Many diabetics develop serious foot problems as a result of poor circulation to the lower extremities. This is due to hardening of the arteries or arteriosclerosis.

Impact: Poor control of blood sugar levels interferes with the ability of the white blood cells to fight off infection. Frequent glucose monitoring is mandatory in order to ascertain the amounts of insulin required to keep sugar levels normal. The foot may become infected, but neuropathy may mask the pain associated with this serious condition. This may allow the progression of the process before consultation from a physician is sought. Unless treatment is started promptly the infection may spread rapidly and gangrenous changes could make amputation a necessity.

Prevention: Prevention and attention to minor problems before they become major could help the diabetic population avoid as many as 75 percent of these devastating procedures. Any injury of the foot, in those whose circulation is already compromised, may precipitate infection and delay healing. The best approach to the problem of the diabetic foot is to prevent the development of foot ulcers through education and prophylactic foot care. It is wise to make sure shoes have adequate toe room to prevent rubbing, which can cause ulcers and/or blisters. Soft, well fitting shoes play an important role in preventing serious foot problems. It is important to know that the key to blood glucose control is rational choices of diet. Exercise also plays an important part in reducing the risk of long-term complications of diabetes mellitus and the devastating effects of the diabetic foot.

Finally the majority of foot and leg amputations in Bermuda are due to diabetes. Diabetes affects one in every five people over the age of 65.

Additionally, 40 percent of this age group have some glucose intolerance.

Prevention of Pressure Sores Prevention of pressure sores is a dominant feature in the nursing care of the elderly, whether at home or in the hospital. The development of pressure sores not only increases the time that the elderly are treated in hospital, but also increases the amount of nursing care required and the cost of their overall health care. The development of pressure sores interferes considerably with the patient's rehabilitation and can be a contributing cause of death.

A pressure sore can form within a day, but can take months to heal. Therefore the prevention and treatment are extremely important and deserve much consideration. The main cause of tissue damage, and ultimately pressure sores, is "sustained pressure'' to a particular area. It should therefore be the aim of the caregiver to alleviate pressure in vulnerable areas of the patient.

Prevention: Good skin care should be initiated by the caregiver. The areas most at risk are; the heel, elbow, shoulder, head, and buttocks. The patient is greatly at risk if he/she suffers from: poor nutrition; anaemia; urinary incontinence; fecal incontinence; or both.

The general health of a patient must be considered, as pressure sores obviously do not usually occur in those who are healthy and well nourished.

Rest: Rest in bed resulting in immobility is usually the most common complication in the development of pressure sores. Therefore it is most advisable that whenever possible the patient be turned a minimum of every two hours, to avoid further skin deterioration.

Diet: The patient should be given a regular well-balanced diet. This may be complemented with high protein drinks, and fluids must be encouraged.

Finally the complications of pressure sores are many and serious, thus reinforcing the thesis that prevention is better than cure.

Paulette Godfrey is a qualified geriatric caregiver and the matron of Herb Garden Seniors Residence in Southampton.

HEALTH HTH