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Diabetic Foot Care
Tuesday, April 3, 2007
Diabetes mellitus, often simply referred to as "diabetes", is a chronic metabolic disorder characterized by high blood sugar (hyperglycemia). This condition can result either from failure of the pancreas to produce insulin (type 1 diabetes mellitus) or from insulin resistance, with inadequate insulin levels to sustain normal metabolism (type 2 diabetes mellitus). Insulin is a hormone that aids in the uptake of sugar (glucose) by cells in the body and clearance of excess sugar from the bloodstream. Type 2 diabetes mellitus is the more common form; it accounts for approximately 90% of cases of diabetes. People at risk for type 2 diabetes include those that are sedentary and overweight. Type 1 diabetes is usually diagnosed in children and young adults. It was previously known as juvenile diabetes. Genetic factors play a role in type 1 DM.
Statistical trends suggest that the number of Americans with diabetes is expected to increase to more than 30 million by the year 2030. In the past few years, there has been a 30% increase in type 2 diabetes in adults 30-39 years of age. Diabetes occurs in people of all ages and races, although some groups have a higher risk of developing type 2 diabetes, including African-Americans, Latinos, and Native Americans. Having diabetes increases the risk of many serious complications. Chronically elevated blood sugar can lead to damage to multiple organs in the body, including the eyes, kidneys, heart, brain, and nervous system. Treatment of diabetes is aimed at normalizing blood sugar as much as possible.
Type 1 diabetes is also referred to as insulin-dependent diabetes mellitus. In this condition, adequate insulin is not produced by the body, and it must be taken exogenously. There are a variety of oral medications available to assist with blood sugar control for those with type 2 diabetes. Insulin may or may not be required. Proper diet and regular exercise are very important in the management of type 2 DM. Exercise helps to moderate blood sugar levels. It makes cells more responsive to the action of insulin. Exercise also burns calories, so that it can reduce body weight. Often a 5-10% reduction in body weight can result in a reduced need for diabetes medications. Studies have shown that exercising alone -- even without reduction in body weight -- can result in improved blood sugar levels. An additional benefit of aerobic exercise is that it can improve circulation, which is often impaired with diabetes. If you have diabetes, speak with your health care provider about measures to achieve good blood sugar control and treatment options. A dietitian can help provide nutritional guidance.
Foot problems are common in those with diabetes. Over time, up to 50% of all individuals with diabetes develop problems with the nerves and blood vessels in their feet. Poor blood flow can result from injury to very small arteries in the feet. Ulcers and infections can develop. In the most severe cases, toe or foot amputations must be done because of poor blood supply and/or the presence of foot infections. Infections can occur in the soft tissues (cellulitis) or in the bones of the feet (osteomyelitis). Nerves can be damaged, leading to pain, tingling, or loss of sensation in the feet. Loss of sensation increases the risk of arthritis, especially a debilitating form of arthritis that results from repetitive trauma to the feet (neuropathic arthropathy or "Charcot joint").
Proper foot care is essential for those with diabetes. First, it is important to maintain blood sugar within appropriate levels, to minimize further damage to blood vessels and nerves. If you smoke, quit. Smoking damages small blood vessels, impairs circulation, and reduces wound healing. Check and protect your feet daily. Maintain proper foot hygiene: keep your feet clean and your toenails trimmed. Cut toenails straight across, rather than in an arc-like fashion, and smooth them with an emery board. Get a complete foot exam by your physician. Be sure to remove your shoes and socks in the exam room. If there are any swollen or red areas on your feet or any ulcers, be sure to show these to your health care provider. Inform your clinician right away about any feelings of burning, numbness, or tingling in your feet. Choose shoes with adequate toe room, and discard shoes that don’t fit. Use smooth, absorbent socks. Remember to wear shoes when outside to protect your feet from injury. If you need help with routine toenail care or calluses, visit a podiatrist.For more information about foot problems that can occur diabetes and proper foot care, please see the following sites: