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ARROYO FOOT & ANKLE CLINIC

Diabetes

Don't Let Diabetes Get A Foothold On Your Life

Diabetes Mellitus- often called "sugar disease"- is a serious disorder that can lead to blindness, amputation, kidney failure, stroke and heart attacks. Marked by the inability to manufacture or properly use insulin, diabetes impairs your body's ability to convert sugar, starches and other food into energy. The long-term effect is damage to the eyes, heart, kidneys, feet, nerves, and blood vessels.

  • An estimated 16 million Americans have diabetes, yet half of them -eight million people- don't know it, putting themselves at terrible risk:
  • Diabetes claims more lives each year than either AIDS or breast cancer- 178,000 people died from diabetes last year alone.
  • Each year, more than 67.000 lower limbs are amputated due to complications from diabetes.
  • Diabetes is the leading cause of end-stage kidney disease.
  • Individuals with diabetes are two to four times more likely that the general population to experience heart disease and stroke.
  • Among adults under the age of 75, diabetes is the leading cause of new blindness.

While there is currently no cure for diabetes, there is hope. With proper diet, exercise, medical care and watchful management at home, a person with diabetes can keep the most serious of these consequences at bay.Until there is a cure, the key to living successfully with diabetes is early detection and early intervention.

How Do You Get Diabetes?

No one yet knows how you "get" diabetes, but once diagnosed, you will have the disease for the rest of your life. Certain characteristics put you at higher risk for developing diabetes:

  • Does someone in your family have diabetes?

Are you overweight?

Did you develop diabetes while you were pregnant?

Are you over the age of 45?

Are you a member of one of the following ethnic groups: African American? Hispanic American? Native American? Asian American? Pacific Islander?

If you answered "yes" to one or more of the preceding questions, you are at increased risk for developing diabetes at some point in your life. Certain characteristics are hereditary and you can't do anything about them. However, one of the more serious predictors of diabetes is within your control: your weight. More than 85% of people with diabetes are overweight, many of them obese. One of the better ways to delay or prevent the onset of diabetes is to exercise and keep your weight down.

What If I Have Diabetes?

Because diabetes affects so many organs of the body, if you have the disease, you will be treated by a team of doctors, nurses and other healthcare specialists. Family physicians, endocrinologists, podiatric physicians and nutritionists all work together to monitor your condition and keep your diabetes under control.

Diabetes Warning Signs

If you experience any of the following symptoms, it could spell DIABETES.

  • D iuretic symptoms- the frequent urge to urinate
  • I ncreased infections
  • A bnormal weight loss
  • B lurred vision
  • E xcessive thirst
  • T ingling or numbness in your feet or hands
  • E xtreme hunger
  • S low-to-heal wounds

Remember, the sooner you find out that you have diabetes, the sooner you can do something about it. Contact your physician or other health professional without delay if you have one or more of these symptoms. A simple blood test is usually all that's necessary to rule out diabetes.

Proper care, hygiene and inspection of the feet are critical for a person with diabetes. Nerves damaged by the disease are not as sensitive to pain, heat or cold, so people with diabetes can injure their feet, and not know it, and develop infections. Poor circulation compounds the problem, by reducing the number of infection-fighting white blood cells that are carried to and from the wound site. If left untreated, an unhealed and infected wound can, ultimately, lead to amputation.

Fifteen percent of all people with diabetes will develop open wounds on their feet at some point during their lifetimes. Of these ulcerations, 20% will result in amputation. And more than 50% of those who undergo an amputation of one limb will also lose the other within three to five years.

Yet, with strict adherence to diet, exercise, medication and hygiene, more that half of the lower extremity amputations among people with diabetes could be prevented. The role of good footcare cannot be overemphasized in this equation.

Your Doctor Of Podiatric Medicine and You

As a foot and ankle specialist, the doctor of podiatric medicine (DPM) plays an integral role in the medical care of people with diabetes. In fact, DPMs have documented success in the prevention of amputations. The key is to see a podiatric physician for a foot check-up at least annually and preferably more often.

The podiatric physician will conduct specific diagnostic tests to assess the presence or progression of diabetic complications, and to determine if you have any other conditions that may place you at higher risk for amputation. A medical history will be taken, and circulation and sensation will be evaluated. X-rays may be included to examine the structure of your foot.

Six known characteristics place people with diabetes at higher risk for possible amputation:

  • Tingling, numbness, or the loss of sensation in the feet
  • Restricted blood flow to the legs and feet
  • Foot deformities, including hammertoes
  • Stiff joints
  • Calluses on the soles of the feet
  • A history of open sores on the feet, or a previous lower extremity amputation

In addition to following medical advise, there are many things that you can do, on your own, to reduce the possibility of injuries to your feet. Shoes are one of the primary culprits, and should be fitted by an experienced shoe fitter. Shoes should have leather or canvas uppers and fit both the length and width of the foot, leaving room for the toes to wiggle freely. They should also be cushioned and sturdy, like athletic footwear. New shoes should be comfortable at the time of purchase, and not require a break-in period; however, it is a good idea to wear them for only short periods of time at first.

