good evening.

Thank you so much for watching HealthLine here on PBS Fort Wayne.

I'm your host Mark Evans.

Tonight we're going to talk about something very important especially these days diabetes and along with that foot ulcers, the prevention and care.

So if you were someone you know and love has diabetes and or foot ulcers, this will be a show to watch and we have a very special guest tonight, Michelle DYS who is a nurse practitioner.

Thank you for being here and we talked before the show that you look familiar but we boiled it down to the fact that I've seen you on with Sandy Thomson on one of our other programs LIFE Ahead.

Yeah.

So it's nice to have you here on this set and thank you for being here this evening.

>> Very important topic but I want to talk about what you do for a living your your title as a nurse practitioner.

Can you tell how did you get to that position, what it takes and how do you differ from say a registered nurse?

>> Okay um well a little bit different nurse practitioners are masters prepared so we have that master's degree along with several hundred hours of clinical time with another provider that can be another nurse practitioner or a physician of some sort for ourp.

So while we're going through our education, we're also getting clinical time treating patients and and learning how to diagnose and order imaging and prescribe.

Would you be considered more of a physician's right hand person more than maybe a registered nurse, maybe an upper level or I know that they're also important.

>> Well, nurse practitioners have a collaborating physician so I have a collaborating physician that I work with closely who kind of oversees what I do.

But nurse practitioners are independent providers so we can prescribe, we can diagnose, we can see patients by ourself within the health care systems though a lot of nurs practitioners function function differently depending on their specialty.

>> And in fact I just saw a nurse practitioner last Friday for this call thing I've got going on it just won't go away.

She was excellent and she was subbing for the doctor that day so but I felt like I got very adequate care.

>> So great.

Thank you for what you do.

Let's go ahead and move on and before I do that I want to go ahead and plug our phone number because it is an open concept open arena show if you will 866- (969) to seven to zero.

>> That's number you can call to ask your question or questions and please do that in the next 30 minutes.

Of course you know we don't stop down because we're not commercial TV.

>> We are public television and thank you for watching tonight so Michelle, let's talk about diabetes in general before we get into the foot ulcer thing, can you provide some stats about how many people in America that diabetes is actually affecting?

>> Yeah, of course quite a bit actually.

I just read recently that it's about nine percent of the population nine percent, nine percent.

So that's quite a bit and we're diagnosing an earlier in age two .

So even into your 30s or before that we're seeing diabetes.

>> I did read that there's over thirty seven million Americans that are diagnosed with it and then there's an additional one to two more million diagnosed each year and what is causing oh I think it's a lot of things.

It's it's our fast pace of life .

It's the fast foods and the processed foods a lot of our jobs and daily activities aren't real mobile.

We're not moving enough.

So I think a lot of it is just based on the busyness and we need convenient things but those convenient things aren't always healthy for us.

>> Right.

And there's not just one type of diabetes with two or three uh really two I am by no means a diabetes expert but I know how it affects what I do.

But typically there's I mean there's a lot of subcategories which would I would defer to endocrinology but for sure diabetes type one and type two diabetes type one is more of a congenital or a very early diagnosis.

So as an adolescent or even at birth you would be diagnosed with type one which is a lot more tricky to to treat typeptwt ?

>> OK, is it hereditary?

You know there's more and more research about that.

I do believe there kind of is a connection to it for sure.

But then there's a lot of outside influences too like I mentioned our diet, our lack of activity, the types of foods we prefer.

>> OK, and let's talk about before we get into the foot ulcers we know that is one of the complications but what other complications can diabetes bring on to someone?

>> Well, it can really affect most of the systems.

You know, it can affect your heart and heart disease.

It's really a vascular disease is what I've kind of learned.

So diabetes affects your microbus vascular system so your vessels that provide circulation, it affects your neurological system causing changes in the nerves so your sensation changes.

>> There's just it just about effects every system.

>> Wow.

