Manicures on diabetics

[ProperPrincess]

Dear Sandman, you should not feel guilty for asking questions, if you don't know the answer to something, you need to ask, simple as that.
So I'm going to give a somewhat broader statement here and then answer you as concisely as possible.
When you come across something that in your studies said contra indicated, while you were studying the correct course for you was to avoid it.
Now you are qualified the correct course is to find out why it's contra indicated and see if there is a way for you to safely adapt your service.
So you have a diabetic client come to you for a manicure.
Put the condition to one side for a moment and look at the client. What is their age group? What is there skin like, how do their nails look.
These are the bones of the service you will give.
Once you have that out of the way you then need to know certain things from them.
You explain to your client that in the event of an accident in the work place you need to know things to tell an ambulance crew. Anyone can trip and bang their head
So are they type 1 or 2 diabetic. Type 1. The body can not process sugar at all and the condition is controlled by injection (this is a broad answer, so please don't anyone jump down my neck here) Type 2, the body is not very good with processing sugar and the client helps with, sometimes diet alone, sometimes with diet and tablets.
It's helpful if you can write on the client card who their doctor is, what type of medication they take and how often.
Then you want to know what their blood sugar reading is. A none diabetic in good health will have a reading of 5 or very close to that.
A controlled diabetic will have a reading of somewhere between 4 and 9.
Ask them, have they any loss of sensitivity in their hands or feet. They will know, every time they see the diabetic nurse for a review they have a sensitivity test. Make a note of it.
This is where you will be making your adjustments. For example, when I give my husband a pedicure, I am very careful to test the water temp for his foot bath, this is because he has a slight loss of sensitivity in one foot and in his hands, so asking him if the temp is ok, is a waste of time.
Using a cuticle pusher or nippers is the same as for anyone else, you examine the skin and provided its normal in appearance, carry on.
Ex foliation scrubs etc have more to do with skin type then anything else.
If your client is elderly and has thin paper like skin I wouldn't use a scrub, if they happen to be diabetic or not.
Pedicures. This is where we are so very helpful. We will see the bottom of the feet. We can see if there are cuts or anything unusual and we should not keep quiet about them. We know what a normal foot looks like and we should be willing to write a note to be passed along to a doctor saying what we have seen. Don't diagnose for goodness sake (doctors hate that) but state what we have seen and ask the doctor to have a look and tell us if this is ok. We are trained to cut nails correctly. We will spot an in growing toe nail. An infected hang nail, bacterial infection. That is where we are the professionals. If you are ever faced with a diabetic who can not tell you what their blood sugar level is, or says it's more then 10. I would tell them that until their blood sugar is under control I would not be able to treat them.
Again this is not because I think I'm going to harm them with a treatment, it's because I would worry that my insurance would not cover me and because I'm encouraging a diabetic to take better care of them selves.
So all my ranting aside. I hope this answer has helped and I strongly suggest you talk to the diabetic nurse at your own doctors practice. If you ring and explain to reception that you want a greater understanding so as to carry out treatments so could you have a call back when ever the nurse isn't busy. You should get a happy nurse feeding you info as quick as you can take it in.
Diabetic uk has a wealth of information, all written in easy to follow language and style. It's aimed at new diabetics who are trying to understand what's happening to them.
Lastly if you don't do pedicures, you should, good money to be made and there are some really good extra courses you can take which will allow you to become a tech who offers more then the average.
HTH xx

I don't know if you will ever need this information but a pregnant type 1 or 2 diabetic or even someone with gestational diabetes will be aiming for a blood sugar reading between 4 and 6 xxx

 

[gr8nailz]

It is best to get information, not second hand, but directly from the source. I always refer directly to American Diabetes Association. I linked an article earlier in this thread.

I would caution anyone from giving medical advice even if we are the primary caregiver. There's much that can be lost in interpretation. We're nail professionals, not medical professionals. When we start talking about different levels and readings etc, those areas are better left to those who know the subject matter best, medical professionals.

Even those that have diabetes and have commented on this thread have referred back to official diabetic websites for conclusive information. That is what should be used...please heed the advice.

