Diabetes is a disorder
where the body cannot properly produce insulin, a hormone secreted
by the pancreas (see diagram) that controls the body's level of blood
sugar--the form of energy used by the body's cells.
Diabetes results in
abnormally high blood sugar levels, which can lead to a host of
devastating effects on the health of the body.
Indeed, diabetes is
the fourth leading cause of death in this country.
How prevalent is
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.
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
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
disease, accounting for about 40 percent of new cases.
Diabetes can also cause diminished eyesight, blurry
even blindness. In fact, diabetes is the
leading cause of blindness among adults age 20-74
What types of foot problems can
Diabetes-related foot problems are the third most common
reason for hospitalization and the leading cause of amputation in the lower
leg and foot. While research has produced new technology and treatments to
address this situation, we still have a long way to go before we find a
One reason why diabetes is so dangerous is that it
often leads to what is known as peripheral
neuropathy, a condition in
which nerve function deteriorates in the body's hands and feet.
This damage leads to a gradual loss of normal
feeling in the hands, arms, legs and, especially, the feet. The
patient may feel numbness, weakness
a tingling in the extremities, or in some cases, shooting pains
or a burning sensation.
Most problematic, however, is the loss of the body's ability to sense pain
in the affected areas. Pain enables the patient to know
something is wrong. Without it, patients often fail to seek timely treatment
for cuts, bruises, burns or blisters of the feet that heal poorly owing to
diabetes-related circulatory problems.
Because of this, otherwise minor skin problems of the feet tend worsen and
can easily become infected.
How bad can sensation loss become?
We have found pins, needles, nails, screws,
thumbtacks and pins...........
..........inside the feet of diabetics, almost always without the patient even being aware
they were present !
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
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
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
from the heart.
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 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
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
Prior history of developing diabetes while pregnant
Being over the age of 40
Being a member of one of the following ethnic groups:
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
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.
Tolerance Test is more accurate still.
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 addition to keeping a careful watch on their
blood glucose levels with a blood glucose monitor (like the one on the
right by Almira Medical), eating a balanced diet and exercising
regularly, diabetics should inspect their feet carefully every
day, using their hands to feel for areas of hard or dry skin, and a
mirror to check the bottoms of the feet for any redness or cracking.
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
With the help of a podiatrist, some diabetics may need custom-made
shoes made for them (a specialization of our
offices). These precautions can help prevent the feet from becoming ulcerated
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:
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.
Do's and Don'ts of Diabetic Foot Care
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.
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
Give up smoking.
Tobacco can contribute to circulatory problems, which can be
especially troublesome in patients with diabetes.
Cut toenails straight
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.
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 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.
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
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
Commercial, over-the-counter preparations that remove
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