OK, so let's go ahead and slide into the as we've got a call coming in we'll get that in just a second slide into the foot ulcer issue.

What exactly are those can you describe what they look like and what causes them?

>> OK, so a diabetic foot ulcer is usually just it's typically on maybe the bottom of the foot or the side of the foot.

It can start for a number of reasons.

It can be that maybe a patient stepped on something and as I mentioned before, diabetes decreases your nerve sensation especially in your feet.

So a patient may step on something and have a sore that then doesn't heal because maybe their blood sugar is a little bit too high.

>> It could be related to improper fitting footwear too too big or too small especially if you have swelling in your lower extremities.

You may see that foot you know a shoe doesn't fit you the same every time.

So there can be a lot of factors.

>> It can start out as trauma and then it doesn't really heal because the blood sugar is not controlled so the blood sugar is the key.

>> In fact, I've got a couple of questions regarding that later on in the show we have a call coming in and Paul prefers not to be online and that's quite all right.

>> You can either speak it yourself or we can read it for you.

But Paul is asking what does prediabetes mean?

>> And that's a great question, Paul.

Yeah, that is again, I would I would defer to probably endocrinology or even primary care but pre diabetes is a condition where you're sort of headed towards diabetes so meaning your blood sugars may run a little higher than average meaning your insulin levels or your pancreas is secreting more insulin to control your blood sugar.

>> So you've got there's actually kind of some criteria that helps you meet pre diabetes.

>> So there's some lab levels and things like that that primary care can help you determined but it sort of means you're headed towards diabetes if you don't make some simple changes in your life like exercise and diet, things like that.

>> OK, is there certain BMI and somebody that we you'd have to watch for and what is it the body?

Yeah I mean over thirty you're starting to have some excess weight.

>> BMI is kind of a hard thing just because it's not you know it's different for everyone.

>> It it really is you know so that's not the only single thing that you can look at but if you're having some extra abdominal weight you're probably we tend to store there and then it's harder to control our blood sugar and getting back to the foot ulcer, I had a grandmother who had those and they were just terrible.

There were some days that she could walk and some days she couldn't.

>> So why is it important to get care as soon as possible?

>> Really it's the risk of infection.

OK, when your blood sugar is high, your body is- kind of in a state of chaos meaning it's trying to do a lot of things at one time and if your blood sugar is high, your immune system really can't fight off bacteria the same as someone who's not diabetic can.

>> So you have a better immune response with the blood sugar that's controlled.

I see.

Now I think you touched on drop of the year.

We're heading that direction a few minutes ago.

>> What exactly is that and how could that affect foot ulcers?

The main thing with neuropathy.

So as I said, if you have a prolonged period where your blood sugars are not controlled, they're higher than normal.

It kind of affects the way your nerves sense things.

So oftentimes a diabetic patient may not be able to feel their feet at all.

You could touch a bottom with, you know, an instrument or your finger and they wouldn't feel it because that's that's naturopathy.

>> So those nerves have dead and over time.

So that puts you at risk because if you put on that too small of shoe or something like step on something sharp because you're walking around at home with no footwear on you, you don't know it and I've had many patient that come in and have a you know, they've had a foot ulcer for much longer than what they realized because you can tell with the amount of infection and damage there oh no.

>> We're talking a lot about adults here.

>> But can children get foot ulcers as well?

Oh yeah.

Especially like we mentioned a diabetic type one patient.

You know, again, diabetes type one is very, very hard to control and there's definitely a difference between the two .

>> But that immune response in those Type one diabetic patients is is just really suppressed.

It's much harder to control.

So for sure if you've got a congenital state of diabetes type one they could get an ulcer.

>> All right.

And I want to remind our viewers that our phone number is 866- (969) 27 two zero.

We're speaking to Michelle D'Souza, a nurse practitioner of course the subject tonight diabetes and foot ulcers, the prevention and care.

>> So give us a call when you can.

So you think you've got a foot ulcer or maybe one of your family members says Mom, Dad , you might want to get that checked out.

