• Diabetes

    Diabetes Made Simple

    Overview:

    Diabetes is a metabolic disease that causes a rise in blood sugar by not producing sufficient supply of insulin, or producing cells that do not respond properly to the insulin that was produced.

    Our bodies ingest food, which is broken down through various chemical reactions to form energy for the cells throughout the body.  This energy is basically glucose and needs to enter and nourish the body at the cellular level, to maintain healthy bones, organs, skin, muscles, basically every part of a living entity.  The problem is that glucose can not enter most cells without the aid of insulin.  A diabetic may have sufficient supply of glucose but without insulin to guide it into the various cells, the glucose will build up in the blood stream, or pass out of the body in the urine. Diabetes is diagnosed when there is an elevation in glucose in either urine or blood.  The most typical forms of diabetes are the following:

    Type 1 Diabetes:  the body is not capable of producing insulin; therefore injections of insulin are necessary. This is also referred to as Juvenile or Insulin-dependent diabetes mellitus.

    Type 2 Diabetes:  the bodies cells fail to use insulin properly, they form a condition called insulin resistance. An insulin deficiency may also occur which may require limited injections, but typically oral medications will suffice. This type of diabetes is referred to as Adult Onset or Non-insulin dependant diabetes and it is growing exponentially in America today.  This type of diabetes is a result of obesity in children and adults alike and has become a huge medical concern. If too much glucose is introduced to the body, insulin levels even when normal can become overwhelmed, the excess glucose builds up in the blood and can cause short-term and long-term complications.

     

    Gestational Diabetes:   this condition occurs during pregnancy when an expecting mother, without history of diabetes, has a high blood glucose level.   This may be indicative of possible future problems with Type 2 diabetes.

    The latest statistics show that the number of diabetics in America today is nearing and possibly exceeding 24 million.  This number is growing exponentially and this has become a concern of all health care professionals especially podiatrists.

     

    The Diabetic Foot:

    Feet, being the furthest from the heart, typically have the poorest circulation of the body. Changes in blood flow, within both the small and large blood vessels, may progress at different rates.  There can be palpable flow to the arteries in the feet, and simultaneously, complete occlusion to the digits, due to deposits of plaque within the capillaries feeding the toes.  On the other hand, there may be no palpable pulses noted in the foot and yet circulation is still excellent due to collateral propagation of vessels.  As a podiatrist that routinely treats diabetics, I have found that a diagnostic tool called a Doppler can, within a few minutes, determine the blood flow from the lower leg to the foot and from the foot into the digits.  Diabetics run a higher risk of calcification or hardening of the arteries, especially in the lower extremity, which will severely decrease blood flow to the foot.  Podiatrists work closely with Vascular Physicians in a joint effort to reduce the amputation rate amongst diabetics.  This collaboration, over the past decade, has significantly reduced the number of diabetic lower leg and foot amputations, due to earlier intervention, and new techniques in correction of peripheral arterial disease.

    Circulatory changes within a foot can also lead to a higher infection rate.  When blood vessels can’t deliver important nutrients or medications to an area, that area will be slow to heal.  Concurrently, a higher level of glucose in the diabetic patient will make them susceptible to various infections. With the reduction of circulation, the increase in vulnerability to infections, and finally the decrease in sensation called neuropathy, the diabetic foot is a disaster waiting to happen.

    Diabetic peripheral neuropathy is a condition that causes changes in the nerves within the foot, lower leg, and occasionally the hands and arms.  This condition may present as a tingling, or burning sensation in the toes or feet, numbness, or pain that may be more evident at night.  The cause of diabetic neuropathy is still under investigation but is likely due to a combination of several factors.  Most researchers agree that neurovascular changes can lead to damage within the blood vessels that carry oxygen and nutrients to the nerves. High blood glucose, abnormal blood fat levels, even low levels of insulin may affect the nerves.  Autoimmune factors that can cause inflammation to the nerves, inherited traits that increase susceptibility to nerve disease and lifestyle choices, such as smoking and drinking have an adverse affect on the chemical composition of nerve fibers.  Not only do diabetics have a tendency for higher infections, peripheral vascular disease and neuropathy, but since all parts of the body are involved, the skin, bones, soft tissue, ligaments, muscles are all susceptible to changes.  For the diabetic foot that means there can be physical changes such as bunions, hammertoes or even a complete break down of the medial arch.  A diagnosis of diabetes is distressing but with proper treatment, education and determination complications can be avoided.

    Diabetic Complications Overview:

    When diabetes goes undiagnosed or ignored there can ensue both short and long term complications.  Symptoms often present initially as a feeling of being tired and weak, very thirsty, urinating a great deal and hunger.  A person may become more susceptible to infections, notice small cuts and abrasions, that would normally heal rapidly, take much longer to resolve.  Vision can become blurry, and balance may be unsteady.  Left untreated for years the devastation to the body is severe.  Chronic complications of diabetes include eye disease such as retinopathy that can lead to blindness, kidney disease called nephropathy which can necessitate dialysis or transplantation, nerve disease called neuropathy which can lead to amputations. Diabetes is also commonly associated with heart disease, high cholesterol and elevated lipids, which can lead to heart attacks and strokes.   It is important to note that with proper care diabetes can be controlled and occasionally reversed.  Diet and exercise play a key role in reducing the long term complications from this devastating disease.

