N excare is committed to

N excare is committed to providing premium skin care products that help people with severely dry skin enjoy a more comfortable life. An important part of that commitment is education. That s why Nexcare has worked with the American Diabetes Association (ADA) to produce this valuable skin care guide. The ADA is the nation s leading health organization providing research, information and advocacy. As Nexcare continues its mission of producing quality products that help people, the ADA has been an important resource in helping us to further that mission. The ADA does not endorse any particular skin care product; it is dedicated to providing comprehensive educational information regarding diabetes. Why Skin Care is Important Diabetes can affect every part of the body, including the skin. As many as one third of people living with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. Diabetes can hurt your skin in two ways: 1. If your blood glucose is high, your body loses fluid. With less fluid in your body, your skin can get dry. Dry skin can be itchy, causing you to scratch and make it sore. Also, dry skin can crack. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds germs and makes infections worse. Skin can get dry on your legs, feet, elbows, and other places on your body. 2. Nerve damage can decrease the amount you sweat. Sweating helps keep your skin soft and moist. Decreased sweating in your feet and legs can cause dry skin. The best way to help lower your risk of skin problems is keeping your blood glucose levels on target. The goal of diabetes management is to prevent peaks and dips in blood glucose levels. High blood glucose levels may make you thirsty and cause you to urinate more, as your body tries to get rid of the extra glucose. This could lead to dehydration, so be sure to drink plenty of water when your blood glucose is high. Follow your physician s recommendation on what levels are right for you and learn to recognize the signs of high and low blood glucose levels. 1

Hot baths have a tendency to leave your skin drier because it removes natural oils in your skin and allows water to evaporate from your skin faster. Stick with lukewarm water instead. Skin Care Tips A good skin care routine not only helps alleviate discomfort from dry skin, but also helps you keep in tune with your body to help prevent serious complications down the road. You may avoid skin problems by managing your diabetes through proper diet, exercise and medication, if needed. Here are some additional tips for good skin care: See your doctor for major cuts, burns or infections or skin problems you are unable to treat yourself. Keep skin clean. Wash with a mild soap or a gentle cleanser. Avoid very hot baths and showers if you have loss of sensation, because you can easily burn yourself without knowing it. Stick with lukewarm water instead. Take this opportunity to check your skin for red, dry or sore spots that could lead to infection if untreated. Pat your skin dry gently with a soft towel. Be sure to remove moisture in the folds of skin where fungal infections are more likely. Apply a daily moisturizing lotion or cream after bathing. Doing this while your skin is still damp helps trap the moisture in your skin. Pay close attention to problem areas such as hands and knuckles, elbows and feet. Look for things like calluses, blisters, cuts or scrapes that might need extra attention. Drink plenty of water to keep your skin hydrated. During cold, dry months use a humidifier in your home to add moisture to the air. Bathe less during this weather, if possible. Use a good sunscreen with an SPF of 15 or more to help prevent sunburn. Wear gloves for extra protection when engaging in activities that are harsh on the hands, such as gardening. Natural ingredients such as vitamin E, aloe and vegetable oils may be beneficial to help strengthen skin s protective function. Treat minor cuts, scrapes and skin cracks right away to help prevent more serious problems from developing. Skin Problems and Injection Sites If you are injecting insulin, it is recommended that you rotate your injection sites to help prevent problems from occurring in and under the skin. The main problem that could occur at injection sites is hypertrophy the overgrowth of cells, usually fat cells, that make the skin look lumpy. It can look similar to scar tissue. When a site is used over and over again, fat deposits can accumulate in that area. The abnormal cell growth can limit the absorption of your insulin. Inject away from the lumps and remember to rotate the sites. Ask a member of your health care team to check your injection sites periodically. 2 3

