DIABETES

How prevalent is diabetes?

There are estimated to be nearly 2 million diabetics in Canada, and 16 million diabetics in the United States, half of whom probably are unaware of their condition. And each year these two countries see approximately 900,000 new cases diagnosed.

Can diabetes be cured?

Diabetes cannot be cured yet, but it can be treated and managed with proper medical care, dietary control and regular exercise.

What potential medical problems do diabetics face?

Diabetes can have a host of effects on the body.

Individuals with diabetes are two to four times as likely to experience stroke and heart disease.

Diabetes is also the leading cause of end-stage kidney disease, accounting for about 40 percent of new cases.

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Diabetes can also cause diminished eyesight, blurry vision, and even blindness. In fact, diabetes is the leading cause of blindness among adults age 20-74

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Once we even found a jack--the kind of jack from the childhood game of "ball and jacks" (see photo at right)--inside the foot of a 33-year old woman. The only way she knew something was wrong was from the smell of the subsequent infection !

And we have on many occasions performed amputations without even a need for anaesthesia !

Other common results from decreased nerve function in the feet can be minor effects such as the alteration in the levels of perspiration, to much more major effects, like ulcerations, holes in the skin, usually on the bottom of the foot, that can allow infection to develop.

Ulcers are even more likely to develop when the degree of nerve loss gets so severe that it leads to a complete collapse of the arch, known as a Charcot foot. As you might imagine, this means a loss of foot function.

Being furthest from the body, the feet are most susceptible to another common effect of diabetes--decreased blood circulation from the heart.

Atherosclerosis
A Normal Vessel above on the left
and a plaque-filled vessel (one with atherosclerosis) above right

Diminished circulation occurs for a variety of reasons, but the net effect is that both the larger vessels become more plugged with plaque (a disease known as atherosclerosis), and the small vessels become affected, as the walls of these vessels become thicker, making it harder for the nutrients that do make it down to the foot, to leave the vessels to nourish the cells.

This diminished circulation can lead slower-than-normal healing, infections, gangrene, amputation. Approximately 100,000 lower limbs are amputated annually in the United States and Canada due to complications from diabetes. These circulatory effects are even worse if the diabetic patient also smokes.

If you add up all these possible effects, you can begin to see some of the devastating effects diabetes can have on your feet.

How many types of diabetes are there?

There are two major forms of diabetes. Type I, which develops in childhood and is controlled with injected insulin is rarer (5-10% of diabetics), but more severe. Type II, which develops in adulthood, can be controlled with pills or injected insulin.

How do I know if I have diabetes?

Early symptoms of hyperglycemia may include frequent urination, excessive thirst, extreme hunger, unexplained weight loss, tingling or numbness of the feet or hands, blurred vision, fatigue, slow-to-heal wounds, and susceptibility to certain infections. People who have any of these symptoms and have not been tested for diabetes are putting themselves at considerable risk and should see a physician without delay.

Certain characteristics put people at a higher risk for developing Type II diabetes. These include:

A family history of the disease
Obesity
Prior history of developing diabetes while pregnant
Being over the age of 40
Being a member of one of the following ethnic groups:
- African American
- Native American
- Latino American
- Asian American
- Pacific Islander

African Americans are 1.7 times more likely to have diabetes than the general population, with 25 percent of African Americans between the ages of 65 and 74 diagnosed with the disease.
Hispanic Americans are almost twice as likely to develop type 2 diabetes, which affects 10.6 percent of that population group.
Native Americans are at a significantly increased risk for developing diabetes, and 12.2 percent of the population suffers from the disease. In some tribes, as many as 50 percent of members have diabetes.
Weight is the most important risk factor, with more than 80 percent of diabetes sufferers classified as overweight.

If you suspect you have diabetes and wish to know for certain, your doctor will order some bloodwork.

A Random Blood Sugar test will give you an idea of where your sugar is at a given instant in time, but because blood sugar levels can fluctuate wildly during a day, it isn't too accurate to know what's going on overall. After all, you could get a normal reading at a given point in time, but it could be off the charts had you taken the test 3 hours later.
A Fasting Blood Sugar test is more accurate that a Random Blood Sugar, as it tests how your body processes sugar several hours after not eating.
A Glucose Tolerance Test is more accurate still.
Another test that's worth doing is a Hgb A1c, or a Glycosylated Hemoglobin. This will give you a measure of how your sugar level has averaged over the past 3 months.

What can diabetics do to help their condition in general?

We recommend that diabetics see their family physician or internists regularly for control of sugar levels, an ophthalmologist regularly to keep a watch on any deterioration of eyesight, and a podiatrist regularly to regularly examine the feet for any early abnormalities that may develop. A specialist will likely need to be consulted if any kidney problems develop, too.

With the help of a podiatrist, some diabetics may need custom-made diabetic orthoses and/or moulded shoes made for them (a specialization of our offices). These precautions can help prevent the feet from becoming ulcerated or infected.