 

[Blue Rose]

So I'm going to give a somewhat broader statement here and then answer you as concisely as possible.

HTH xx

Thank you Susie for taking the time, trouble & effort to write that post. It was very informative & even I learned a few nuggets of info & I've been qualified 20 years.

Shame there had to be a spoiler afterwards though :sad:

 

[beauti-licious]

Dear Sandman, you should not feel guilty for asking questions, if you don't know the answer to something, you need to ask, simple as that.
So I'm going to give a somewhat broader statement here and then answer you as concisely as possible.
When you come across something that in your studies said contra indicated, while you were studying the correct course for you was to avoid it.
Now you are qualified the correct course is to find out why it's contra indicated and see if there is a way for you to safely adapt your service.
So you have a diabetic client come to you for a manicure.
Put the condition to one side for a moment and look at the client. What is their age group? What is there skin like, how do their nails look.
These are the bones of the service you will give.
Once you have that out of the way you then need to know certain things from them.
You explain to your client that in the event of an accident in the work place you need to know things to tell an ambulance crew. Anyone can trip and bang their head
So are they type 1 or 2 diabetic. Type 1. The body can not process sugar at all and the condition is controlled by injection (this is a broad answer, so please don't anyone jump down my neck here) Type 2, the body is not very good with processing sugar and the client helps with, sometimes diet alone, sometimes with diet and tablets.
It's helpful if you can write on the client card who their doctor is, what type of medication they take and how often.
Then you want to know what their blood sugar reading is. A none diabetic in good health will have a reading of 5 or very close to that.
A controlled diabetic will have a reading of somewhere between 4 and 9.
Ask them, have they any loss of sensitivity in their hands or feet. They will know, every time they see the diabetic nurse for a review they have a sensitivity test. Make a note of it.
This is where you will be making your adjustments. For example, when I give my husband a pedicure, I am very careful to test the water temp for his foot bath, this is because he has a slight loss of sensitivity in one foot and in his hands, so asking him if the temp is ok, is a waste of time.
Using a cuticle pusher or nippers is the same as for anyone else, you examine the skin and provided its normal in appearance, carry on.
Ex foliation scrubs etc have more to do with skin type then anything else.
If your client is elderly and has thin paper like skin I wouldn't use a scrub, if they happen to be diabetic or not.
Pedicures. This is where we are so very helpful. We will see the bottom of the feet. We can see if there are cuts or anything unusual and we should not keep quiet about them. We know what a normal foot looks like and we should be willing to write a note to be passed along to a doctor saying what we have seen. Don't diagnose for goodness sake (doctors hate that) but state what we have seen and ask the doctor to have a look and tell us if this is ok. We are trained to cut nails correctly. We will spot an in growing toe nail. An infected hang nail, bacterial infection. That is where we are the professionals. If you are ever faced with a diabetic who can not tell you what their blood sugar level is, or says it's more then 10. I would tell them that until their blood sugar is under control I would not be able to treat them.
Again this is not because I think I'm going to harm them with a treatment, it's because I would worry that my insurance would not cover me and because I'm encouraging a diabetic to take better care of them selves.
So all my ranting aside. I hope this answer has helped and I strongly suggest you talk to the diabetic nurse at your own doctors practice. If you ring and explain to reception that you want a greater understanding so as to carry out treatments so could you have a call back when ever the nurse isn't busy. You should get a happy nurse feeding you info as quick as you can take it in.
Diabetic uk has a wealth of information, all written in easy to follow language and style. It's aimed at new diabetics who are trying to understand what's happening to them.
Lastly if you don't do pedicures, you should, good money to be made and there are some really good extra courses you can take which will allow you to become a tech who offers more then the average.
HTH xx

Thank you very much for the info in this post, much appreciated

 

[gr8nailz]

Shame there had to be a spoiler afterwards though :sad:

The fact that you felt my post was "a spoiler" is the very reason I posted the comment in the first place. There is so much left to interpretation and so much can be misinterpreted. You most certainly misinterpreted me.

