Diabetes is a scary condition to be diagnosed with.  When diagnosed with diabetes, you may worry about what foods you CAN eat, how much exercise you should do and whether you will have to give yourself shots every day.  In the world of podiatry, we work with many patients who also have the fear of future amputation of a toe, part of the foot, or even the leg.  Some patients associate diabetes with eminent amputation of body parts.  This does NOT have to be the reality.  Prevention is key in diabetes and the better care you take of yourself, the less likelihood you will have to face amputation.

Diabetes affects many body systems and changes how your body functions to perform daily tasks.  Uncontrolled Diabetes affects the nervous system in many ways and this can then lead to affects on your blood flow, sensation, ability to regulate temperature and sweat, digestion and in some cases your memory and cognitive reasoning.  To help you understand the processes at play, it is important to discuss WHY diabetes affects the nervous system.

Diabetes is a disease in which the ability to regular blood sugar levels is compromised.  Either your body does not produce enough insulin to break down sugars or your body is resistant to the insulin that is normally produced in the pancreas.  This can lead to very high high's and/or very low low's in your blood sugar levels.  When blood sugars are low, typically people experience fatigue and at the worst a comatose type of state.  When blood sugars are high, it can lead to excessive thirst and urination, fatigue, an increased risk of infections and again a comatose state.

The nervous system comes into play when blood sugars are too high because the elevated blood sugars actually alters the body's pH.  pH is a term used to describe the chemical environment in the body.  All functions in the human body require a 'normal' pH of approximately 7.4.  When blood sugars are elevated, the pH of the body can become lower than 7.0.  Consider that this is on a scale of 0-14 and that's a big change for a living being!  When the body's pH is consistently altered by high blood sugars (acidic), it damages the lining of the nerves, called myelin.  Myelin is what protects and insulates nerves and allows for normal conduction of nerve signals.  Myelin is normally present on all types of nerves in the body.  This is similar to insulated wiring in electricity.  When the myelin is damaged, there is an interruption of the electrical signal in the body.  In nerves that transmit sensation, this can result in burning, tingling, shooting and (after a certain degree of damage has been done) sensations of numbness.  In nerves that conduct signals to the eye for vision, this can result in blurred vision and ultimately blindness.  In nerves of the gut, it can cause a disturbance in digesting food. 

Take note of how many times the word 'can' was used in the above paragraph.  It is a daunting reality check, looking at even just a few of the things that CAN happen in diabetes.  What is vital to remember is that none of these things HAVE to happen or WILL happen, if you take care in treating your diabetes!  The detrimental effects of diabetes are caused by the blood sugars being elevated, so the solution is to regulate your blood sugars closely.  Every decision you make can either work towards maintaining or improving your level of health or it can lead down the path of side effects and complications.  Will you take your medication today?  Will you indulge in high sugar treats?

So as we see, the basic principle is regulation of blood sugars.  To specifically prevent foot complications, the next step is to have routine foot assessments and avoid risky behavior with the feet.  It is recommended that people with Diabetes be seen at least once annually for a foot assessment with a doctor - whether it be a podiatrist or a primary care doctor.  If it is determined that your risk level is higher, you may need to be seen more frequently.  In either case, a daily routine of looking at your feet is vital.  If sensation from the feet is not optimal, it is common to have a sore develop on the foot and not realize that it is there until it's too late.  Before bed every night, you need to look at the bottoms of the feet, either directly or with use of a hand mirror on the floor.  Because the nerves that keep the skin healthy are also affected in diabetes, daily use of moisturizer is also key to maintaining healthy skin that is less prone to cracking - so slather up before bed each night after looking at your feet - and don't get any of that lotion between the toes.  This seems to be the area that never needs any extra moisture.

Some habits to avoid when you have diabetes are as follows; First, if you notice anything strange on your foot that wasn't there before - don't put off having it checked out by your podiatrist!  Even if it turns out to be nothing, you can have peace of mind.  If you have nails that are difficult to cut or ingrown - don't try to cut these out yourself!  A trained professional has the advantage of both experience and access to carefully care for these issues and be sure there is not more to the problem than originally thought.  Don't skimp on shoes.  An accurate fit and type of shoe prevents excessive pressure and friction on the skin and therefore reduces the chance of developing a callus or sore on the foot.  When the shoes are wearing out, replace them!  Worn out shoes can allow moisture, bacteria and fungus to collect on the skin of the feet and cause infection or softening of the skin that can lead to an open sore.  Don't go barefoot!  Even at home, there are occasionally things that can get stepped on and can cause an injury to the skin.  In addition, unsupported feet tend to take up more pressure in certain areas of the foot and predispose them to calluses and sores.

Avoiding bad habits and instituting a nightly routine is the best way to avoid foot related complications of diabetes, including infection and amputation.  Remember that every decision you make has an impact on your overall health and the health of your feet.  Think carefully before you make a decision that can put your health in jeopardy.  Life is worth living and living life is such a bigger challenge if you don't have your health.  Take care of yourself and don't hesitate to call if you are worried about your feet because of diabetes.