More than 1 in 10 Americans over 20 are diabetic, which means that there are probably a number of diabetics among your clientele. These clients are prone to infection and heal more slowly, so cuts and nicks can be devastating to them. Unfortunately, the health risks involved with servicing diabetics can make nail salon owners and techs feel hesitant to work with them. But you can safely service diabetics by taking a few simple precautions. Here’s what you need to know.
Put simply, diabetes is a metabolic disease in which the body’s blood glucose, or sugar, is too high. The body uses insulin, which is a hormone produced by the pancreas, to get glucose from the food we eat into our cells in order to convert it to energy. The disease develops when the body isn’t making enough insulin—or isn’t producing any at all. Without proper insulin function, the body’s glucose just sits in the blood. “Think of it like having sugar in the gas tank of your car; the gas won’t flow as well,” says Dana Canuso, DPM, a podiatric surgeon in New Jersey. “Diabetes impairs your blood flow because you literally have sugar in your blood slowing it down.”
Diabetics commonly have additional health complications that include high blood pressure and heart disease, but there are a few other issues that are important for those working in the salon to understand. White blood cells, crucial for wound healing, don’t tend to work as well as they should in diabetics, says Athena Philis-Tsimikas, MD, a clinical endocrinologist and vice president of Scripps Whittier Diabetes Institute in La Jolla, California. This makes cuts and nicks in the salon even more dangerous for these particular clients. If someone with diabetes gets a cut, the impaired blood flow means that there isn’t enough healthy blood—containing nutrients, oxygen and white blood cells—getting to the injury to help it heal.
Over time, high blood sugar can essentially poison your nerves, adds Christina Teimouri, DPM, a podiatrist at the Beaver Valley Foot Clinic in Pittsburgh. This can lead to neuropathy—nerve damage that causes a loss of sensation or numbness and commonly affects the extremities. A diabetic with neuropathy might cut the bottom of her foot but not feel it and keep walking on it, increasing her exposure to bacteria and subsequent chances of infection, Teimouri says. An infection raises blood sugar levels even more and can get really bad before a diabetic knows it’s happening.
Ask About Health Issues
It’s smart to ask all clients about their health history, whether they have diabetes or any other health issues, before doing their nails. Make sure to include a section in your client record cards where they can list what medications they’re taking, including aspirin, which many people don’t realize is a blood thinner that can make them bleed more if cut. Not only do questionnaires help nail techs create customized services for each and every client, but they can also be an important line of defense to protect techs from lawsuits if anything goes wrong during a service. If a client doesn’t note on the questionnaire that she’s diabetic, at least the nail tech asked and could potentially be covered from a legal standpoint, Teimouri says. If a client indicates that she is diabetic, however, and a nail tech sees cuts or signs of infection on the client’s skin, she should refer her to a doctor and discontinue the nail service. “Nail techs are in a position of power and are experts in their field,” Teimouri says. “If you’re looking at clients’ feet and say, ‘you need to see a podiatrist,’ maybe they will listen.”
Proceed With Caution
In general, you may need to rethink the services and products you use on your diabetic clients. For instance, your client might not realize that she has neuropathy, which is commonly underdiagnosed, Dr. Philis-Tsimikas says, and the root of potential problems servicing this client base. If she does have neuropathy, she won’t realize when the water is too hot, so make sure to test the water for her and err on the side of warm/cool water, not hot. These clients also shouldn’t soak very long because it makes the skin more vulnerable to nicking, Canuso says.
Another side effect of diabetes is swollen feet, which makes these clients more susceptible to ingrown toenails. Use caution when dealing with ingrown toenails, as with any client. Cut the nail straight across so the nail is less likely to dig into the skin and cause infections. And, of course, if there’s any sign of infection present, discontinue the service and refer your client to a physician.
Be extremely careful when it comes to filing the nails and cutting the dead skin around a diabetic client’s nails because it’s not worth the risk of infection if you accidentally nip them. “People without diabetes might heal from a nick the next day, whereas with a diabetic, it could take four to five days, making infection more likely,” Canuso explains. Plus, infections love sugar, she adds, which makes them very difficult to control in diabetics.
It’s best to avoid using pumice stones and foot files as well. Diabetics’ skin is more sensitive, and roughing up the skin in any way can cause microabrasions that bacteria can get into. “Fungus likes trauma, and every rift you make in the skin creates more places for fungus to grab onto,” Canuso says.
While there’s nothing intrinsic in scrubs that might promote infection, Dr. Philis-Tsimikas notes, the problem with using this particular type of product on diabetic clients is that they can’t tell you when you’re scrubbing too hard because they can’t feel it. Diabetics have poor circulation, which makes their skin less pliable and resilient, so be delicate and use a light touch when massaging them, Teimouri says. Also, avoid getting lotion between diabetic clients’ toes; that area of the body is particularly vulnerable to bacteria and infection because it’s difficult to keep it dry and clean.
Although it requires taking some additional precautions, there’s no need to be afraid to see diabetic clients. Says Dr. Philis-Tsimikas, “As long as they have sensation and feel comfortable, they should be fine with some extra care.”
What’s your best advice on performing services on diabetic clients?
-Virginia Pelley is a freelance journalist and editor based in Tampa, FL.