     

     

    Diabetic Foot Summary:

    If you read nothing else, read this.  A diabetic foot can go from a minor annoyance to an amputation in a matter of days.  DO NOT wait, I have an agreement with my diabetic patients; if there is ever an emergency during business hours we will work them in, if they have an emergency during hours the office is closed I will meet them there.  They are not to wait, I hate being called on a weekend or holiday but not as much as I hate having one of my patients lose a leg.

     

    • Inspect feet daily.  If you are unable to see your feet have someone else look at them.  Inspect for redness, cuts, blisters, any changes.

     

    • Wash feet daily and make sure you dry between toes, moisture build up can cause maceration followed by fungal infections and bacterial infections.

     

    • Moisturize your feet daily but not between the toes. Diabetes causes dry, flaky skin¸ so extra moisture is needed.

     

    • DO NOT walk barefooted, shoes are protection. Walking barefooted, even at home, can lead to a puncture wound.  Many diabetics have lost a foot to a splinter wound that became infected.  In our area walking on hot sand without shoes can be devastating.

     

    • Wear clean, dry socks that fit properly.  If the socks are too big they will bunch up and cause blisters.   If too tight they can disrupt circulation.

     

    • Be very careful cutting nails, if you have good circulation with no changes in the nails then carefully cut straight across with a clean nail clipper.  If you have any problems reaching your toes or if the nails are thick and crumbly, get to a podiatrist.  Injuries sustained while a diabetic  attempts to trim a nail is one of the most common causes of infection in toes, left untreated bone infections will follow.

     

    • Never use a corn or callus remover.  The package in very small print warns that diabetics should never use the product.  A corn remover is acid and will destroy good skin as well as bad skin often leading to an ulceration of the skin.

     

    • Choose shoes carefully,  if you have any problems with proper fitting of shoes see a podiatrist, we carry all the latest diabetic shoes and can properly measure and fit you.

     

    • Make sure you check your shoes prior to slipping them on, a small object lodged in a shoe can have devastating results.

     

    • DO NOT SMOKE, smoking destroys the circulation especially in the extremities such as hands and feet, simply stated the chances of losing a foot or a leg is increased tremendously in diabetics that smoke.

     

    • If your feet have a tendency to be cold wear socks to bed.

     

    • Keeping your sugar under control is not easy, but it has been shown that wild fluctuations will over time cause long term damage, especially to the feet. Diabetics need a team approach and I highly recommend a support group, this is a difficult disease so please use all the resources available to help reduce the risks that are associated with this malady.

     

    Diabetic Neuropathy:

    When there is damage to a nerve, whether traumatically, surgically or chemically, the nerve no longer functions properly.  Symptoms will differ depending on the nerves involved, the extent of the damage and the overall health of the patient.  There are sensory nerves, motor nerves and autonomic nerves, all can be involved to some extent.  The autonomic nerves work primarily involuntarily, they control various bodily functions, but for purposes of this article, we will not be addressing their role.  The sensory and motor nerve damage is usually first noted in the feet.  The common belief is that the blood vessels feeding these nerves are not functioning properly; they may be occluded (closed) or partially occluded and therefore unable to deliver the nutrients needed to thrive.  If blood supply is poor to an area, whether it is muscle, nerves or bones, overtime damage will occur.   Circulation is not the only cause of changes within a nerve. A diabetic can have excellent circulation with strong pulses and still have neuropathy. There are many theories to the causes of neuropathy; prolonged exposure to high blood sugar has been identified as a leading cause of diabetic neuropathy.  Nevertheless, neuropathy can occur to non-diabetic patients and has been linked to Shingles (post herpetic neuralgia), vitamin deficiencies such as B12 and folate, Alcohol, autoimmune diseases, kidney failure, AIDS, heavy metal poising, a variety of drugs especially those used in cancer treatments, the list goes on and on.  Even with the vast array of causes for this condition, often no cause is found and this is referred to as Idiopathic Neuropathy.

    Neuropathy symptoms include:

    v  Tingling, burning, radiating pain in toes, feet, lower legs, as well as arms and fingers

    v  Weakness due to changes in motor nerves

    v  Numbness, sections of the feet or lower leg unable to sense touch

    v  Intestinal problems such as nausea, indigestion, vomiting, diarrhea or constipation

    v  Dizziness, fainting upon initial standing

    v  Problems with urination, erectile dysfunction or vaginal dryness

    There are treatments which have shown promise over the years, but as of today there is still no definitive cure.  Gabapentin, Lyrica, Cymbalta and many other oral medications help alleviate some of the symptoms.  Vitamins such as Mentax have a proven track record and are certainly helpful.  Anodyne therapy which is a light treatment can help alleviate the symptoms but seems to only last a very short time.  Laser Therapy has proven to be a safe and effective treatment but will require 2-3 series of treatments a year to be lasting and valuable.

     

    MSL Laser Therapy improves circulation, reduces pain and edema and helps alleviate neuropathy.  This modality has helped reduce ulcerations, increase feeling and reduce the burning associated with neuropathy. Nevertheless, the most important treatment for diabetic neuropathy is maintaining proper blood sugar levels, good eating habits and exercise. Laser therapy may be amazing but with continuing high glucose levels the results will be minimal and will be only of a short duration.  If you are a diabetic and have been experiencing neuropathy treat it early, see a podiatrist that specializes in Diabetic Foot Care and can offer the newest technologies, treatments and diabetic shoes and socks.  I hope you will consider seeing us at Eastern Shore Foot Center 251-626-5065.