|
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.
Part of keeping your
diabetes in control is testing your blood sugar often. Ask
your doctor how often you should test, and what your blood
sugar levels should be. Testing your blood and then
treating high blood sugar early will help you to prevent
complications. The
socioeconomic costs of diabetes are enormous. The costs
have been estimated at $98 billion annually, about $44
billion of which are direct costs from the disease with
$54 billion indirectly related. Diabetes is the sixth
leading cause of death by disease in the United States,
and individuals with diabetes are two to four times as
likely to experience heart disease and stroke.
The growth of the disease
worldwide is especially alarming. The World Health
Organization (WHO) expects the number of new diabetes
cases to double in the next 25 years from 135 million to
nearly 300 million. Much of this growth will occur in
developing countries where aging, unhealthy diets,
obesity, and sedentary lifestyles will contribute to the
onset of the disease.
- According to a recent
survey, about 86,000 lower limbs are amputated annually
due to complications from diabetes.
- Diabetes is the
leading cause of end-stage kidney disease, accounting
for about 40 percent of new cases.
- Diabetes is the
leading cause of new cases of blindness among adults,
age 20 to 74.
While there is 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.
How Do You Get Diabetes?
No one knows why people develop diabetes, but once
diagnosed, the disease is present for life. It is a
hereditary disorder, and certain genetic indicators are
known to increase the risk of developing diabetes. Type 1,
previously known as insulin-dependent diabetes mellitus or
juvenile-onset diabetes, afflicts five to ten percent of
diagnosed cases of diabetes. This type occurs most
frequently in children and adolescents, and is caused by
the inability of the pancreas to produce the insulin
needed for survival. Type 2, previously called noninsulin-dependent
diabetes mellitus or adult-onset diabetes, affects the
other 90-95 percent of all diagnosed cases of diabetes,
many of whom use oral medication or injectable insulin to
control the disease. The vast majority of those people (80
percent or more) are overweight; many of them obese, as
obesity itself can cause insulin resistance.
Certain characteristics put people at a higher risk for
developing Type 2 diabetes. These include:
- A family history of
the disease.
- Obesity
- Prior history of
developing diabetes while pregnant
- Being over the age
of 40
- Being a member of
one of the following ethnic groups:
- African American
- Native American
- Latino American
- Asian American
- Pacific Islander
- 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 its members have diabetes.
Of all the risk factors, weight is the most important,
with more than 80 percent of diabetes sufferers classified
as overweight.
The Role of Your Podiatric Physician
Because diabetes is a systemic disease affecting many
different parts of the body, ideal case management
requires a team approach. The podiatric physician, as an
integral part of the treatment team, has documented
success in the prevention of amputations. 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:
Skin color changes
- Elevation in skin temperature
- Swelling of the foot or ankle
- Pain in the legs
- Open sores on the feet that are slow to heal
- Ingrown and fungal toenails
- Bleeding corns and calluses
- Dry cracks in the skin, especially around the heel
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 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 have
shown impressive success rates.
If You Have Diabetes Already . . . Do:
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
changes to the toenails, such as thickening or
discoloration. If age or other factors hamper
self-inspection, ask someone to help you, or use a mirror.
Lose weight.
People with diabetes are commonly overweight, which nearly
doubles the risk of complications.
Wear thick, soft socks.
Socks made of an acrylic blend are well suited, but avoid
mended socks or those with seams, which could rub to cause
blisters or other skin injuries.
Stop smoking.
Tobacco can contribute to circulatory problems, which can
be especially troublesome in patients with diabetes.
Cut toenails straight across.
Never cut into the corners, or taper, which could trigger
an ingrown toenail. Use an emery board to gently file away
sharp corners or snags. If your nails are hard to trim,
ask your podiarist for assistance.
Exercise.
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 appropriate athletic shoes
when exercising. Ask your podiatric physician what’s best
for you.
See your podiatric physician.
Regular checkups by your podiatric physician—at least
annually—are the best way to ensure that your feet remain
healthy.
Be properly measured and fitted every time you buy new
shoes.
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.
Don’t go barefoot.
Not even in your own home. Barefoot walking outside is
particularly dangerous because of the possibility of cuts,
falls, and infection. When at home, wear slippers. Never
go barefoot.
Don’t 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.
Don’t 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.
Don’t 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 yourself.
Commercial, over-the-counter preparations that remove
warts 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 cases.
Your podiatric
physician/surgeon has been trained specifically and
extensively in the diagnosis and treatment of all manners
of foot conditions. This training encompasses all of the
intricately related systems and structures of the foot and
lower leg including neurological, circulatory, skin, and
the musculoskeletal system, which includes bones, joints,
ligaments, tendons, muscles, and nerves. |
Diabetes mellitus is a
chronic disease that affects the lives of about 16 million
people in the United States, 5.4 million of whom are
unaware that they even have the disease. Every day, 2,200
new cases of diabetes are diagnosed, and an estimated
780,000 new cases are identified each year. The disease is
marked by the inability to manufacture or properly use
insulin, and impairs the body’s ability to convert sugars,
starches, and other foods into energy. The long-term
effects of elevated blood sugar (hyperglycemia) are damage
to the eyes, heart, feet, kidneys, nerves, and blood
vessels.
