DIABETES
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.
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 dollar 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 currently 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 which are
controlled by oral medicine or insulin injections. The vast majority of those people (80
percent or more) are overweight; 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 members have diabetes.
- Weight is the most important risk factor, 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, one of the most serious conditions that they treat. 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 level of 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 indicate that when applied to wounds, even those that are hard to heal, such products achieve 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 other changes
that may be less obvious. 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.
Give up 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.
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 the appropriate athletic shoe when
exercising. Ask your podiatric physician what’s best for you.
See your podiatric physician.
Regular checkups by your podiatric physician—at least
annually—is 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 other foot injuries on unfamiliar
terrain. When at home, wear slippers. Never go barefoot.
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.
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.
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.