Our colleagues who were so kind to share their life experiences with this disease are also the very ones that said that official diabetic websites should be utilized so that we are properly informed. We have seen first hand that this thread has been littered with misconception and wrong information. I am very thankful that some decided to share their personal stories with us. It was brave and enlightening. The information they provided was very helpful; however, my point is that when we, non medical professionals, start talking about readings and levels etc, too much can be misinterpreted. Some will take their misinterpretions and run with it.

I believe in going to the source, not getting second hand information. The American Diabetes Association is made up of doctors, not patients or caregivers. They are doctors on the cutting edge of medicine. I will go there for the most concise, accurate information. No offense intended to our colleagues who took the time to provide us valuable information.

 

[missjodylee]

When one person asks a question, countless more gain education from it.

I've learnt heaps from this post so thanks to all for contributing

 

[sophiegees]

Perhaps the Guild of Beauty Therapist can help with this as they are on this forum.

I am with the Guild and have my insurance through them and cannot do a manicure, or even a simple polish on diabetics without a doctors note. This is because the course I took advised this. Infact I cant treat hardly any illnesses without a doctors note - high blood pressure etc. Basically whatever your course taught you, you have to abide by.

So you could have, in theory, one course which teaches you to treat diabetics with care but you can treat, another which says you cant even apply nail polish to a diabetic without a doctors note - and they could have the same insurance policy....

I wonder what your thoughts are on this

xx

 

[mum]

Perhaps the Guild of Beauty Therapist can help with this as they are on this forum.

I am with the Guild and have my insurance through them and cannot do a manicure, or even a simple polish on diabetics without a doctors note. This is because the course I took advised this. Infact I cant treat hardly any illnesses without a doctors note - high blood pressure etc. Basically whatever your course taught you, you have to abide by.

So you could have, in theory, one course which teaches you to treat diabetics with care but you can treat, another which says you cant even apply nail polish to a diabetic without a doctors note - and they could have the same insurance policy....

I wonder what your thoughts are on this

xx

This is a really interesting point! The Guild have posted on here and suggested that policies are checked for this. I have recommended several times before that people should check policies for many things. I think you would be surprised at what policies DO NOT cover you for.

I don't know how underwriters can prove or disprove exactly what an individual was taught on their course though. However, different policies have different 'small print' so despite all the arguing on this thread some may not be insured to provide nail services for those with diabetes.

 

[FreyaBeauty]

How a therapist is taught to perform a treatment (bad or good) is not the fault of the therapist!

No therapist alive knows EVERYTHING

You will never know everything as treatments, products and health and safety change often!!

Keep you eyes peeled and don't ever stop learning....x

 

[shuntersue]

this post has been very interesting and informative, but MY GOD! does it have to get bitchy nealy everytime! Stick to the question!!! Please don't be slagging people off, if there is a comment you hugely don't agree on, just politely say, there is no need for nastiness.

 

[Susie H]

Like I said in the info, contact diabetic nurse and Diabetic uk.
Yes mum and others are right you do need to contact your insurance company and find out what they will and will not cover. Then you need to see if it's time to change insurance company.
My insurance company cover me provided that the medical conditions are declared on the client card.
They have taken this approach because increasingly doctors will not write letters unless paid to do so, my own doctors practice charges £48 per letter, and I know they are not the most expensive.
As a foot note, the way that blood sugar is measured has now been changed.
But not in all doctors practices. So one more time I will stress, please contact the correct medical professional and make sure your information is up to date.
This applies to any condition. Quiet often someone with an underlying condition has more need of our services and we would be foolish to turn them away just because we have not taken the time to find out how to adapt our service.

 

[Susie H]

I don't know if you will ever need this information but a pregnant type 1 or 2 diabetic or even someone with gestational diabetes will be aiming for a blood sugar reading between 4 and 6 xxx

Thank you Princess, I didn't know that, good to add to my knowledge too

 

[beauti-licious]

I believe in going to the source, not getting second hand information. The American Diabetes Association is made up of doctors, not patients or caregivers. They are doctors on the cutting edge of medicine. I will go there for the most concise, accurate information. No offense intended to our colleagues who took the time to provide us valuable information.[/QUOTE]

i have just read their info and found it very interesting. they actually condone the use of metal tools, as they can be sanitised far better than orange sticks- a very valid point?

