What is Diabetes?
Diabetes Mellitus is increased blood sugar. Complications associated with diabetes include Vasculopathy, Neuropathy and Immunopathy. Due to the increased sugar in the blood, Diabetes causes the arteries in the legs and feet to become hardened and clogged. This prevents blood from circulating properly. Diabetic Neuropathy is nerve damage believed to be caused by chronic high blood sugars. When Neuropathy affects your sensory nerves, you may develop a loss of feeling in parts of your body. Most frequently, the feet are affected. Immunopathy is when the immune system becomes affected. The immune system does not work as well. Therefore, Diabetics are more susceptible to infections. Even a minor respiratory infection can become life threatening. Small cuts and scrapes on the feet and legs can become infected more quickly.
Signs of Diabetic Neuropathy
You may lose sensation and your feet may feel numb. At other times, you may feel shooting pains, prickling, tingling and/or burning on the skin of your feet and legs.
Living with Neuropathy
To date, there is no cure for Diabetic Neuropathy. In and of itself, Neuropathy is not dangerous. The danger lies in being unaware that you have lost feeling in your feet and allowing a foot injury to be neglected as a result. If you have Neuropathy, you need to protect yourself against the risk. The best way to protect yourself is to inspect your feet frequently. I advise checking feet thoroughly once in the morning and once before bed. It is also wise to change shoes and socks once or twice during the day. Inspect the feet closely at that time also. There are two reasons for changing shoes and socks. By changing your shoes several times a day, you can shift the pressure points on your feet that the shoes cause. Also, changing shoes and socks can help eliminate damage to the skin and reduce the risk of infection and sores, which the friction of continually worn shoes can cause.
Your skin and foot problems
The skin is your body’s barrier against infection, so potential and actual skin injuries need immediate attention. This is especially important if you have diabetes because poor circulation and a decreased infection-fighting system have decreased your healing capacity. Small wounds may lead to infections and larger non-healing wounds can eventually result in the loss of a part or all of the foot. Dry skin may lead to cracks, which bleed and become infected. The moisture content of a person’s skin depends on hereditary and environmental factors. Some people have skin that rarely needs moisturizers. Others need to use creams several times a day to prevent the skin from drying. Dry skin around the edges of the heel is especially susceptible to cracking. This can sometimes be treated by applying a liberal amount of cream to the dry skin before going to bed and covering the area with a piece of clear plastic wrap and wearing a sock over the wrap during the night. This can be repeated 2-3 times a week. If severe dryness persists, consult your podiatrist.
Toenails
Most people with Diabetes can care for their own toenails. However, you should probably have someone else care for your nails if you have poor circulation, have lost sensation in your feet, have extremely poor eyesight or have severe arthritis in your hands, back or knees/hips.
Calluses and Corns
In the Diabetic patient, calluses and corns are referred to as closed ulcerations. An ulcer is a pressure sore. So are calluses and corns. These are being caused by a particular mechanism that may be treated effectively by your foot doctor.
Dermatitis
This condition reduces the skin’s ability to function as a barrier against bacteria and to fight infection. Your podiatrist or dermatologist should treat any dry, scaly, reddish patches or fluid-filled blisters that itch.
Tips to proper daily foot care program
- Wash and examine your feet every day. Inspect for injuries. Wash feet in warm, soapy water. Rinse feet well and dry them carefully, especially between the toes, after you have washed and dried your feet, examine them closely in a good light. If you cannot bend over to see the bottoms, place a hand mirror on the floor and hold each foot, in turn, over it so that you can see the reflection in the mirror. If you have poor eyesight, ask someone to examineyour feet for you. Apply moisturizing creams to dry skin. Creams such as Nivea, Eucerin or Keri help restore moisture to the skin. Creams are better than lotions because they hold moisture in the skin for a longer period of time. Apply cream starting at the heel and working toward the toes. This will help you to avoid leaving excess amounts of cream between the toes, which can lead to wearing away of the skin, and possibly infection.
- File your toenails regularly. If you, a family member or a friend care for your toenails, file them with an emery board. Do not use scissors or clippers as these instruments can cut your skin as well as your nails. File nails to the ends of your toes, but no shorter. Ingrown nails should be brought to the immediate attention of your podiatrist. Treat cuts and scrapes promptly. Seek medical attention if necessary. If you have a cut or scratch on your foot, wash the affected area with warm water and soap promptly. Do not soak. Apply a mild antiseptic such as Neosporin or Bacitracin or Polysporin. Do not use Iodine, Betadine, Mercurochrome or Boric Acid. Cover the area with a dry, sterile dressing. Use paper tape or telfa. Do not use adhesive tape. See a doctor if the affected area does not improve within 24 hours.
- See a podiatrist about corns and calluses. These may blister and become infected. This may lead to bone infection and amputation if neglected.
- Take care of athlete’s foot promptly. Any dry, scaly, reddish patches or small fluid-filled blisters or itchy lesions that do not respond to over-the-counter remedies such as Tinactin, Desinex, Lotrimin AF or Lamisil AT should be brought to the attention of a physician.
- Seek medical attention for any new lesions on your feet. This is very important. Unless you are a doctor, do not attempt to treat anything you cannot identify.
- Select footgear carefully…preferably with the advice of a physician. Wear shoes or slippers with sturdy soles with soft sides around the house to protect the bottoms of your feet if you step on something and protect the tops and sides of your feet from pressure. The best shoes for walking outside the house are those that are soft and have some arch support. Athletic shoes with soft uppers, cushioned soles, arch support and firm counters are appropriate. SAS-type shoes are made for the diabetic patient. Plan on any good-fitting, good quality shoes to be fairly expensive. Few people think $100.00 is too much to spend for a pair of shoes if they could have their foot back.
Click here to view a presentation of a lecture given by Dr. Rampertab on The Diabetic Patient.
What is Diabetic Neuropathy?
Diabetic Neuropathy is a loss of nerve function that is seen in patients with Diabetes. This condition gradually progresses over time at an unpredictable rate. The nerves most often affected early on are the sensory nerves. The patient loses the ability to differentiate sharp and dull, sense vibratory impulses, sense heat and eventually become unable to tell what positions the joints are in. This is a painful condition usually causing tingling, burning and numbness in the hands and feet. The pain starts in the fingers and toes and gradually works it's way up the extremity. Some patients relate coldness in the toes even when they are warm, or hot feeling in the toes when they feel cool to the touch. Some patients relate that it feels like they are walking on broken glass while others say it feels like they are walking on cardboard. The symptoms vary considerably from patient to patient, but most patients localize the majority of their pain to the toes and up to the area behind the toes.
At azcryo, we have been performing Cryoanalgesia(cryo) of the affected nerves for the treatment of the pain associated with Diabetic Neuropathy for over two years. The series of precedures is performed in the office under local anesthesia using ultrasonic guidance of the cryoprobe.