>> What are what are you looking for ?

I mean can be mistaken for a mosquito bite or I mean is it going to be kind of bloody maybe some pus in it?

>> I mean what would be I would suggest giving us a picture but it's probably not something we want to see.

>> It may not it can start out just as redness or often a diabetic patient.

It's a callus because their step has changed so they have different pressure points and that's just a result of the uncontrolled diabetes.

So if you have a specific pressure point that continuously rubs in your shoe that can form a callus which is just thick skin and often you'll see a diabetic patient when you get friction in between the layers of the skin they'll develop an ulcer or a fluid collection er so it can start out as just redness.

It may or may not have pain because maybe the patient can't feel that but if they do have pain are they going to be painful.

>> Yes.

Mm hmm.

Oh I see yeah.

And sometimes that pain we call it neuropathic pain because nerves are kind of sharp and shooting so if you've got patients with other health conditions, maybe a back injury or something like that and they combine that with diabetes and neuropathy from that you can have different types of nerve pain which can be very painful I would imagine.

>> Now you suspect that you have a foot ulcer.

What's the first thing you ought to do?

>> Who should you call?

You can start with, you know, your primary care physician.

You can start with the walking clinic first and foremost.

I would just suggest cleaning it up and covering it with some sort of bandage or Band-Aid.

>> Well, I was going to ask you that eventually to that if found if at all, sir.

And you need to get some care and you've got an appointment.

See the doctor how are you going to care for that until then?

>> Yes, simple stuff.

It's keeping it clean and covered and then trying to figure out what else is going on.

Is it your footwear to just step on something?

You know, is there something a foreign object in your foot still that can happen as well, you know?

So but if you want to go back to the first part, it's kind of cleaning it up, keeping it covered and then making a phone call to either see primary care going to walk in clinic a lot of wound clinics or self referrals.

They're specialized now so you can do you know any of those things but you do want to try to do pretty timely.

>> I would imagine those things can get really infected.

What is the result with an infected wound ulcer foot ulcer?

>> What can happen?

OK, well there's first you have delayed healing OK so you're going to have delayed healing and that bacteria can just destroy more and more tissue going deeper into the foot.

So a lot of times we call that or we call that cellulitis.

So you may see, you know, your-a walking clinic and they're going to see some redness or maybe there's some odor or some funny looking drainage or something like that.

They're going to put you on antibiotics but then you have to figure out, you know, why why isn't this healing correctly?

>> So you go back to the drawing board and sort of dig deeper, see a wound clinic, something like that.

I see deeper infections again like antibiotics will help it but you still have to do kind of your part again making sure that footwear is good, making sure you're keeping your blood sugars controlled because if not you can end up in the hospital requiring IV antibiotics and then in more severe cases, you know, diabetes those patients can develop what we call gangrene requiring a certification possibly for surgical intervention and even amputation.

>> Even more importantly, you need to get this checked out as soon as you can.

Correct.

All right.

Let's go back to the telephones now.

We have a Kim on the line actually she doesn't want to be on the air but she's asking does exercise have any effect on diabetes after being diagnosed?

>> Yes, because again when when we're active our bodies is just functioning better so it doesn't have to be anything real strenuous but we encourage a lot of our diabetics to walk as long as you've got that good footwear.

That's the tricky thing about our diabetic patients.

If you don't have the good footwear, exercise can almost bring on more complications so you have to be careful.

But moving is healthy for our body.

It promotes circulation and as I mentioned earlier, diabetes is also a microvascular disease .

So all the small blood vessels within your feet and your toes those can easily be affected in the circulation can be decreased when you have diabetes.

So when you get moving you're promoting that blood pumping and getting circulation going and you're going to feel better.

>> Yeah, that makes sense.

Makes sense.

>> So get off the couch and do something.

Yeah.

Yeah.

All right.

So what is important this can go several directions but you need to control certain aspects of your life and what is important to control if you have these foot issues?

