By: Michael Zapf D.P.M., M.P.H., F.A.C.F.A.S.

I just returned from visiting Tom in the hospital. Tom has partially lost his battle against diabetes. More specifically, his foot lost the battle. Walking down the hospital corridor I realized once again that this disease, so commonly seen in a podiatry office, can be very cruel. I am going to tell you about Tom so that you can take some precautions if you have diabetes.

Tom, 51-years old, has been a patient of mine for nearly a year. I see him every month or two to make sure his nails and calluses are kept in check and are not causing him any harm. When I saw him a month ago his foot looked fine. When he showed up last week his foot had an infection that had invaded the bones of the foot. There was no way to save it.

Tom first noticed the early signs of an infection a week prior but he tried to treat the foot on his own. He persuaded himself that it was getting better. His wife knew better and forced him to come to my office. Tom discounted the serious nature of his foot because of neuropathy. His foot was totally numb. Diabetes has a way of converting some sugar, when the blood levels of sugar are high, to sorbitol. Sorbitol is a sweet sugar that our bodies cannot use. Some of the sorbitol gets trapped in the nerves and causes them to cease functioning. At first diabetic neuropathy causes burning pain. In later stages the nerves are numb. Without sensation coming from his feet Tom, had no idea that his foot was as badly infected as it was.

Diabetes also decreases the ability to fight infections. An infection that would be only a minor annoyance in a non-diabetic patient can be limb threatening in a diabetic. Tom thought that a few antibiotic pills would help his foot. He did not realize that his body stopped fighting the infection and he needed early treatment with high doses of antibiotics.

Diabetes causes early blockage of arteries. While Tom has enough oxygen getting to his feet to keep a non-infected foot healthy, he does not have enough to fight a badly infected foot.

The triple threat of neuropathy, decreased immune status and decreased blood flow placed his foot at a very high risk of infection. For that reason virtually every non-HMO insurance plan, including Medicare, will pay for regular podiatric foot care for diabetic patients. Many podiatrists become expert at providing just this care. While many Congress people will decry from the floor of the House and Senate that podiatrists get paid "millions to just cut toe nails" this service is only covered for high-risk patients, like Tom. (The new Medicare rules, by the way, now pay all of $12 a visit for trimming the nails of high-risk patients like Tom. So much for podiatrists getting millions for cutting nails. The hospital admissions avoided by regular care for diabetic patients far outweigh the cost of the preventive services.)

If you have diabetes you need to be aware of the following guidelines:

1. Take every corn, ingrown nail or swollen toe seriously. If there is any sign of an infection show it to your doctor immediately.

2. If you have neuropathy or poor circulation, see a podiatrist regularly. If you need a referral from your primary care doctor for podiatric care, do what you can to obtain one.

3. Inspect your feet daily for trouble signs like redness, calluses and infections. If you cannot bend well enough to see the bottom of your feet, set a mirror on the floor across from the commode and prop it against the wall. If your eyesight is poor, have someone else inspect your feet.

4. Never walk barefoot or without protection for your feet. Splinters, pieces of glass and furniture legs all pose threats.

5. Moist feet do not cause cracks that will allow bacteria to enter. Rub your feet daily with a hydrating cream.

6. Soft absorbent socks are better than thin socks, which, in turn, are better than no socks. A good commercial brand is Thor-Lo.

7. Every study on the subject has shown that there is NO benefit in foot soaking. With an infection, soaking can even present an element of danger.

8. Smoking accelerates the clogging of arteries and can be a death sentence for your foot and leg. Diabetic patients must quit smoking.

9. The better the blood sugar control the longer you get to keep your feet, eyesight and kidneys. Take your medicine as directed and work closely with your doctor to keep your blood sugar under control.

10. A good diet, normal weight and an exercise program will prolong anyone's life, especially someone who has diabetes.

Developing a lifestyle to deal with diabetes is a life-changing event. Danger lurks for all those who deny their diabetes. Yet there is great hope. Just follow these rules and learn all you can about this disease and plan to live a long life free of complications.