While there is currently no cure for diabetes, there is hope. With a proper diet, exercise, medical care, and careful management at home, a person with diabetes can keep the most serious of the consequences at bay and enjoy a long, full life.

What can diabetics do to help their feet?

The podiatric physician, as an integral part of the treatment team, has documented success in the prevention of amputations. For example, a 1999 article in the Journal of the American Podiatric Medical Association showed that high risk Medicare patients with diabetes who received preventive podiatric medical care had 75 percent fewer lower extremity amputations than high risk Medicare patients who didn’t receive such care.

The key to amputation prevention in diabetic patients is early recognition and regular foot screenings, at least annually, from a podiatric physician.

In addition to these check ups, there are warning signs that you should be aware of so that they may be identified and called to the attention of the family physician or podiatrist. They include:

Skin color changes
Elevation in skin temperature
Swelling of the foot or ankle
Pain in the legs
Open sores on the feet that are slow to heal
Ingrown and fungal toenails
Bleeding corns and calluses
Dry cracks in the skin, especially around the heel

What can be done for wound healing?

Ulceration is a common occurrence with the diabetic foot, and should be carefully treated and monitored by a podiatrist to avoid amputations. Poorly fitted shoes, or something as trivial as a stocking seam, can create a wound that may not be felt by someone whose level of skin sensation is diminished. Left unattended, such ulcers can quickly become infected and lead to more serious consequences. Your podiatric physician knows how to treat and prevent these wounds and can be an important factor in keeping your feet healthy and strong. New to the science of wound healing are remarkable products that have the appearance and handling characteristics of human skin. These living, skin-like products are applied to wounds that are properly prepared by the podiatric physician. Clinical trials indicate that when applied to wounds, even those that are hard to heal, such products achieve impressive success rates.

The Do's and Don'ts of Diabetic Foot Care

DO:

Wash feet daily.
Using mild soap and lukewarm water, wash your feet in the mornings or before bed each evening. Dry carefully with a soft towel, especially between the toes, and dust your feet with talcum powder to wick away moisture. If the skin is dry, use a good moisturizing cream daily, but avoid getting it between the toes.

Inspect feet and toes daily.
Check your feet every day for cuts, bruises, sores or other changes that may be less obvious. If age or other factors hamper self-inspection, ask someone to help you or use a mirror.

Lose weight.
People with diabetes are commonly overweight, which nearly doubles the risk of complications.

Wear thick, soft socks.
Socks made of an cotton are good, but avoid mended socks or those with seams, which could rub to cause blisters or other skin injuries.

Give up smoking.
Tobacco can contribute to circulatory problems, which can be especially troublesome in patients with diabetes.

Cut toenails straight across.
Never cut into the corners, or taper, which could trigger an ingrown toenail. Don't tear nails. Use an emery board to gently file away sharp corners or snags.

Exercise.
As a means to keep weight down and improve circulation, walking is one of the best all-around exercises for the diabetic patient. Walking is also an excellent conditioner for your feet. Be sure to wear the appropriate athletic shoe when exercising. Ask your podiatric physician what’s best for you.

See your podiatric physician.
Regular checkups by your podiatric physician—at least annually—is the best way to ensure that your feet remain healthy.

Be properly measured and fitted every time you buy new shoes.
Shoes are of supreme importance to diabetes sufferers because poorly fitted shoes are involved in as many as half of the problems that lead to amputations. Because foot size and shape may change over time, everyone should have their feet measured by an experienced shoe fitter whenever they buy a new pair of shoes.

New shoes should be comfortable at the time they’re purchased and should not require a "break-in" period, though it’s a good idea to wear them for short periods of time at first. Shoes should have leather or canvas uppers, fit both the length and width of the foot, leave room for toes to wiggle freely, and be cushioned and sturdy.

DON'T:

Go barefoot.
Not even in your own home. Barefoot walking outside is particularly dangerous because of the possibility of cuts, falls, and other foot injuries on unfamiliar terrain. When at home, wear slippers. Never go barefoot.

Wear high heels, sandals, and shoes with pointed toes.
These types of footwear can put undue pressure on parts of the foot and contribute to bone and joint disorders, as well as diabetic ulcers. In addition, open toed shoes and sandals with straps between the first two toes should also be avoided.

Drink in excess.
Alcohol can contribute to neuropathy (nerve damage) which is one of the consequences of diabetes. Drinking can speed up the damage associated with the disease, deaden more nerves, and increase the possibility of overlooking a seemingly minor cut or injury.

Wear anything that is too tight around the legs.
Panty hose, panty girdles, thigh-highs or knee-highs can constrict circulation to your legs and feet. So can men’s dress socks if the elastic is too tight.

Never try to remove calluses, corns or warts by yourself.
Commercial, over-the-counter preparations that remove warts or corns should be avoided because they can burn the skin and cause irreplaceable damage to the foot of a diabetic sufferer. Never try to cut calluses with a razor blade or any other instrument because the risk of cutting yourself is too high, and such wounds can often lead to more serious ulcers and lacerations. See your podiatric physician for assistance in these cases.