This could be the most important page on my web site. Diabetes leads to foot
problems. Foot problems lead to infections and ulcerations. Ulcerations lead to
amputations. Most amputations are preventable!
I repeat:
75% of all AMPUTATIONS ARE...
PREVENTABLE!!!
More hospital days are spent on diabetic foot ulcers than on any other
complications of diabetes.
Diabetics should have a complete foot exam once a year and a foot inspection
each visit with his or her family doctor.
What is
diabetes?
Diabetes is, simply, too much sugar (glucose) in the blood. The way the
system works is that you either take in sugar or food that is converted to sugar
and the hormone insulin moves it into your cells where it is used for energy.
You can develop too much sugar in the blood by not making enough insulin or by
not responding to your insulin. Either way your blood sugar levels rise to
levels that are too high. In general, blood sugar levels above 130 are bad and
indicate diabetes. [ 130 really means 130 micrograms per deciliter written as
130 mg/dl - OK now ignore this part and just think about the big numbers]
If you have diabetes you know that sometimes your sugar levels are high and sometimes
they are low. There is a way to determine how they have been during the last
month. This test is called the HbA1c [hemoglobin A-1-C] When you come to my
office, or your doctor's office, we will measure the HbA1c levels, [also called glycosylated
hemoglobin]. In general levels of the test are as follows:
HbA1C
level corresponds to an average blood
glucose level
5
90
6
120
7
150
8
180
9
210
Blood sugar levels can be treated by the following:
1. DIET AND EXERCISE - good for reducing blood sugar HbA1c levels up to a per
cent or more.
2. ORAL MEDICATION (pills) - either 1, 2 or 3 in combination. each one seems
to reduce the HbA1c level by almost 1%.
3. INSULIN which is injected and can lower the blood sugar to any level you
want.
How does diabetes affect the feet?
Diabetes affects the feet in the following ways:
1) Clogs the circulation - the more your diabetes is out of control the more
the disease will cause a blockage of the arteries. Sometimes the blockage can be
so great that feet and legs are in jeopardy. You cannot heal an infection or
close a wound if there is not enough blood.
2) Kills nerves - high glucose levels in the blood cause a small portion to
be converted to Sorbitol - a funny sugar that will gum up the nerves of the feet
and legs. It is not all that unusual for long term diabetic patients to have
virtually no feeling in their feet. This is very risky because if such a patient
stepped on a thumb tack they would not feel it. If a corn ulcerated of a nail
became ingrown they might not appreciate that an infection was developing.
3) Lowers immunity - this is the third of the unholy triad. Long term
diabetic patients are not able to mount as effective a response to an infection
as their non-diabetic counterparts.
What do people with diabetes need to do for themselves?
QUESTION: I
received this internet question from Rebecca In The Middle Of Nowhere: My
question is I love to go barefooted and I haven't been able to find any cream or
lotions for my dry skin and especially my feet. I have type 2
diabetes and my feet are really dry to the point of
cracking and I have corns as well as warts what do I do?
ANSWER: Dear
Rebecca, Thank you for your question. Every podiatrist has seen many diabetic
patients that have suffered devastating complications from the disease. Even
when you do everything right it can be devastating, but if you do not respect
the disease it can take you toes, feet or life. The disease ends up causing
neuropathy, where you cannot feel or appreciate trauma, bad circulation where
you cannot get blood to the site of a trauma and decrease in immune function
where you have trouble healing a wound or dealing with an infection. With long
standing diabetes an ingrown nail can lead to disaster. Please obey the
following rules:
1. NEVER GO
BAREFOOT: Bare feet always loose when it comes to a challenge like an chair in
the dark or a needle in the rug. A break in the skin can lead to an
underappreciated infection.
2. KEEP THEM
MOIST: Rub a good skin cream or moisturizing lotion on them once or twice a day
3. KILL THE
FUNGUS: If you have athlete's feet be sure to use an easily obtained anti-fungus
cream on your feet every day. That fine scale that you see on your skin that you
think is just "dry skin" is probably fungus.
4. INSPECT YOUR
FEET EVERY DAY: Since you cannot feel trauma you must look for it. If your
eyesight is poor have someone else look at them every day. This includes the
bottom. If your weight or arthritis makes it so you cannot personally inspect
the bottom of your feet prop up a little mirror across from the toilet and hold
you feet up next to the mirror to see them more closely.
5. KEEP YOUR BLOOD
SUGAR UNDER CONTROL: Every day your blood sugar goes over 130 mg/dl you are
damaging your feet. Do whatever it takes to keep the sugar under control.
Increasing exercise and maintaining the proper body weight aver very important.
6. SHOW EVERY FOOT
PROBLEM TO YOUR DOCTOR: Your doctor or podiatrist should know about every corn,
callus and infected nail. Please do not try to take care of these yourself.
7. MAKE REGULAR
VISITS TO YOUR FOOT DOCTOR: If your "nowhere" has an ISP (internet service
provider) it cannot be that far from somewhere. Most "somewhere" have a foot
doctor. Please visit him or her twice a year just to check things out.
8. GET FREE SHOES:
If you are old enough for Medicare and have diabetes you may well be eligible
for a free pair of shoes every year. Your foot doctor will carefully size and
fit your foot to a New Balance, Florsheim or other fine shoe that will exactly
fit your feet. Ask for details from your foot doctor.
When do people with diabetes need to see the podiatrist?
Answer; Twice a year if you are not having problems and
immediately if you are.
What will the podiatrist do?
COUGH SYRUP FOR NEUROPATHY?
The is an interesting report that oral dextromethorphan, widely available as
an over-the-counter cough suppressant (the DM in Robitussin DM or Benylin DM)
may alleviate some types of neuropathic pain. In one study patients who took 3
tsp. every 6 hours had some reduction in pain symptoms. The side effects are
drowsiness, headache and nausea. This was not a great study and contained more
anecdotal info than real data but it seems harmless enough. A better method has
been, and always will be, keeping the blood glucose levels close to normal.