Foot Care Tips People with diabetes need to pay special attention to their feet. With diabetes, your skin is more likely to be deprived of its own moisture. This can cause the skin to dry and crack, leaving it more susceptible to infection. Additionally, poor circulation in the lower legs and feet can slow the flow of oxygen and nutrients needed to help heal wounds. Keeping your blood glucose levels under control will help you keep your feet healthier. Here are some tips for good foot care: Check your feet carefully every day. Look between your toes, and don t forget to look at the bottoms of your feet use a mirror if you need to. Watch for sores, blisters, bruises, swelling, or other problems that may need attention. Wash your feet every day with a gentle soap or a mild cleanser and dry them carefully, especially between the toes to prevent fungal infection. Treat minor skin cracks with a protective waterproof coating. Treat foot injuries immediately. Stay alert for signs of infection. If you re unsure how to treat an injury, ask your doctor. Keep your feet soft and smooth by applying moisturizing lotion, cream or balm. Avoid the area between the toes. When trimming toenails, cut them straight across with a toenail clipper. Don t cut the nails shorter than the ends of your toes or cut into the corners. Use a cardboard emery board to smooth sharp nail edges. If your nails are too thick to cut with a clipper, have a podiatrist trim them for you. Protect your feet from hot and cold. Wear shoes at the beach or on hot pavement. Don t put your feet in hot water. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it. Foot Care Don ts Don t walk barefoot. Wear shoes or slippers, even around the house. Don t soak your feet. Soaking can dry out your feet and create cracks in the skin that can lead to infection. Do not cut corns or calluses yourself. Don t use razor blades, corn plasters, or liquid corn and callus removers they can damage your skin. Don t break in a new pair of shoes by wearing them for the whole day. Gradually work up to this, inspecting feet for pressure spots each time you wear them. Do not put lotions or creams between your toes because this might cause an infection. Include your health care team Even if your feet feel fine, it s still important to have your feet examined regularly by your health care provider. Visit your health care provider every three to four months. Remove your shoes and socks to make sure your feet are examined. Discuss any problems or questions you have. Make sure you have a complete foot exam every year. TIPS FOR PROPER footwear Wear comfortable shoes that fit properly. Choose shoes with a firm sole and a wide toe box. It s best to buy shoes in the afternoon because that s when your feet are slightly swollen. Avoid styles with tight, pointy toes and buy shoes made of leather or cotton to allow your feet to breathe. Avoid wearing sandals or going barefoot. Bare feet can easily become cut or bruised and result in deep sores. Check inside your shoes before wearing them. Make sure lining is smooth and there are no objects inside. Wear soft-cotton or woolblend socks, and avoid tight nylon stockings and tight knee-highs. Look for socks that don t have inside seams or ridges. 4 5

Diabetes and Wound Care Diabetes can slow down your body s ability to fight infection.this makes it important to regularly monitor your skin for dry and itchy patches that could lead to more severe cracking. Bacteria and germs can get into the skin cracks, feed on elevated glucose in the body and cause infection. It is particularly important to thoroughly check your hands and feet for problems as the extremities are most often where blood circulation is the poorest. Things to look for include: cuts or cracks that could lead to infection calluses building up on knuckles, elbows or heels swelling of fingers or feet loss of sensation in the hands or feet Treating Cuts and Scrapes To prevent cuts and scrapes from becoming infected, it is important to keep the wound clean and covered. Clean the wound to remove any dirt or debris using water or an antiseptic wipe and dry thoroughly. Cover your wound with a sterile dressing that seals the wound from water, dirt and germs. For minor skin cracks that don t need a dressing, use a protective, waterproof coating. This will act like a liquid bandage helping to heal while blocking out dirt and germs. Check with your doctor immediately if the wound or crack appears infected. Redness or swelling, pain or itching, fever, yellow or green discharge are all signs of infection. Foot Ulcers An injured or infected area of the bottom of the foot can develop an ulcer. Layers of skin are destroyed by the infection, which causes an open area or hole. Foot ulcers are serious business. If untreated, the ulcers may go as deep as the bone. When the infection is very deep, a part of the foot, or even the entire foot may need to be removed. If you discover that you have a foot ulcer, you need to see your provider that day or visit the emergency room. Studies have shown that when a wound is covered and kept moist and not allowed to scab over, it is less painful and heals faster. Other Complications Diabetic Neuropathy About half of all people with diabetes have some form of nerve damage, called diabetic neuropathy. It is more common in those who have had the disease for a number of years. Signs include tingling, pain, numbness, or weakness in your feet and hands. There s a lot you can do to prevent or delay nerve damage, or delay further nerve damage: Keep your blood glucose levels in your target range. Report all signs of diabetic neuropathy. If you have problems, get treatment right away. Take good care of your feet by following the tips in the foot care section. Get special shoes, if needed. Be careful with exercising. Some physical activities are not safe for people with neuropathy. Consult with a diabetes clinical exercise expert who can guide you. For information on other types of neuropathies and other skin complications, consult the American Diabetes Association s website at www. diabetes.org. 6 7