People with diabetes who have difficulty finding shoes that fit should ask their podiatric physician to prescribe corrective shoes, or refer them to a shoe specialist, the pedorthist.

For those who are eligible, Medicare provides coverage for extra-depth shoes, or specially molded shoes and inserts for those with advanced cases of diabetes. The medical or osteopathic physician treating an individual for diabetes can certify the need for therapeutic shoes, and a medical or podiatric physician can prescribe them.

 Before putting on any pair of shoes, shake them out, and feel inside for rough stitching or foreign objects, such as small pebbles. Socks with seams can also pose a threat to the desensitized foot. It is also a good idea to change shoes once or twice during the day to relieve pressure areas. If you have diabetes, these small inconveniences can mean the difference between keeping or losing a foot.

Dos And Don'ts For People With Diabetes

Dos:

Wash your feet daily

using mild soap and lukewarm water. Dry carefully with a soft towel, especially between the toes, and dust your feet with talcum powder. If the skin is dry, use a good moisturizing lotion or cream daily, but avoid getting it between your toes. In extreme cases of dry skin, a prescription lotion may be required from your podiatric physician.

Caution: before putting your feet in bath water, always test the water temperature first with either your elbow or a thermometer. The diabetic foot may be unable to detect scalding temperatures.

Inspect your feet daily

Check your feet every day for cuts, bruises, sores or other changes that are less obvious. If self-inspection is hampered by age or other factors, ask someone to help you, or use a mirror.

Wear thick, soft socks

Avoid mended socks or those with seams, which could cause blisters or other skin injuries.

Cut toenails straight across

Never cut into the corners, or taper, or you could get an ingrown nail. Use an emery board to gently file away sharp corners or snags.

Be measured and fitted each time you buy a new pair of shoes

Foot size and shape may change over the years, and the nerve damage that many people with diabetes suffer from contributes to this change. Everyone, but particularly the person with diabetes, should have his or her feet measured by an experienced shoe fitter when buying a new pair of shoes. Poorly fitted shoes are involved in as many as half of the problems that lead to amputations.

Lose weight

People with diabetes are commonly overweight, which nearly doubles the risk of complications. Obesity itself can cause insulin resistance, and may lead to the development of diabetes.

Exercise

As a means to keep weight down and improve circulation, walking is one of the better all-around exercises for everyone, and for a person with diabetes in particular. Walking is also the best overall conditioner for your feet.

Don'ts

Never go barefooted

Not ever in your own home. Outdoors is particularly dangerous because of the possibility of cuts, falls, and other foot injuries on unfamiliar terrain.

Avoid high heels, sandals and shoes with pointed toes

In addition, never wear shoes with open toes, or sandals with straps between the first two toes.

Don't smoke

Tobacco can contribute to circulatory problems, in addition to all its other damaging effects. People with diabetes already have impaired circulation, and smoking just makes it worse.

Drink only in moderation

Alcohol can contribute to neuropathy (nerve damage), which is also one of the consequences of diabetes. Even in small amounts, alcohol deadens the nerves, and increases the possibility of over-looking a seemingly minor cut or injury.

  Don't wear anything tight around the legs

Tight panty hose, panty girdles, thigh-highs or knee-highs can constrict circulation in your legs and feet. So can men's dress socks, if the elastic is too tight.

Never use heating pads or hot water bottles on cold feet

In fact, never use any external source of heat on your feet, because of the risk of burning a desensitized foot. If your feet get cold at night, wear loose socks.

Never try to remove calluses, corns or warts by yourself

Commercial, over-the-counter preparations that remove corns or warts contain chemicals that can burn the skin. Never try to cut calluses with a razor blade or any other instrument; the risk of cutting yourself is too high. See your podiatrist for assistance.

Know Your ABCs

If you have diabetes, and you experience any of the following symptoms in your feet, see your podiatric physician immediately:

  • A ches and pain in the legs, either at rest or while walking
  • B leeding within the skin around or at corns or calluses
  • C olor changes of the skin
  • D ry cracks in the skin, especially around the heel
  • E dema (swelling) of the foot or ankle
  • F ungus-infected (thick, yellow-brown and crumbly) or ingrown toenails
  • G aping (open) sores, with or without drainage, that are slow to heal, or have redness or swelling
  • H igher skin temperature

Early detection and early intervention could save your foot.

This information is provided as a public service of The Foot Health Foundation of America, a national health initiative of the American Podiatric Medical Association (APMA), and the Arroyo Foot and Ankle Clinic, P.C.. For further information on diabetes, or other conditions that affect the foot, please contact your local podiatric physician or:

  • The Foot Health Foundation of America
  • c/o American Podiatric Medical Association
  • 9312 Old Georgetown Road
  • Bethesda, MD 20814-9200
  • Phone: (301) 571-9200
  • Fax: (301) 530-2752
  • www.apma.org
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