You know, as far as I mean you have to be watching your when it's diabetic related you have to watch your blood sugar, I'm sure.

>> Yeah.

And and there's monitoring and equipment for that.

I'm sure that people are very familiar with that.

So what are you looking for there?

What do you have boundaries that you need to keep it within ?

What I tend to say is you want to keep your blood sugar around one fifty that can be challenging for diabetics but your body is going to be able to tackle things better and you're going to be overall more healthy if you've got a blood sugar level around one fifty.

The other important thing for all diabetic patients is just checking their feet in their skin because you you want to stay ahead of the game a bit.

You want to prevent the ulcers.

So if you can be looking for dry skin that Craxi easily on your feet and heels, that can be one of those things that turns into an infection for a diabetic patient because their blood sugars aren't controlled.

So it's really just watching really closely taking good care of yourself, moving and controlling that blood sugar.

>> And it's not only the feet that possibly can't heal as quickly.

>> It's like if you got cuts in any type of lacerations, things like that, correct?

>> Yeah, it can be a surgical wound.

A lot of our patients that maybe have you know, trauma are involved in a rack of some sort or have an emergent surgery.

They're going to be less likely to heal after a knee replacement or you know, after a hysterectomy or any of those number of surgeries you're going to have delayed healing is what's going to happen anywhere.

>> I see delayed healing.

>> All right.

So you brushed over some of these things but like to encapsulate a little bit more once diagnosed what's necessary to promote a healing process for the foot care?

>> OK, usually you're going to have pretty close follow up with a provider that's treating the ulcer again.

You want to have a really controlled blood sugar so that would be around one fifty.

I think your body can kind of handle things if you're under two hundred it's got less tasks to do at one time so goal of one fifty to two hundred really good foot care keeping the wound clean following the instructions of a provider who's treating you.

And then again we're going to go back to that really important thing of just good footwear and that can be you know, following up with a podiatrist who looks at your feet annually and maybe does a neuro neuropathy test to tell you how well your sensation is doing or not doing many times podiatrist or even the provider that is taking care of your diabetes.

>> You can do where you can work with them annually to get diabetic shoes and orthotics and then be fitted specifically so you'll have what's called a paid authors to a foot specialist look at your feet and fit you for the best shoes that you can be in and then with inserts that are replace three to four times a year to help you not get the the ulcer to begin with.

>> See and then you should definitely go back to see your provider to get checked up on and how often should you do that for diabetes or just for Felser?

>> Well let's do both.

OK, well diabetics if you're pretty well controlled I'm-goino be seeing your primary care or endocrinologist you know, at least one to one to two times per year, OK, if you're not controlled and you're not at goal and your your blood sugars are up and down, it's probably going to be more frequent than that because there really are a lot of great medicines that are helping people control their blood sugars, lose the weight, get moving.

You know, when you when you lose the weight you can get moving more easily.

So if you're not controlled I would guess you're going to be seeing your provider maybe every one to three months if you're controlled.

>> Follow up on diabetes is pretty important for lab work and other testing one or two times a year for sure.

>> OK, we have a call coming in from Peter and he's asking are people with diabetes allowed to drink alcohol because it's probably not a good idea, right?

Well, you know, I don't want to say you can't have any fun but definitely in moderation because a lot of the different alcohols have a high sugar content, you know?

So there are I don't want to say you can't but I would I would definitely keep it in moderation and because most of them just aren't are good for diabetics really any of us.

But you might want to specifically talk to your provider about that because I would definitely say in moderation for sure and that word moderation.

>> I'm sure you've heard a thousand maybe a million times.

>> Yeah.

And you preached it yourself, I'm sure.

Yeah.

Let's talk about oh yes.

I was going to ask you when you're talking about neuropathy, is that reversible?

>> Hmm.

Good question.

I know your nerves can regenerate that that we know I I've seen patients sort of regain some sensation in their feet as they get their blood sugars controlled.