 

[brittone05]

Is it not time then that training providers started to look into offering more concise and thorough add on's to their courses focusing solely on contra-indications and how to work with clients who have illnesses, medication requirements and allergies etc?

 

[beauti-licious]

Is it not time then that training providers started to look into offering more concise and thorough add on's to their courses focusing solely on contra-indications and how to work with clients who have illnesses, medication requirements and allergies etc?

i totally agree, i dont think we learnt enough about contra-indications, medication on any of my courses

 

[FreyaBeauty]

Is it not time then that training providers started to look into offering more concise and thorough add on's to their courses focusing solely on contra-indications and how to work with clients who have illnesses, medication requirements and allergies etc?

Yes lecturers need to spend more time on contra indications and health and safety! Very true x

 

[MissOwen]

Is it not time then that training providers started to look into offering more concise and thorough add on's to their courses focusing solely on contra-indications and how to work with clients who have illnesses, medication requirements and allergies etc?

I think its unlikely that they will..... for the same reason that many have advised to check with their insurance before commencing a treatment on someone with a medical condition. We all need to cover our backsides, training companies too.

If training providers start giving more detailed instruction on how to treat these conditions, it would probably leave them open to possible legal action should anything go wrong during a treatment.

I also think it would be risky for them to pass out too much info in these sorts of circumstances without being a medical proffessional.

I'm not saying its right, but i just think it would be too much of a risk for companies to start providing indepth medical condition training. As we've noticed on this thread, things are often misinterpreted and that could leave them wide open to legal issues!

 

[mum]

I think it's very dangerous to start getting into details of specific conditions, illnesses and medications etc during training. I think the medical profession would have a lot to say if nail technicians, in general, professed to have an in-depth knowledge, in fact they would put a stop to it.

The National Occupational Standards are developed after consultation with many different disciplines and anything with any greater knowledge requirement falls into different qualifications. What should be covered in basic training is very clear in the NOS. The trouble is no one in the world of FE 'sing from the same hymn book' and everyone thinks they are right! Teaching is far too varied and always has been. Because money is involved training providers, country and brand wide, have never been prepared to get together and agree what is right for the industry as a whole.

Anyone wanting to further their knowledge can continue learning and there are some very useful suggestions on this thread. However, if a technician does develop a greater knowledge and understanding in specific areas, they MUST check with their insurers that they can recommend certain things based on medical circumstances.

 

[Luscious85]

I have learnt so much from reading this - I must say that when I trained at college a lot of time was spent on more minor contra-indications like bruising/cuts/fungal nail infections/conjunctivitis etc and hardly and time on things like diabetes and medications taken etc. Although I do carry out a consultation on every new client, I feel quite exposed and will definitely be investing some time on brushing up on this topic.

Contacted my insurers straight away to find out what their policy is - I wrote a very carefully worded email obviously requesting a detailed reply and I even asked specifically about diabetes, medication, and exactly what questions they expect to be covered in my consultation to make sure I'm doing everything correctly but received a short reply just telling me to adhere to whatever the training provider taught (does that mean the college?), and telling me to keep all client cards should someone make a claim. This doesn't help and doesn't fill me with any confidence. My insurance is due for renewal in October, think I may change.

Can anyone suggest a good official overall source of information for all contra-indications?

 

[brittone05]

I didn't necessarily mean in depth training to a medical standard but more so like a refresher type course that offers techs the ability to learn more about technical issues such as clients where metal tools shouldn't be used, massage should be avoided etc

I know that sometimes it boils down to common sense - elderly clients may have thinner skin so be more gentle, diabetic clients are known to have lack of sensitivity to the feet area especially so be more careful etc

It is something that isn't massively covered on training courses and perhaps it is something that training and insurance providers alike should work together on? xx