Wednesday 14th the November is World Diabetes Day
From Riyadh to Rio, from Paris to Perth, the world is facing a silent health crisis and it is called diabetes. High genetic susceptibilities combined with a sedentary existence and staple diet of high sugar content foods has ensured diabetes is in epidemic proportion. Diabetes is a condition where levels of blood sugar (glucose) are high because either the body does not produce enough insulin or our insulin is not working properly. Insulin is a hormone, which helps sugar breakdown carbohydrates. The disease presents in two types, Type I, affects younger people and relates to a lack of insulin production from the pancreas; Type II Diabetes is more likely to challenge the lifestyle and health of aging adults. The incidence particularly common among the 30+ demographic is on the increase. Whilst most people diagnosed with diabetes cope well, about 15% develop foot complications. One third of that group will develop an ulcer within a year of diagnosis and unless treated these can lead to amputation. Complications from diabetes usually occur within 10 to 20 years of getting the disease. What is particularly pernicious is most Type II Diabetics go undiagnosed for up to a decade during which time severe nerve damage may already be established.
The changes associated with diabetes can seriously affect the legs and feet. Clogging of the arteries with fatty plaques may reduce blood flow to the legs causing ischaemia. This gives a range of symptoms from ice cold to hot burning feet. Leg cramps become more likely and come after mild exertion or at rest. These symptoms should be reported to the doctor. Increased blood sugar levels cause delayed healing and frequently an infected ingrown nail or septic corn will not heal. People living with diabetes are prone to all kinds of acute infection from the simplest cuts or abrasions on the skin. Diabetes can also affect the nerve supply and damage caused by high sugar levels may present as numbness, pins and needles (paraesthesia), burning sensation and hypersensitivities to pain, touch and temperature. Most diabetics complain of a strange feeling under their toes, described as ‘standing on crumpled bedclothes’. Some people have no feeling whatsoever in their feet. When the absence of pain is present this means many diabetics are unaware of gaping wounds all prone to infection. This makes the feet vulnerable. The earlier these symptoms are reported to your health care professional, the better. The sooner treatment begins the more likely there is reduction in complications that may develop otherwise. So it is a good idea to routinely inspect the feet for cuts and sores. Shoes are often cited as a leading cause of injury so checking the shoes for rough edges, torn seams, sharp objects like tin tacks and broken glass can help reduce the problem. Simple self-pedicure such a toe nail cutting or corn scrapping become fraught with dangers when undertaken by people whose eyesight is poor (another complication of diabetes) and neglect of dry skin frequently causes cracking (fissures) which is then vulnerable to infection. When the feet become unmanageable then this is good reason to visit the foot clinic. Skin and nails regrow every three months, so four visits a year is often enough to keep trouble at bay.
Recent research has shown regular exercise combined with a balanced diet of low cholesterol (fat) and low GI foods help those living with diabetes. This is also helped considerably by stopping smoking and reducing the daily intake of alcohol. Compliance with these life style changes combined with early detection of the disease can reduce foot complications entirely. Physical activity helps to make the insulin work more effectively by burning fat, which is always good for loosing weight. Muscle activity gives the blood vessels a good squeeze and pumps blood through the arterial tree, which improves the breakdown of blood sugars. When the blood pressure is reduced and combined with lowered cholesterol levels, the risk of heart disease and stokes becomes much less. Regular daily exercise is considered the smart thing to include into your waking schedule. Experts recommend thirty minutes and whilst it sounds a lot you derive the same benefits from three lots of ten minutes. Physical effort does not require anything fancy or expensive. Gardening and housework do burn the same calories as Pilates or any item of torture you can buy through late night television infomercials. Before you start any new activity or increase the amount you are already do, please check with your GP first. It is also advised if you are prescribed tablets or insulin for diabetes, to check blood glucose levels, before, during and after exercise. This is easier to do when exercising indoors. For brittle diabetics always carry some jellybeans (7) or a fruit drink (not the diet variety) to top up on low blood sugar levels, should you feel faint or unwell.
Foot Inspection and routine hygiene
Foot disease is the most common complication of diabetes leading to hospitalisation. Common symptoms include absence of feelings in the legs and feet including numbness, tingling or loss of sensation. When there is an absence of feeling this means even the smallest of cut can go unnoticed or ignored. A daily foot inspection and routine wash hygiene will help alert us to these complications.
Note and report if you have any of these symptoms:
Pain in the legs
Open sores that are slow to heal.
Dry cracks on the heels
Bleeding corns or callus
Ingrown or fungal nails
Skin colour changes
Swelling of the foot or ankle
High skin temperatures.
Routine Foot Hygiene
Always check between the toes, backs of the heels, and the soles of the feet for sores. Use a car inspection mirror or better still find a friend to help you.
Wash your feet every day with bland soap and water. The temperature of the water should be no more than hand hot (46oC) and the feet are bathed for no more than ten minutes. Dry the skin carefully especially between the toes.
Use bland creams, any brand will do. Rub into the heel, sole, top of the foot but not in between the toes. Lightly talc the skin.
Only cut the toenails if you can reach to see them and it is in good light. Cutting the nails after a shower or bath helps soften them. Always cut them carefully, never too short, and always across the growing edge and never down the sides. You can file the nails with an emery board.
Wear shoes that fit the feet well and are comfortable. Choose a shoe style and sock that suit your physical activities.
Be careful when you walk barefoot inside and outside the home.
Do not smoke as this reduces the blood circulation to your feet.
Have your feet checked regularly by your health care worker and see a podiatrist if the skin and nails are unmanageable.
Six important points when buying shoes
The best time to buy shoes is in the afternoon when the feet swell. They are at their largest size.
Always match length and breadth of the feet to the shoes . You can trace an outline of the foot on paper and cut it out if you are buying for others.
Always try shoes on in the shop and walk about in them. Shoes do not require to be broken in and if they are uncomfortable then choose another pair.
Check for proper length with 5-10 mm of room between the tip of the longest toe and the end of the shoe.
Shoes should fit snugly at the heel and arch with ample room for the toes to move (wriggle). Straps or laces help prevent unwanted foot movement.
Choose shoes with soft uppers. Hard wearing soles suitable for the activities you intend to put them too.
Check for unseen seems or tears in the shoes lining.