Diabetes and your feet_ Disease management must focus on head-to-toe health

 

 

 

 

By Rodrigo Valderrama, MD
Endocrinologist @Trinity Medical Endocrinology & Diabetes Center.

 

 

 

 

 

Diabetes affects 25.8 million people, or 8.3% of the U.S. population. It is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.

About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage that may result in impaired sensation or pain in the feet or hands. In 2008 alone, more than 70,000 people with diabetes had a leg or foot amputated. While diabetes can lead to serious complications and premature death, by taking steps to control the disease, including being extra aware of foot health, people with diabetes can manage the disease and lower their risk for complications, including lower-extremity amputations.

Why diabetes affects the feet

Diabetes has the potential to harm your feet because blood flow is reduced to certain areas of the body, especially limbs such as the legs. This makes it harder injuries to heal. Also, diabetes-related nerve damage may cause you to no longer feel pain in your feet, and you may not realize you have a wound or injury that needs treatment.

Typical warning signs of nerve damage in the feet include:

• pain in your legs or cramping in your buttocks, thighs, or calves during physical activity
• tingling, burning, or aching in the feet
• lost sense of touch or unable to feel heat or cold well
• a change in the shape of your feet over time
• loss of hair on your toes, feet, and lower legs
• dry and cracked skin on the feet
• thick and yellow toenails
• fungal infection between your toes
• blisters, sores, ulcers, infected corns, and ingrown toenails

Protecting Your Feet

Over half of diabetes-related amputations can be prevented with regular exams and patient education which includes the following simple tips from the Centers for Disease Control and Prevention.

·         Check your feet each day. Because you may not feel foot pain, look at the tops and bottoms of your feet and toes every day to check for scratches, cracks, cuts or blisters. If you can’t see well, ask a family member or friend to help. Call your doctor if you have any sores.

·         Wash your feet daily. Don’t soak your feet, as it can dry out your skin, which can lead to infections. Be sure to dry your feet carefully, especially between the toes. Rub a doctor-recommended lotion on the tops and bottoms of your feet—but not between your toes; moisture between the toes will allow germs to grow that could cause infection.

·         Trim your toenails carefully. After washing and drying your feet, trim your toenails. Trim the nails to follow the natural curve, but don’t cut into the corners. If you can’t see well, or if your nails are thick or yellowed, get them trimmed by a foot doctor or another healthcare provider. If you see redness around the nails, see your doctor immediately.

·         Never cut or use a razor on corns or calluses. Ask your doctor how to use a pumice stone to rub them.

·         Protect your feet from heat and cold. Hot water or surfaces are dangerous to your feet. Test your bath water with your elbow and wear shoes and socks when you walk on hot surfaces. In summer, use sunscreen on the tops of your feet, and in the winter, wear socks and warm footwear to protect your feet.

·         Always wear shoes and socks. Never walk barefoot—even indoors.

·         Wear shoes that fit well and protect your feet. Don’t wear shoes that have plastic uppers, and don’t wear sandals with thongs between the toes. New shoes should be comfortable when you buy them. Always wear stockings or socks made of cotton or wool to help keep your feet dry.

·         Be physically active. Physical activity helps increase the circulation in your feet. If you are not able to walk, ask your doctor about seated or reclining exercises for your feet and legs.

·         Have your doctor check your feet at least 4 times a year.

 

Primary Types of Diabetes

 

Type 1 Diabetes	Type 2 Diabetes	Gestational Diabetes
Previously called insulin-dependent diabetes mellitus or juvenile-onset diabetes, type 1 diabetes develops when the body’s immune system destroys pancreatic beta cells – the only cells that make the hormone insulin that regulates blood glucose.   To survive, people with type 1 diabetes must have insulin delivered by injection or a pump.	Previously called non–insulin-dependent diabetes mellitus or adult-onset diabetes, type 2 diabetes accounts for 90-95% of all diagnosed cases. It usually begins as insulin resistance, in which the cells don’t use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it.   Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism and physical inactivity. Also, African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or other Pacific Islanders are at particularly high risk.	Gestational diabetes is a form of glucose intolerance diagnosed during pregnancy. It occurs more frequently among African Americans, Hispanic/Latin Americans, and American Indians. It’s more common among obese women and women with a family history of diabetes.   During pregnancy, gestational diabetes requires treatment to optimize maternal blood glucose levels to lessen the risk of complications in the baby.

Previously called non–insulin-dependent diabetes mellitus or adult-onset diabetes, type 2 diabetes accounts for 90-95% of all diagnosed cases. It usually begins as insulin resistance, in which the cells don’t use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it.   Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism and physical inactivity. Also, African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or other Pacific Islanders are at particularly high risk.

Gestational diabetes is a form of glucose intolerance diagnosed during pregnancy. It occurs more frequently among African Americans, Hispanic/Latin Americans, and American Indians. It’s more common among obese women and women with a family history of diabetes.   During pregnancy, gestational diabetes requires treatment to optimize maternal blood glucose levels to lessen the risk of complications in the baby.

 

Dr. Valderrama is board certified in Endocrinology and Diabetes and practices with Trinity Endocrinology & Diabetes Center.