The latest estimates indicate that there are 382 million people living with diabetes worldwide. By 2035, 592 million people or one person in ten will have the disease. A further 316 million people are currently at high risk of developing type 2 diabetes, with the number expected to increase to almost 500 million within a generation. We are increasingly seeing more and more diabetics in our practice. We are seeing a surprising amount of younger patients with the disease. The trend is that we are gaining average weight even as a child. We believe this stems from increase caloric intake, decrease in exercise and eating of more processed foods.
Diabetes affects multiple systems in our body. It affects the feet, cardiovascular system, kidneys, nerves, eyes.
Feet: The two areas of the feet that are most affected are the blood supply and nerve conduction. Diabetes causes the arteries to become less effective due to atherosclerosis. This causes calcification of the vessels which causes less blood to get to the feet . This can affect all the major blood vessels, especially those supplying the feet. Without a good blood supply, you will have problems with cuts and sores, which do not heal very well, and as a result of poor circulation, you may also suffer from cramp and pain in your legs and/or feet. Diabetes causes the nerves to be damaged. This affects how we feel temperature, pain and other sensations. It also affects the sweat glands, reducing secretions and making your skin dry and inelastic. If not looked after the skin may crack and become sore and prone to infection. It also affects the nerves responsible for sending messages to the muscles about movements, such as walking. If the nerves supplying your feet are affected it could cause your feet to alter shape. Your toes may become curled as your arch/instep becomes more pronounced or the arch may ‘fall’ causing flat feet. This can cause the bones in your foot to break when stressed.
Cardiovascular: Your major blood vessels consist of arteries which carry blood away from your heart, and veins which return it. Damage to these vessels is referred to as macrovascular disease. Capillaries are the tiny vessels where the exchange of oxygen and carbon dioxide takes place. When damage occurs to these vessels it’s referred to as microvascular disease. Blockage of an artery leads to the part of the body it supplies being starved of the oxygen and nutrients it needs. This is the cause of heart attack or strokes.
Kidneys: Kidney disease is caused by damage to small blood vessels. This damage can cause the vessels to become leaky or, in some cases, to stop working, making the kidneys work less efficiently. The kidneys are needed to clean out the toxins in our body. Once the kidneys stop working effectively one needs dialysis multiple times per week.
Nerves: Diabetes can cause neuropathy as a result of high blood glucose levels damaging the small blood vessels which supply the nerves. This prevents essential nutrients reaching the nerves. The nerve fibers are then damaged or disappear. There are three types of neuropathy. Sensory neuropathy affects the nerves that carry messages of touch, temperature, pain and other sensations from the skin, bones and muscles to the brain. It mainly affects the nerves in the feet and the legs. Symptoms can include tingling and numbness, loss of ability to feel pain and burning or shooting pains – these may be worse at night time. This can be very dangerous to diabetics because they do not feel pain and can injure themselves and not know it delaying treatment.
Autonomic neuropathy affects nerves that carry information to your organs and glands. They help to control some functions without you consciously directing them, such as stomach emptying, bowel control, heart beating and sexual organs working. Damage to these nerves can result in Symptoms include gastroparesis – when food can’t move through the digestive system efficiently. Symptoms of this can include bloating, constipation or diarrhea, loss of bladder control, leading to incontinence, problems with sweating, either a reduced ability to sweat and intolerance to heat or sweating related to eating food and impotency.
Motor neuropathy affects the nerves which control movement. Damage to these nerves leads to weakness and wasting of the muscles that receive messages from the affected nerves. Symptoms include muscle weakness, which could cause falls or problems with tasks such as fastening buttons, muscle wasting, where muscle tissue is lost due to lack of activity and muscle twitching and cramps.
Eyes: A delicate network of blood vessels supplies the retina with blood. When those blood vessels become blocked, leaky or grow haphazardly, the retina becomes damaged and is unable to work properly. Background retinopathy is the earliest visible change to the retina This will not affect your eyesight, but it needs to be carefully monitored. The small blood vessels in the retina become blocked, they may bulge slightly and may leak blood. Maculopathy is the next step. It is when the background retinopathy is at or around the macula. The macula is the most used area of the retina. It provides our central vision and is essential for clear, detailed vision. If fluid leaks from the enlarged blood vessels it can build up and causes swelling. This can lead to some loss of vision. Proliferative retinopathy occurs as background retinopathy develops and large areas of the retina are deprived of a proper blood supply because of blocked and damaged blood vessels. This stimulates the growth of new blood vessels to replace the blocked ones. These growing blood vessels are very delicate and bleed easily. The bleeding causes scar tissue that starts to shrink and pull on the retina, leading to it becoming detached and possibly causing vision loss or blindness.
Take care of your diabetes. Work with your health care team to keep your blood sugar within a good range.
Check your feet every day. Look at your bare feet every day for cuts, blisters, red spots, and swelling. Use a mirror to check the bottoms of your feet or ask a family member for help if you have trouble seeing.
Wash your feet every day. Wash your feet in warm, not hot, water every day. Dry your feet well. Be sure to dry between the toes.
Keep the skin soft and smooth. Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes.
Smooth corns and calluses gently. If your feet are at low risk for problems, use a pumice stone to smooth corns and calluses. Do not use over-the-counter products or sharp objects on corns or calluses.
Wear shoes and socks at all times. Never walk bare foot. Wear comfortable shoes that fit well and protect your feet. Feel inside your shoes before putting them on each time to make sure the lining is smooth and there are no objects inside.
Protect you feet from hot and cold. Wear shoes at the beach or on hot pavement. Wear socks at night if your feet get cold. Don’t test bath water with your feet. Don’t use hot water bottles or heating pads on your feet.
Keep the blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles up and down for 5 minutes, 2 or 3 times a day. Don’t cross your legs for long periods of time. Don’t smoke.
Be more active. Plan your physical activity program with your doctor.
Check with your doctor. Have your foot doctor check your bare feet and find out whether you are likely to have serious foot problems. Remember that you may not feel the pain of an injury. Call your foot doctor right away if you find a cut, sore, blister, or bruise on your foot that does not begin to heal after one day. If you are a high risk diabetic you need to be seen at regular intervals to make sure you are not developing more serious complications!
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