What is diabetes?
Diabetes is a lifelong health condition in which the body’s levels of blood glucose and the hormone insulin are out of balance. Symptoms include increased thirst, increased frequency of passing urine, and fatigue. There are two main forms:
• Type 1, in which the body doesn’t produce enough insulin.
• Type 2, where either the body doesn’t produce enough insulin, or the body’s cell no longer react to the insulin produced.
An inability to produce insulin, or use it effectively, results in raised levels of blood sugar (hyperglycaemia). If present over a prolonged period, hyperglycaemia is associated with damage to organs and tissue within the body including the heart, blood vessels, nerves, kidney and eyes.
The risk factors for Type 1 diabetes are still being researched, but several have been identified for the commonest form, Type 2. These include a family history of the disease, being overweight, physical inactivity, and unhealthy eating.
What is a podiatrist?
A podiatrist is an important part of a team of health professionals who manage complications associated with diabetes. Diabetes can affect circulation, nerve sensation (feet go numb or tingly), skin health, healing of wounds, and fighting infections. If you have no other complications with your diabetes, an annual foot exam can help detect problems early. Pressure points that turn into calluses, can result in foot ulcerations and infections.
Ingrown or fungal toenails, can lead to infections as well. Some patients require foot care every 2-3 months, to avoid problems with their feet, and closely monitor for problems.
Podiatrists can assess shoes, and even prescribe shoes and orthoses for your feet. They will help prevent the complications, along with accommodating deformities like hammertoes and bunions. If you have had a wound of some kind on your foot, it can also be prevented from recurring.
How does diabetes link to podiatry?
Foot complications in diabetes are common, accounting for more hospital admissions than any other diabetic complication. Foot ulcers present as one of the most significant pathologies, and are associated with neuropathy (nerve damage), and/or peripheral arterial disease (poor circulation). These greatly increase the risk of amputation, with up to 80 per cent of amputations attributed to foot ulceration.
The prognosis for individuals with ulceration and amputation is poor, with a five year mortality rate of 43-55 per cent, and up to 74 per cent respectively. Podiatrists play a leading role in the management of ulceration.
They provide treatments, including wound debridement, dressing and pressure relief. It has been suggested that 80 per cent of amputations are potentially preventable, through the provision of well structured, quality care.
The consequences of diabetes manifest slowly over a period of time. As a result, by the time they occur, it is too late, and the focus of treatment is the prevention of ulceration, and the subsequent fallouts.
It is why patient education is so important from the outset, and should be an ongoing process. Optimising blood glucose control is key; by providing regular foot checks, it can be reinforced, serving as a warning to those who are developing the complications.
Every person with diabetes, should pay careful attention to the systems of the body that can be affected directly and adversely These are the cardiovascular system, the renal system (kidneys), the eyes, and feet. It is recommended that every patient with diabetes have at least an annual check on all of these systems.
As far as the feet are concerned, people with diabetes can have severe, even life-threatening foot problems. This can happen because of a snowball effect the disease can have on the circulatory and nervous systems of the body. Essentially, diabetes can cause:
• decreased foot blood flow
• decreased healing potential
• decreased infection fighting capability
• numbness of the feet
These problems can all come together in a diabetic foot, causing drastic results.
It is entirely possible, for example, that a diabetic could step on a nail, and being numb, not even be aware.
Then follows a severe infection (which the person may not be able to fight), decreased healing potential, decreased blood flow, and problems can spiral quickly.
Often this patient may not even realise he/she stepped on a nail for a few days; by then, a severe infection has set in, and the problem is serious.
Every diabetic should have a podiatrist, whom those with numbness in the feet, should see on a regular basis each year. These problems are preventable, and are not inevitable. Regular check-ups with your podiatrist can prevent problems; as well, nail and callus trimming can be done, if you cannot manage same at home.
November is World Diabetes Month, so stay tuned, and look out for varied topics.
Your feet mirror your general health . . . cherish them!
Leana Huntley is a UK trained Podiatrist attached to Almawi Limited The Holistic Clinic, and Clinical Director-Fit Feet, Special Olympics Trindad and Tobago. E-mail: email@example.com or visit the website at www.almawiclinic.com.