Diabetes is a serious disease that develops from the lack of insulin production in the body or due to the inability of the body's insulin to perform its normal everyday functions. Insulin is a substance produced from the pancreas that helps process the food we eat and turn it to energy.
According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Diabetes is classified into 2 different types: Insulin dependent and Non-insulin dependent. Insulin dependent ,as the name implies, requires supplemental insulin injection to control blood sugar levels. Non-insulin dependent patients can control their blood sugar with oral medication and or diet and exercise.
Regardless of how the blood sugar is controlled the severity of the disease is still the same.
Diabetes disrupts the vascular and neurological systems, affecting many areas of the body such as the eyes, kidneys, legs, and feet, but nowhere are these affects more profound than the feet.
Diabetic patients are extremely vulnerable to foot problems. Typically there is decreased circulation, decreased or absent sensation, loss of function of the small muscles of the foot and impaired ability to heal. A minor foot problem in a non-diabetic patient, can be limb or life threatening in the diabetic patient.
Here is an excerpt from The American Diabetes Association Position Statement on Foot Care:
Foot ulcers and other foot problems are a major case of morbidity, mortality, and disability in people with diabetes. In the presence of neuropathy (Loss of Sensation) and/or ischemia (Poor Circulation), the sequence of minor trauma leading to cutaneous ulceration and wound-healing failure is a frequent cause of lower-extremity amputations in diabetic patients. Once the amputation of one limb has occurred, the prognosis for the contralateral limb is poor. Techniques to prevent amputation range from the simple, but often neglected, foot inspection to complicated vascular surgery. Diabetes Care, Volume 20, Supplement 1, January 1997, pp. S31-S32.
Of the sixteen million Americans with diabetes, 25% will develop foot problems related to the disease. Diabetic foot conditions develop from a combination of causes including diabetic vascular disease (poor circulation) and neuropathy (loss of sensation).
Diabetic Neuropathy (Loss of Sensation)
Peripheral neuropathy can cause altered or complete loss of sensation in the foot and /or leg. Similar to the feeling of a "fat lip" after a dentist's anesthetic injection, the diabetic with advanced neuropathy looses all pain sensation. Any cuts or trauma to the foot can go completely unnoticed for days or weeks in a patient with neuropathy. It's not uncommon to have a patient with neuropathy tell you that the ulcer "just appeared" when, in fact, the ulcer has been present for quite some time. There is no known cure for neuropathy, but strict glucose control has been shown to slow the progression of the neuropathy. There a many supportive treatments which range from topical agents to oral medications. None of these treatments are absolutely effective in all patients. Diabetics suffering from neuropathy can develop minor cuts, scrapes, blisters, or pressure sores that they may not be aware of due to the loss of pain sensation. If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation. Neuropathy can also cause problems such as Bunions, Hammer Toes, dry skin, and Charcot arthropathy.
Diabetic Vascular Disease (Poor Circulation)
Diabetes often leads to peripheral vascular disease which inhibits a person's blood circulation. With this condition, there is a narrowing of the arteries that frequently leads to significantly decreased circulation in the lower part of the legs and the feet. Poor circulation contributes to diabetic foot problems by reducing the amount of oxygen and nutrition supplied to the skin and other tissue, therefore causing injuries to heal poorly. Poor circulation can also lead to swelling of the foot. Preventing foot complications is more critical for the diabetic patient since poor circulation impairs the healing process, and can lead to ulcers, infection, and other serious foot conditions.
It is very important for diabetics to take the necessary precautions to prevent all foot related injuries. Due to the consequences of neuropathy and vascular disease, daily observation of the feet is critical. When a diabetic patient takes the necessary preventative foot care measures, it reduces the risks of serious foot conditions.
Take Care of Your Diabetes
- Make healthy life style choices to keep your blood sugar close to normal. Work with your health care team to create a diabetes plan that fits your life style.
- Check Your Feet Every Day. You may have foot problems that you may not be aware of. Check your feet for cuts, sores, red spots, swelling, or infected toenails. Checking your feet should become part of your daily routine. If you have trouble bending over to see your feet, use a plastic mirror to help. You can also ask a family member to help you. Important Reminder Â¬ Be sure to call your doctor immediately if a cut, sore, blister, or bruise on your foot does not heal after one day.
- Wash Your Feet Every Day. Wash your feet in warm, NOT HOT, water. Do not soak your feet because your skin will get dry. Before bathing or showering, test the water to make sure it is not too hot. You should use a thermometer or your elbow. Dry your feet well. Be sure to dry between your toes. Use talcum powder to keep the skin dry between the toes.
- Keep the Skin Soft and Smooth. Rub a thin coat of skin lotion or crÃ¨me on the tops and bottoms of the feet. Do not put lotion between your toes, because this might cause infection.
- Trim your Toenails Each Week or When Needed. Trim your toenails with clippers after you wash and dry your feet. Trim the toenails so there is no irritation to the skin surrounding the nails and smooth them with an emery board or nail file. If you're nails are thick or yellowed, DO NOT cut your own nails, have a doctor trim them.
- Wear Shoes and Socks At All Times. Wear shoes and socks at all times. Do not walk barefoot, not even indoors. It is extremely easy to step on something and hurt your feet. Always wear seamless socks, stockings, and nylons with your shoes to help avoid the possibility of blisters and sores developing. Be sure to choose seamless socks that are made of materials that wick moisture away from your feet and absorb shock and shear. Socks made of these materials help keep your feet dry. Always check the insides of your shoes before putting them on. Make sure the lining is smooth and there are no foreign objects in the shoe, such as pebbles. Wear shoes that fit well and protect your feet.
- Protect Your Feet From Hot and Cold. Always wear shoes at the beach or on hot pavement. Put sunscreen on the tops of your feet for protection from the sun. Keep your feet away from radiators or open fires. DO NOT use hot water bottle or heating pads on your feet. If your feet are cold, wear seamless socks at night. Lined boots are good to keep your feet warm in the winter. Choose socks carefully. DO NOT wear socks with seams or bumpy areas. Choose padded socks to protect your feet and make walking more comfortable. In cold weather, check your feet often to keep your feet warm avoid frostbite.
- Keep the Blood Flowing to Your Feet. DO NOT cross your legs for long periods of time. DO NOT wear tight socks, elastic, or rubber bands, or garters around your legs. DO NOT wear restrictive footwear or foot products. Foot products that can cut off circulation to the feet, such as products with elastic, should not be worn by diabetics. DO NOT smoke. Smoking reduces blood flow to your feet. If you have high blood pressure or high cholesterol, work with your health care team to lower it.
- Be More Active. Ask your doctor to plan an exercise program that is right for you. Walking, dancing, swimming, and bicycling are good forms of exercise that are easy on the feet. Avoid all activities that are hard on the feet, such as running and jumping. Always include a short warm-up or cool-down period. Wear protective walking or athletic shoes that fit well and offer good support.
- Communicate With Your Doctor. Ask your doctor to check the sense of feeling and pulses in your feet at least once a year. Ask your doctor to tell you immediately if you have serious foot problems. Ask your doctor for proper footcare tips.