socks as these will help absorb any moisture and also prevent injury.

7. In the event of any occurrence of numbness of the sole (diabetic neuropathy), as can be quite common in diabetics, extra foot care is essential to prevent injury.  Injury is very common as the sole is totally numb and the pain of injury cannot be felt.  One becomes totally unaware of any injury and continues aggravating it, and because of neglect, the wound gets infected.  Wounds in the numb soles do not heal well and the chances are high of these becoming chronic infected ulcers.  Never walk barefooted as the chances of injury are much higher.  Do not wear open slippers as the chances of injuring the toes are higher.

8. Washing of feet.  Use warm water, not hot.  Hot water can cause blistering and subsequent wound infection.  Similarly in some diabetics with numb feet, hot water may damage the skin without the patient being unaware of it.

What happens to infected areas or injuries to the feet?  Injuries can get infected.  Infection spreads, either to surrounding soft tissues (a condition known as cellulitis), or via the lymphatics to the draining lymphnodes with inward spread of infection up from toes to the hip and beyond, or into the bone with resultant osteomyelitis.  Treatment of these complications is with antibiotics, and unfortunately in a lot of cases, especially those with bone infection, the only way to solve the problem is by amputation of the affected part as antibiotics may not work well.  Sometimes amputation has to be progressively more and more inward such as from toe to forefoot to the whole foot, to the ankle, the lower leg, the knee and the thigh.  This is because infection can spread progressively deeper and deeper.

1. Controlling the blood sugar
2. Prevention of complications
3. Management of complications as and when they occur.

The ultimate purpose of the above is to ensure long term survival with as few complications as possible.  To that end one needs to identify the various organs/systems that tend to be more affected in diabetes, especially uncontrolled diabetes and to try to prevent problems, or at the very least, delay the onset of problems, and if they do occur, to manage them.

Diabetes is a multi-organ problem as far as complications are concerned.  The major more common areas that are affected are:

1. The central nervous system
2. The skin
3. The kidneys
4. The eyes
5. The limbs
6. The heart

These will be dealt with in other posts.

However it is important that you take certain steps at work so that your diabetic control remains stable. Your diabetes must not suffer because of your work, and your work must not suffer because of your diabetes.

1.  Make sure you take your medicines to work.  Wear, if possible, medical identification tags such as bracelets or pendants that identify you as diabetic.
2.  Your diabetec dosage of medicines should remain the same at work or at home.
3.  Ensure that your food intake does not vary too much at work.  Going hungry, missing out on your meals during work with resultant hypoglycemia is not an option.
4.  Make sure some trusted colleagues or your boss knows you are diabetic just in case you get hypoglycemic.
5.  If you know you are going to miss out on meals, cut down slightly on your medication for that episode.  It is probably far better to have a slightly higher blood sugar than a low sugar.
6.  Have some glucose source in your pocket for emergency use just in case you become hypoglycemic.  Some people stock glucose tablets, others stock liquid glucose.
7.  Ensure that some responsible persons at work can recognise symptoms of hypoglycemia in you, such as hunger, sweating, trembling, mild confusion, and know how to treat for it.
8.  Have regular medical checks so that early complications of diabetes can be detected and are not allowed to interfere with your work.

A shortened version of the illness Diabetes Mellitus. A condition where there is an excess of glucose in the blood, due primarily either to the body being unable to produce enough insulin to manage this glucose or the inability of the body to utilise this insulin.

This illness is so common. The World Health Organisation estimates that currently there are about 246 million people worldwide suffering from diabetes. Figures are estimated to reach 380 million by the year 2025. The costs in treating this as yet incurable disease comes to billions of dollars yearly. The costs of managing the complications of the illness comes to even more billions of dollars. And yet the word diabetes fails to strike fear in a lot of people. Who has not heard of a friend or relative with diabetes? This problem is so commonplace these days that one lives with it, not bothering too much until the complications of diabetes hits one in the face.

Common problems to look forward to in poorly-managed diabetes:
Eyes: cataract, glaucoma, retinal tears, retinal bleeds, blindness
Kidneys: kidney failure
Heart: heart attacks
Brain: strokes
Skin: Increased skin infection, poor healing wounds
Limbs: poor blood supply leading to pain, painless ulceration due to nerve destruction, gangrene leading to loss of limbs by amputation

These are only a few of the more common complications.

Nutrition of the nerves supplying sensation to the skin of the foot can be compromised resulting in the sensation of numbness or tingling, or an inablity to feel pain, heat or cold. This results to injury to the foot or toes without the patient realising it and taking care of it, and ultimately the toe or foot gets infected and can turn gangrenous. This is complicated by the fact that circulation to the foot in diabetics tends to be poor due to narrowing of vessels.

The ultimate result: gangrene, poor healing ulcers in the foot, and ultimately amputation of the affected limb in order to save the remaining part of the limb from spreading infection and further need for more amputation.

Thus care of the foot is very important, starting from care of the nails to prevent infection of the nail folds, to care of the skin of the feet to prevent injury. Proper walking shoes are important. Socks need to be worn frequently to prevent injury. Make sure you wash your feet in warm, not hot water, as you may not feel the difference and this can result in burns. Make sure that there are no foreign materials in the shoe which can act like pebbles and ultimately damage the foot. Keep circulation good to the foot. Get your doctor to attend to any sores on the skin.

Last but not least, Control Your Diabetes

Cataract

Glaucoma

Diabetic Retinopathy

Fortunately most patients recover from this problem after surgery.