I don't know that it's one hundred percent though so more to come probably on that.

But you know, there is there does seem to be some sensation that returns in in some people and probably based on the severity.

>> Correct.

All right.

Very good.

>> I'm glad I remembered to ask that.

Let's talk about nutrition now.

Of course you don't want to keep the sugar level down and all that, but are there other things that you should be eating or should not be eating when you have diabetes mostly protein.

So if you can find good proteins and it can be kind of tricky to find good proteins because a lot of our labels on our food they make you you think it's a good product and a healthy product but it's not necessarily that.

But you know, healthy meats see foods, things like that are always good along with like a high protein lower carb vegetable choice, you know, so you want to avoid the processed foods and the things that are notably high in sugar.

>> But you also have to remember there's kind of good carbs and bad carbs and so you know, if if you think about that sugars are a carb.

So when you when you go through your diabetes education typically prescribed by the primary care or the person who diagnosed you with it, you will learn the difference in the good carbs and the bad carbs and that's really important to remember because carbs are carbs at the end of the day and they're they require more insulin to digest and keep your blood sugar controlled.

>> All right.

And at the beginning of the show we talked about how prevalent diabetes is these ays when I was younger even as a kid, people who got once in a while you would find like one of my schoolmates would have the type one diabetes.

>> Yeah.

And actually back then to me it was kind of rare and the kids had to have their injections.

>> Parents had to give them injections and things like that.

I always felt sorry for those kids but you gave us some stats at the beginning of the show about nine percent of America has diabetes whether it's type one, type two , most of it I'm sure is the type to adult onset.

>> So why besides the sugars and all that, why are the younger people getting the type two type of diabetes?

>> Well, I think it kind of comes back to what we talked about.

I think it's our food choices.

You know, we have a lot of fast food choices, high carb foods and I mean if you think about it, the the high carb foods are really good but you have to again make good choices and do some of that in moderation.

Enjoy a little bit but don't go overboard.

>> OK, what about the sedentary lifestyle?

A lot of gaming going on, a lot of TV watching.

>> Yeah yeah I I tend to say just keep moving because there's a lot of things that happen when you don't move you're going to you're probably going to gain weight your vascular or vessels your circulation decreases arthritis sets in so all those things are really important if you can get up and move every day you know you can still enjoy some of the gaming or the good TV shows but you need to incorporate exercise into your daily rotine as well.

>> OK, Base has our final question for tonight how many different machines or apparatus apparatus are there to check your blood sugar?

>> That is a great question.

I couldn't tell you a specific-t with amazing things to to continuously monitor your sugar.

>> You can do it through your cell phone.

Yeah.

And what is it is the stick something you said a little sensor there.

>> There's no needle there right is just as well there's a little catheter so and I apologize but I don't know each product might be a little bit different on how often you replace that.

Some of them are a couple of days some of them might be longer than that but it's much more convenient without the needle sticks and it connects to your phone.

>> A lot of the apps will tell you when you have a high or a low so they have come out with so many great things that you can talk to your endocrinologist or primary care about because it's not fun to poke your finger three to four times a day or to recheck if you're having a low.

>> So there's so much technology out there that it's a long way.

They absolutely have.

Yeah, I think we've got about thirty seconds left some take home points for our audience.

>> How can you prevent diabetes and I know we talked a little bit about this throughout the show so a lump sum it for us.

>> Yeah it's just keep moving keep exercise, try to make good choices on your foods educating yourself I think going online and looking for healthy food options is really important because we don't always realize that we're making a bad choice.

You based on the labels so keep moving, make good choices and ty not to overdo it in one category and oh see your doctor regularly.

>> Absolutely.

Michelle, this nurse practitioner, thank you so much for being here tonight.

>> Very informative.

We've got to have you back again.

All right.

Thank you.

All right.

Thank you for watching.

>> And another show coming up next Tuesday at seven thirty.

Until then, good night and good