Types of Product There are many types of effective treatments for dry skin. Your choice of treatment can be dependent on the area of body being treated and the degree of skin dryness. Moisturizers tend to come in three main forms: Lotions generally lighter and least greasy, ideal for overall use for mild dryness. They contain large amounts of water to help deliver the moisturizer, making it easy to spread. Creams contain a higher content of moisturizers, ideal for moderate dryness on areas like feet, lower legs, or hands. Ointments/Balms contain the highest level of moisturizers, ideal for spot treatment of severely dry, cracked areas such as elbows, knuckles, knees and heels. The materials used in moisturizers are chosen to have different effects on dry skin. They include: Occlusives work on the skin s surface, providing a layer of oil to slow moisture loss. They consist of oils such as mineral oil, petrolatum, and silicone oils. Effective at preventing moisture loss through the skin, but may leave a shiny appearance and an oily or greasy feel. Emollients consist of natural oils, waxes and synthetic esters that are similar to the body s own skin oil. They absorb more easily and help replenish the skin s own moisture-retentive function while also supplying some occlusiveness. Helps smooth and soften the skin by filling the spaces between skin flakes. Humectants work below the skin s surface by increasing its moisture-holding capacity. They consist of water-loving materials including glycerin, urea and lactic acid. 8 Most moisturizers contain both emollients and humectants, with some also containing occlusives. Many skin care products also include antioxidants such as vitamin E or C to provide the skin some protection from the environment, and botanical substances that may soothe, reduce itchiness, or improve the appearance of skin. Whichever type of treatment you choose, it is important to maintain a regular moisturizing routine and use a product that is designed to target your problem areas. Allantoin: Active principle of comfrey root known to help heal and soothe irritated skin. Bisabolol: Active principal of chamomile known to help protect and calm irritated skin. Evening Primrose Oil: A highly moisturizing and emollient oil rich in essential fatty acids. Foot Ulcer: Layers of skin destroyed by infection that has caused an open area or hole. Glucose: A simple sugar obtained from the breakdown of carbohydrates in food; the body s source of energy after a meal. Glycerin: A vegetable-based humectant that helps to attract water to the skin and hold it there. Also called glycerol. Hypertrophy: The overgrowth of cells, usually fat cells, that make the skin look lumpy that can develop by using the same injection site too often. Mineral Oil: A light, stable hydrocarbon oil derived from petroleum that provides an occlusive barrier on the skin to seal in moisture. Neuropathy: Disease of the nerves. Glossary of Skin Care Terms Olive Oil: A non-greasy, natural vegetable emollient which quickly absorbs into the skin, replenishing lipids to help improve the skin s health. Petrolatum: A heavy, stable hydrocarbon grease derived from petroleum that provides an occlusive barrier on the skin to seal in moisture. ProVitamin B5: Provides quick, soothing, deeply penetrating moisturizing to soften and condition skin. Also called panthenol. Shea Butter: A natural oil that s high in unsaponifiable lipids, providing long-lasting soothing, moisturizing, and protecting effects. Silicone Oil: A non-sticky water-repellent oil that spreads easily and provides good skin protection. Also called Dimethicone. Soybean Oil: A non-greasy, natural vegetable emollient which quickly absorbs into the skin, replenishing lipids to help improve the skin s health. Sunflower Oil: A non-greasy, natural vegetable emollient which quickly absorbs into the skin, replenishing lipids to help improve the skin s health. Synthetic Esters: A wide variety of emollient oils and waxes prepared by combining natural or synthetic fatty acids and alcohols. They provide skin softening and smoothing. Vitamin B6: Helps promote healthy skin and may reduce inflammation. Vitamin E: Provides antioxidant protection against numerous environmental chemical and physical stessors. Smoothes and conditions skin. Also called tocopherol and may be present in the form of tocopheryl acetate. Urea: A synthetic material also found in the skin s own natural moisturizing factor that softens and smoothes skin.

Additional Resources American Diabetes Association 800-342-2383 www.diabetes.org Centers for Disease Control and Prevention 800-CDC-INFO www.cdc.gov/diabetes American Association of Diabetes Educators 800-338-3633 www.aadenet.org American Dietetic Association 800-877-1600 www.eatright.org Pedorthic Footwear Association 800-673-8447 www.pedorthics.org The Neuropathy Association 212-692-0662 www.neuropathy.org American Board of Podiatric Surgery 415-553-7800 www.abps.org 3 Consumer Health Care 3M Center St. Paul, MN 55144-1000 USA 1-800-537-2191 www.nexcarediabetes.com 3M and Nexcare are trademarks of 3M Printed in USA 3M 2007 70-2009-7358-7