High deductible. Limited coverage of outpatient care. Would really help to know what tests, evaluations are required to diagnose diabetic ulcers and follow it after treatment.?
Not easy. Keys are changing weight-bearing, good wound care, absolute nicotine avoidance, good glucose control, verifying good circulation or improving it, if possible. Special shoes to get your weight off the ulcers is best use of money ($4-500). Wound care can be relatively simple with silvadene (silver sulfadiazine) cream. Doctor can feel pulses in feet = no vascular work up needed. Avoid regranex, dermagraft, appligraf, hbo.
Diabetic ulcers. The diagnosis is clinical. There are no tests to determine there is an ulcer. However, following the appropriate evaluation, good glucose control is essential to heal the ulcer. Furthermore, offloading of the area, keeping the ulcer clean, a good evaluation of blood supply, and periodic visits to your wound care specialist all play a vital role. These costs are less than amputation.
Don't skimp. Diabetic ulcers can progress to severe infection and limb amputation if not treated appropriately. Get strict control of your sugars, see a wound care specialist, and follow your wound care instructions meticulously. The details of the tests, evaluations, etc depend on the severity of the ulcer. You may just require a history and physical. More tests may be indicated however.
Diabetic Ulcers. First, if diabetes has been diagnosed(fasting blood sugar), the diagnosis of a diabetic ulcer is usually made from the location (lateral aspect of the ankle), lack of history of trauma and poor healing. Ulcers are treated by keeping blood sugars under control, debriding edges, using antibiotics if infection present and occasionally using growth promoting factors.
Several. Foot ulcers are multifactorial and if mistreated will surely have a bad outcome, and so cutting corners is not recommended. At least i would recommend a hba1c to gauge adequacy of blood sugar control( very important to heal ulcers), a vascular study to assure adequate flow to heal the ulcer, an appropriate debridement and dressing based on exam, an offloading shoe/cast. May need MRI if to bone.
Lipoprotein a levels. If you can check lipoprotein a levels - causes repeated damage to vessel wall - keep ulcers protected by not putting pressure on this area - for more info take a look at my woundcare cheatsheet lecture at http://drbrown.Us.