Diabetes is a condition where the blood glucose (sugar) levels in the body are too high. Over time high blood glucose levels can harm many of the body’s organs, including the kidneys, liver, eyes, immune system, nervous system, and vascular supply.
Glucose is the main type of sugar found in the blood and is needed by our cells for energy. For glucose to leave the blood and be absorbed by our cells, it is essential that the hormone insulin is present. Insulin is released by the pancreas and if there is not enough insulin to enable this process to occur, then glucose levels within the bloodstream remain at a high level, resulting in the development of Diabetes.
Type 1 (onset normally occurs in infancy)
Type 1 diabetes is an ‘auto-immune’ condition. The immune system, which normally protects against infection, destroys the cells that make insulin. As a result the body is unable to create enough insulin to keep blood glucose levels within normal range.
Type 2 (usually occurs in later life – in many cases can be prevented.)
In type 2 diabetes, either the body doesn’t produce enough insulin, or the cells in the body don’t recognise that insulin is present. This results in high blood glucose levels. Type 2 diabetes can be caused by genetics or an unhealthy lifestyle. A combination of these factors can cause insulin resistance.
Diabetes affects the feet in two ways, by damaging both the systemic nervous system and vascular supply of the lower limb. Both of these problems are closely associated with prolonged periods of high blood glucose levels.
Nerve damage or Neuropathy, can locally affect the feet by causing dry skin, toe deformities (increased pressure points), numbness, pins and needles, sharp shooting pains, and the inability to recognise foot trauma with diabetic feet. For example, some patients can stand on a nail and walk around for hours without any realisation that the trauma has occurred. This places them at risk of local/systemic infection, delayed healing, ulceration, amputation, and even mortality.
Our vascular supply carries oxygen and nutrients to all areas of our body. A diminished vascular supply puts a limb at risk of tissue death (gangrene). It can result in rest pain, poor skin quality, local/ systemic infection, black toes, ulcerations, and again mortality.
The pathological process that can occur in the diabetic foot.
Podiatrist have a set of unique skills, aimed at monitoring the nervous and vascular supply of the lower limb. They are trained to help prevent and treat serious foot conditions such as ulcerations and systemic infections. Regular podiatry treatments and annual foot screening appointments are essential in preventing and treating serious foot problems. Early intervention, and treatment have been medically proven to decrease the risk of amputation, and the mortality rate.
Compliance to health care advice, low blood glucose levels, and a clear understanding of Diabetes and its systemic impact on the body, helps patients live long and full lives. The diabetic foot is not ‘hopeless’ it just needs a lot of care and attention. Do not put off coming to see a Podiatrist!
Caroline McWilliams is a podiatrist at City Podiatry clinic.