What is Diabetes?
Diabetes mellitus is a disorder of the pancreas that affects the entire body. The pancreas produces insulin, an important hormone that is essential for the body’s cells to absorb glucose. Glucose is a sugar molecule that we use for energy. We break it down from food we digest and then absorb it into our body’s cells. Insulin is a hormone our pancreas makes that allows to absorb glucose in to our cells. When the pancreas does not produce enough insulin, the sugars digested from your food cannot be absorbed from your bloodstream. Those sugars stay in your bloodstream, doing damage while your cells starve for the glucose they need for energy.
Diabetes and Circulation:
Diabetes often affects our small blood vessels and prevents them from working as they should. These vessels especially will affect circulation to the eyes, the kidneys, and the feet. Retinopathy is a diabetes-related condition that can affect vision. Healthy kidneys adjust the amount of water your body retains, and they filter impurities from the blood. If diabetes affects the kidneys, they do not filter the blood efficiently and toxins – literally poisons – build up in the bloodstream. Some people end up on dialysis because of the permanent damage to the kidneys.
If the circulation to the feet decreases, you can experience many effects. Your feet feel cold more easily, toenails grow more slowly, and in very severe cases, fall off. The hair growth on your toes, feet and legs slows or stops entirely. Skin can become thin, shiny, and fragile. You will not heal as quickly and do not resist infection as well.
Diabetes and Your Nerves:
The nerves of your feet (and sometimes hands) are often affected in a condition called Diabetic Peripheral Neuropathy. There can be a partial or total loss of sensation. This is particularly important in protecting yourself from injury or recognizing early that something needs care. Imagine the potential damage if you walked on a stone in your shoe and could not feel it. So, instead of adjusting your weight or removing your shoe, you put your full weight on the stone for the entire day!
Parasthesias: Some people have burning pains, shooting pains, the sensation of pins and needles or feel as if insects are crawling all over your feet and/or legs. These sensations, known as paraesthesias, can be so bad that they interfere with normal sleep.
Neuropathy: Some people find that with the foot numbness, their balance is poor because their brain is not getting enough information to figure out how they are standing and where the pressures are!
At The Foot Advantage, we provide MLS Laser Therapy for Diabetic Neuropathy. We have found that it has significantly reduced the paraesthesias that people experience and even improved sensation in some individuals. Most important, their quality of life through improved sleep has been much better!
What Do I Need to Do?
All of these complications of diabetes are not inevitable. You have a great deal of control over your destiny. First and foremost, there is nothing more important than getting your blood sugar under control. Take your blood sugar regularly, adjust your meals, and medications as advised by your supervising medical professional. Attend a diabetic education program(s) so that you become confident in understanding your medications and food choices. Involve your partner, friend, or other family member in the education. Regular exercise helps to maintain your blood sugar and improves circulation.
Your doctor should see you regularly and be testing the Hemoglobin A1C in your blood. This gives a three-month average for your blood sugars. So, understand that you cannot fool the doctor by being good for a day or two before your appointment! If your score is good only when you go to the doctor, you are only hurting yourself. Ask for the A1C. Consistently maintaining your blood sugar within an acceptable range is your best defense against the potential complications of diabetes.
Who Should I See About My Feet?
See a Foot Specialist regularly. Everyone with diabetes should see a Foot Specialist at minimum once a year. During that visit, the Specialist should examine your footwear, the integrity of your skin and nails. The will check your sensation, including your toes, balls of the feet, arches, heels, and the tops of your feet. This is to determine if you can feel with your feet well enough to protect yourself from injury. Advice will be based on the findings of your evaluation and information/education on ways to reduce your risk level. Your level of risk will determine your next scheduled evaluation (3 months or less, six months or one year).
If you are unable to manage your own foot care, regular visits to the foot specialist are essential. Going for a pedicure is risky! There is no reliable information about the infection prevention and control standards the estheticians and spas must maintain. Your foot specialist can cut your nails and address any corns and calluses you might have. You must continue to maintain good foot hygiene and keep the skin moist and supple. If you allow your skin to get too dry, it can split open. These splits – known as fissures – are painful and an opening through which bacteria can enter your feet. This can end up becoming a dangerous, even life-threatening infection. At The Foot Advantage, we offer special products to help you with dry skin concerns. These are innovative new products that improve skin integrity and help the skin to naturally retain its own moisture better.
Do I Need to Take Any Precautions?
If you have reduced feeling in your feet, it is important that you look at your feet every day. Look for cuts, or openings in the skin, blisters or calluses or corns, foreign bodies in your feet, any unusual swelling, redness, or warmth. These are all signs that your feet need immediate professional attention! Never put on a pair of shoes without first checking inside! If you cannot feel that little rock in the shoe and you walk on it all day…. I have had several patients who have done serious damage because they no longer bothered to check inside their shoes.
Shoes should be wider than your feet and at the toes when you are weight bearing. Check also that they are ¼” longer than your longest toe – whichever one that is. If your 1st toe is not the longest, and you fit the shoe to the 1st toe, you can cause permanent damage to the longer toes. Damage can also be done to toes being squeezed by your soft socks or stockings. Ideally, choose a quality cotton or wool diabetic sock with no constriction at the neck. If your soft socks are too snug, they can cause the toes to adopt some challenging shapes.
How Can We Help You?
At The Foot Advantage we can provide you with routine foot care – cutting toenails, removal of corns, calluses, treatment of ingrown toenails and warts, and diabetic foot ulcers. We can assess you for risk of ulceration and assist and educate you to minimize those risks. At The Foot Advantage, we have special products to improve the integrity of your skin and reduce risks. We have specialized treatments for painful and inflammatory conditions and especially, Diabetic Peripheral Neuropathy. Also, The Foot Advantage has developed a network of professionals to help deal with any problems that you might encounter. This network includes family physicians, staff at the Central East LHIN, and specialists like Endocrinologists and Infectious Disease Specialists.
The single best thing that you can do for yourself is maintain your blood sugar at an acceptable level. Perhaps the second-best thing that you can do is consult with a Foot Specialist to help prevent problems in the future. And do not worry about bothering us. We would much rather say that “you have nothing to worry about”, than “you should have been here months ago!”.
You can live well with diabetes. Call us and let us help show you how!