Grahams Natural Diabetic Foot Cream

Important: This is general information, based on the best available data at the time of writing. Do NOT rely on or use this information as a substitute for professional medical advice.

Diabetes is a serious and chronic disease state that results from permanently altered carbohydrates metabolism. Because diabetes is a complicated condition that affects many parts of the body, healthcare professionals from a range of different disciplines should be involved in your ongoing care.

Regular consultations with your doctor, podiatrist and specialists are required to correctly manage the full range of disease symptoms.

There is no cure for diabetes, however there are steps that you can take to improve your quality of life as a diabetes patient. Diabetes causes a suite of changes throughout the body, a consequence of innate compensations for the underlying metabolic impairment.

• By better controlling glycemia you can help to mitigate the severity and consequences of these changes.
• Always prioritise having your glycemia (blood sugar) under good control.
• You should seek help from your medical team with your meal plans, exercise, and/or diabetes medicines.

Footcare is substantially less important than careful management your of your glycemia (blood sugar).

About Diabetic Foot Syndrome and footcare:

Poorly controlled diabetes leads to changes in the blood vessels, circulation, nerves and structure of skin and connective tissue that results in

• Limited joint mobility and/or
• Changes in posture and co-ordination and/or
• Decreased or altered nerves sensitivity and/or
• Altered (reduced /impaired) blood flow

As a result the peripheral parts of the body, most particularly the feet are substantially more susceptible to the set of symptoms called Diabetic Foot Syndrome, that includes

• Physical deformation
• Greater susceptibility the sheer, friction and pressure
• Skin Cracking 

Consequential calluses and other injuries, may go undetected because of a reduced ‘protective sensation’ (feeling) in your feet; deep infections can result in part, due to decreased circulation. This happens more often when someone has been living with diabetes for some time.

If you have diabetes, you are at increased risk of foot ulceration however careful and regular foot care can help to prevent some of the most serious complications.

• As a minimum, you should have an annual, professional assessment of your feet (and more often if your risk of foot complications is higher).
• Early recognition and management of independent risk factors for ulcers and amputations can prevent or delay the onset of adverse outcomes.
• Daily, self-examination and attention to foot care is one of the best means to identify and manage risk factors before a foot ulcer occurs or an amputation becomes likely.

A doctor, podiatrist or Credentialed Diabetes Educator should carry out a check on your feet to determine whether your feet have a low or high risk of developing more serious problems. The check-up should include looking at

• Blood flow to the feet (circulation)
• Feeling and reflexes (nerves)
• Unusual foot shapes (including bunions, claw toes and hammer toes)
• Toenails and Dryness, calluses, corns, cracks or infections.

Low risk feet have normal sensation and good blood flow. However it is important to know that low risk feet can become high risk feet without symptoms, so regular checks are still as important.

High risk

• People who have had a foot ulcer or amputation in the past have a high risk of complications.
• Feet with calluses or deformities like claw toes also have increased risk, especially if poor feeling and/or decreased blood flow are also present.
• If your feet are at high risk, you should have them checked by your doctor or a podiatrist every 3 – 6 months.

Triggers of complicating injury can include poorly fitting shoes, poor foot care, or overlooked foreign bodies. Ulcers can result from friction, cuts and injury as well as too much pressure over some areas of the feet. Corns and calluses can be due to too much pressure on one area and can lead to injury and additional stress on the surrounding skin.

Always seek medical help to remove calluses or corns before they become ulcers as these can become infected, risking serious consequences.

For additional Information you and your healthcare professionals may wish to consult

• International Diabetes Federation Clinical Recommendations for the diabetic foot (2017) via https://www.idf.org/e-library/guidelines/119-idf-clinical-practice-recommendations-on-diabetic-foot-2017.html and
• National Evidence Based Guidelines on Prevention, Identification and Management of Foot Complications in Diabetes available via https://www.diabetesaustralia.com.au/best-practice-guidelines

In addition to other relevant, professional resources.

Important Instructions for Use:

What works well for one person, may not be as effective for others. This complex oil-in-water cream contains a range of naturally derived ingredients considered especially suitable for topical use in the diabetic population; however some components may trigger to personal sensitivity reactions in susceptible individuals.

• CHECK the ingredients list before use; do not use if you suspect allergy or sensitivity to any of the ingredients (unless advised to do so by a doctor)
• PATCH test the product by placing a small amount on normal, healthy looking skin; if after several hours there is no irritation or redness, proceed to application to unbroken, affected skin.
• IF at any time during the use of this product you experience atypical redness, sensitivity or other adverse reaction seek medical advice.

For Routine Use:

Skin should be routinely cleansed using a pH neutral cleanser (not alkaline soap) using warm water, and carefully towelled dry. Inspect foot, socks and shoes daily for triggers of injury.

Apply Grahams Natural Diabetic Foot Cream to clean, dry, unbroken skin and nails of the feet daily in conjunction with your foot-self inspection.

• Massage to stimulate circulation and to address rough, dry spots and
• Feel and look for any changes before putting on proper socks and shoes.

If you cannot reach your feet comfortably, use a long handled, clean applicator (such as a soft plastic spatula) to carefully apply. You should also use a strategically placed mirror to examine your feet including skin, toes and nails, everyday.

Get medical treatment within 7 days if you find

• Broken skin between toes
• Callus
• Corn
• Foot shape changes
• Cracked skin
• Nail colour changes

 Get medical treatment that day.

• Ulcer
• Unusual swelling
• Redness
• Blisters
• Ingrown nail
• Bruising or cuts.

TAKE CARE

• Always put cotton socks and properly fitting shoes on before walking or putting pressure on your feet.
• This cream can make hard or wet surfaces slippery.
• Graham’s Natural Diabetic Foot Cream should NOT be applied to broken skin or ulcers.

Some practitioners state the moisturising cream should not be applied between the toes because of an increased risk of wet-friction and/or pathogenic infection. Grahams Natural Diabetic Foot Cream has been designed for application all over the skin and nails, including between the toes. While it is un-medicated it has been specifically designed to help cushion friction, reduce wetness and resist infective organisms.

About this formulated medical device:

Grahams Natural Diabetic Foot cream has been specifically designed to complement and nurture diabetic skin.

The design process has included specific consideration of diabetic skin including

• Excluding humectant, sugars and polyols that are already overly abundant
• Excluding lubricant and structural lipids that are typically in excess and
• Including lipids, emollients and potent antioxidants that under expressed

The cream is formulated to be easily applied, non-greasy and to provide penetrating moisture and a very soft, low friction powder-soft finish that helps to prevent friction and physical stresses on the skin surface.

Intended use:  Grahams Natural Diabetic Foot cream intended for daily use on unbroken skin by diabetics. Massage provides rapid hydration of the skin, helps to stimulate local circulation and a results in comfortable non-greasy barrier to skin friction. It also serves as screening tool enabling rapid self-decision of injuries, that will require prompt attention by medical practitioners.  It is intended as prophylaxis to help alleviate conditions associated diabetic foot syndrome such as dry skin; a consequence of impaired skin barrier function, localised thickening and/or predisposition to ulceration or cracked skin, particularly on the feet.

Humectants draw water from the aqueous formulation base to increase skin hydration. The skins own ‘Natural Moisturising Factor’ (NMF) contains a number of humectants that help maintain water balance and minimise trans-epidermal moisture loss that causes dryness. However, the stratum corneum of diabetic skin typically contains an over-abundance of some NMF constituents such as glycerol and polyols, humectants typically found in normal moisturisers, and also appears to be deficient in aquaporins, the proteins thought responsible for transporting these particular humectants across the stratum corneum. Graham’s Natural Diabetic Foot cream uses exclusively NMF humectants that are typically found to be depleted in diabetic skin specifically ie: Urea, Sodium PCA, Betaine, Hyaluronic acid and Lactic acid.

Lubricating and Emollient Oils and waxes help protect and support the structure and function of skin, and help to stimulate normal skin metabolism. Unlikely normal healthy skin that benefits from application of balanced amounts of cholesterol, ceramides, essential and non-essential free-fatty acids, the altered metabolism of diabetics typically results in the skin containing excesses of cholesterol and ceramides coupled with deficiencies in essential and non-essential free-fatty acids. Graham’s Natural Diabetic Foot cream has been formulated to contain a balance of essential and non-essential fatty acids, from a range of botanical sources, and to minimise cholesterol and ceramides.

Two types of lubricating and emollient lipids are favoured,

• those that that are rapidly absorbed and play the role of intercellular, lamellar barrier support and cushioning skin cells including Castor Seed oil, Medium chain triglycerides, Isopropyl myristate, Linseed oil, and
• semi-occlusive lipids that remain on the skin surface, reducing trans-epidermal moisture loss and softening skin finish such as Carnauba wax, beeswax, hydrogenated castor oil, and coconut oil.

Distearyldimonium Chloride, Isopropyl myristate and linseed oils help to sustain rapid deep-skin hydration and leave a very soft, dry-powdery waxy finish (without greasiness) so that your skin feels comfortably cushioned against dryness and friction.

Antioxidants are integral to this formulation. Oxidative stress and the increased formation of free radicals have been related to skin inflammation and are reported to be among the most important factors in the pathogenesis of skin dryness, dysfunction and stress in diabetic foot syndrome. Studies demonstrate that individuals with diabetes have high levels of lipid peroxidation and decreased antioxidant status. Both simple (ie tocopherol) and complex polyphenols from Pomegranate, Nettle leaf, Calendula and Red Clover are in used in Graham’s Natural Diabetic Foot cream as antioxidants. This provides both lipid and water-soluble antioxidant activity, permitting quenching of reactive oxygen species typical of advanced glycation end products, associated with the diabetic skin conditions and impaired skin barrier function.

Biostatic considerations have also been applied. Substances that are specifically complementary to the diabetic skin condition and that are poorly conducive to acting as food sources for skin pathogens have been favoured. These skin conditioning, biostatic constituents include Distearyldimonium Chloride, Medium Chain Triglycerides, Coconut oil, Benzyl alcohol, Dehydroacetic acid, Lactic acid, Nettle, Chamomile and Red clover extracts.

Appearance: The formulated cream appears as glossy neutral beige to yellow colour, with potentially very small fragments of herbs still visible. It has an intrinsic, natural mild wax odour.  Initially it is very soft, it moves rapidly and easily across the skin, resulting in a rapidly absorbed ‘wet’ feel and leaves a tangible, non-sticky, soft powder waxy protective finish.

This product has been manufactured in Australian, under GMP using (excipient, non-drug) grade ingredients. It is NOT intended for and not suitable for application to open wounds. Store below 30^oC, in closed original container, protect from freezing. If the cream develops an atypical odour or changes in consistency it is important NOT to use it. Discard and replace as merited.