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Diabetes and the foot

Disorder
Diabetes and the foot.

Definition
Diabetes (diabetes mellitus) is a common syndrome in which blood sugar levels are excessively elevated (hyperglycaemia). The body primarily reduces blood sugar levels by the release of the hormone insulin. People who suffer from diabetes either produce insufficient amounts of insulin, or insulin production is unaffected but the body is resistant to its effects.

There are three main types of diabetes. The first type is often referred to as type 1 diabetes, with this type of diabetes control of blood sugar levels is by the injection of insulin. The second type of diabetes is often referred to as type 2 diabetes. With this type of diabetes blood sugar levels are controlled without insulin, mainly by diet and / or oral drugs (tablets). 95% of people suffering from diabetes have type 2 diabetes. The third type of diabetes is known as gestational diabetes. This type of diabetes occurs during pregnancy and usually resolves following delivery.

Diabetes if well controlled need not prevent the person affected leading a near normal life style. However if poorly controlled for whatever reason, complications are common. These complications centre around effects on blood vessels and circulation. Both small and large blood vessels can be affected detrimentally in diabetes. The resulting changes in circulation can impact upon various body systems, however there are specific implications associated with the lower limb and foot.

For those suffering from diabetic complications the foot can become insensitive to pain, the skin may become thin and fragile, the mechanics of the foot may alter due to changes in nerve supply and muscle tone, and infection can become more likely and difficult to treat when it occurs. Some very serious leg and foot disorders are up to 5 times more common in diabetics than none diabetics.

The classic recognition features that may indicate diabetes are those of excessive urination, an excessive thirst and weight loss. In type 1 diabetes the onset of these features may be very rapid. In type 2 diabetes the recognition features may develop slowly and obesity may be present. Some people with diabetes may not present any of these features and only be detected on the presentation of associated complications, or on routine screening.

Incidence / Age
Approximately 2% of people in the United Kingdom suffer from diabetes. The majority of people initially diagnosed with type 1 diabetes will be under 20 years of age. With type 2 diabetes the onset of the condition is usually later in life, most commonly occurring after 50 years of age. Gestational diabetes occurs in 1-3% of all pregnancies.

Treatment
There is no cure for type 1 and 2 diabetes, however diabetes can be controlled.

Diet: All people suffering diabetes need to modify their diet. The diet for a diabetic is basically a good healthy diet. It is best to consult a dietician for advice on what constitutes a healthy diet for a diabetic.

Life style changes: As well as addressing your diet, other changes to life style may be advisable. Regular exercise is all part of a good healthy life style. In diabetes it is essential as it helps maintain body weight and provides valuable exercise for the heart. Smoking is never a good idea, however in diabetes it will greatly increase your risks of developing an associated complication. Routine in diet, exercise and rest are all essential parts of developing a healthy life style in diabetes.

Tablets: In type 2 diabetes it may be necessary to take tablets to help control blood sugar levels. The most common types of tablets used are Sulphonylureas and Biguanides. Sulphonylureas help increase the amount of insulin released into the blood, while Biguanides reduce the internal formation of new glucose and increases the body’s sensitivity to existing insulin levels. It is essential that you follow the dosage and interval information given to you by your doctor or nurse in regard to the use of diabetic tablets.

Insulin: Insulin is given by injection. The needles used are very fine and once trained most diabetics inject themselves, experiencing little discomfort. It is usual to need to inject insulin twice daily. There are a number of different types of insulin available that work in slightly different ways giving differing durations of action.

Diabetes and the foot
Foot complications are common in diabetes. The foot may be at risk in diabetes due to a reduced blood supply and / or alterations in the appreciation of pressure, position and pain. It is worth consulting a State Registered Podiatrist / Chiropodist for a foot health check up and advice on self care if your are diabetic. The following are some specific does and don’ts as far as your feet are concerned.

1: Visually inspect your feet daily, if you have good eye sight. If not get a friend or carer to inspect them for you. Look out for corns and calluses, inflamed areas or bruising. Pay particular attention to any breaks in the skin. If any of these problems occur, consult a Podiatrist.

2: Keep your skin moist. Use a hand or face cream on your feet daily. Rub it well into the skin but do not apply between the toes, as these areas are usually already quite moist. Do not use creams that contain acids unless they have been prescribed for you.

3: Temperature. Be careful as to the temperature of water in which you are to bath or wash your feet. If your feet are insensitive the water may burn the skin. Test the temperature with your elbow or a thermometer. As a general rule, do not soak your feet as this will make the skin more dry.

4: Shoes. Before putting your feet into a pair of shoes inspect them and run your hand inside them. Make sure there is nothing in them and check for rough seams. It is essential to wear well fitted leather foot wear. It is never a good idea to walk bare foot, even around the house.

5: Nail Cutting. Take care when cutting your toe nails. If you have any problems with your eye sight or have difficulty reaching your feet get help from a relative or friend. Always cut your nails straight across, rounding the edges with a file. Alternatively file them regularly instead of cutting them. Do not cut them too short. If your nails are thickened you may require professional help.

6: Corns and calluses. If you have any corns or calluses consult a Podiatrist. Never try to reduce these areas of hard skin with creams, corn plasters or anything sharp. Seek professional help.

Outcome / Prognosis
Diabetes is a controllable condition that need not detrimentally affect ones life style. For some people with diabetes, associated complications can occur. The foot is one area of the body that is commonly affected in diabetes. Daily care of the feet is essential in diabetes.

Recommended links

http://www.feetforlife.org
http://www.diabetes.org.uk

 

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Diabetes and the foot - Common Foot Complaints - Birmingham Foot Clinic