Asked by Brian Reeve, Aruba
I am a type 2 diabetic with an average hemoglobin A1C of 6.1. Would it be safe to use an over-the-counter liquid corn remover on my foot?
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
Dear Brian: Thanks for your question. It's a wonderful opportunity to review what adult-onset or type 2 diabetics should be doing to prevent complications.
Most family physicians and internal medicine specialists are qualified to care for uncomplicated type 2 diabetes. In addition to encouraging the patient to follow a strict diet in which carbohydrates are restricted and patients measure their blood sugar several times a day, we generally will do several other blood tests several times a year.
For example, cholesterol and lipids are measured and abnormal levels treated. Kidney function tests are done to assess for damage. A hemoglobin A1C blood test is usually done every three to six months. The hemoglobin A1C is a measure of blood sugar control levels over the past three months or so. Less that 6.5 percent is good blood sugar control. That test also offers additional information beyond the measured blood sugars.
Diabetics are at risk of diseases of the eye, kidney, nervous system and cardiovascular system. Keeping blood sugars in control decreases the risks of these diseases but does not decrease risk to zero. Every diabetic needs ongoing visits to a physician to handle general diabetes treatment, a podiatrist for foot care, an ophthalmologist for eye exams and a dentist to monitor for gum and tooth disease.
Most physicians would strongly suggest that a diabetic patient see a podiatrist on a regular basis for routine foot care and for examinations. I suggest this even to those who have good control of their disease. Most diabetic patients should have their toenails professionally cut by a podiatrist or a pedicurist trained by a podiatrist. Foot problems are a common complication of diabetes largely due to the combination of neuropathy, which can manifest as numbness or decreased ability to feel pain, and vascular disease, which decreases blood flow to the feet.
A small cut or abrasion on the foot can get infected and develop into an extremely serious problem in a small amount of time. For these reasons, it is generally not recommended that even a well-controlled diabetic use an over-the-counter liquid corn remover. Foot injury, worsened by diabetes, is the leading cause of lower leg amputations in the U.S. and Western Europe.
In addition to having a relationship with a podiatrist, all diabetics should get an annual examination by ophthalmologist. This examination included dilation of the eye and examination of the retina for diabetic eye disease. This can be effectively treated if found early, but is often diagnosed late. Diabetic complications of the eye are one of the leading causes of blindness.
Regular examination and teeth cleaning by a dentist are important for diabetics. Oral hygiene can be difficult to maintain, and inflammation and infection of the gums can complicate blood sugar control. There is even evidence to suggest that serious gingivitis can increase risk of cardiovascular complications.
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