Health matters

Dangers to foot health from Type 2 diabetes

Conway McLean, DPM, Journal columnist

The internet has radically transformed society, and in ways that were not entirely predictable. Along with being able to purchase items from all over the world with a simple keystroke, information of all manner, on every topic imaginable, is similarly available. Unfortunately, the veracity of all this content is sometimes dubious. How is one to know?

Information on health, medicine, and wellness, is of interest to many Americans. How they come by this knowledge will vary tremendously, and often is from unreliable sources. Sometimes important medical concepts are drawn from close personal experience, a family member who had some medical condition. But drawing conclusions from a single individual experience is generally inaccurate.

A particularly relevant example would be that of diabetes, a common disease of lifestyle in which the consumption of excess sugars over time leads to a resistance to insulin by the muscle cells of the body. This condition also leads to disease changes to many nerves, starting with those farthest from your core. Problems also tend to develop with the arteries, resulting in reduced flow to the feet, which has profound effects on these tissues over time. In addition, individuals with diabetes have an impaired immune system which becomes less effective at fighting off infection.

Diabetes is such a unique disease, at least in the education those afflicted should be provided. In contrast, for example, is hypertension, a condition of high blood pressure. We have a variety of medications for treating this common problem, which, along with reducing your salt intake, have been successful in treating it. There isn’t much study needed to live with the condition. Diabetes is quite the opposite.

Most Americans have some personal experience with the ubiquitous malady that is diabetes. Over 38 million of us have been diagnosed with the condition and experts claim 1 in 5 have the disease but aren’t yet diagnosed. With those kinds of numbers, many of us have it, or someone close does. This is a widespread problem, and the consequences of this disease reduce quality of life, as well as the longevity, of too many US citizens.

In contrast to hypertension, people living with diabetes need to be taught how to care for themselves and especially their feet. This requires day-to-day alterations in lifestyle. When they aren’t taught proper practices, more minor skin injuries occur, more ulcers result, often leading to infection. And diabetic infections tend to worsen quickly. Yet these breaks in the skin don’t cause pain because of the nerve problems.

One of the biggest fallacies regarding diabetes is particularly dangerous. This is in reference to the thinking that those with type II diabetes (adult-onset, T2D) needn’t be concerned about these consequences since they are not type I (which require administration of an injectable medication). Nothing could be further from the truth. All the negatives associated with type I diabetes (aka juvenile onset, aka insulin dependent), including said infections, the numbness and pain of neuropathy, even amputation, can be, and more often are, experienced by those with type II. This is true regardless of whether or not you control your blood sugar with diet, oral meds or injectables.

This message bears repeating. Regardless of how you manage your blood sugar, be it diet, pills, or injections, you are prone to neuropathy, vasculopathy, and immunopathy. In other words, everyone with this disease will benefit from regular, daily foot inspections to detect earlier minor skin injuries. It is unfortunate but neuropathy tends to develop even in those with excellent blood sugar control. Poor control will lead to complications more quickly, but excellent blood sugar levels won’t prevent them.

Type II diabetics will benefit from specific and precise education about the performance of daily inspections of the foot. Because of the nerve changes, a diabetic may have some type of injury to the skin but experience no pain. Predictably, practices leading to healthier skin, like regular moisturizer application, will result in fewer skin injuries.

A detailed discussion of shoe gear should be part of these educational efforts. Shoes are a frequent source of pressure or irritation to the skin when they don’t fit correctly or are fabricated of less flexible material. Wearing an incorrectly sized shoe is extremely common in this population since the nerve changes prevent them from feeling the fit accurately.

Accidents happen. But when it leads to some kind of opening in the skin, your prototypical stubbed toe or simple blister, someone with diabetes is far more likely to suffer serious ramifications. Due to the reduced response of the immune system, infections develop easier and worsen faster. Again, pain may not be noted due to the impaired nerve function most develop.

In our current system of medical care, when an individual is first diagnosed with diabetes, they are sent to a diabetic educator. This is an essential task since education is provided in all the myriad topics related to controlling blood sugar. Using their medications correctly, checking blood sugar levels and how best to do that. Also of tremendous importance is the information provided concerning diet. This visit is of great importance and takes some time.

But at no time is the effort made, as a standardized practice, to provide these people with the education so beneficial in reducing the serious complications, specifically infection, hospitalization, amputation, and death. Multiple studies demonstrate a reduction in the rates of these aftereffects when this vital teaching is provided.

This is an effort many podiatrists have taken on, understandable since we see the results of inadequate education and poor home care. We see too many of the ulcers and infections diabetics are prone to, a consequence of poor home practices. If you or a loved one have been diagnosed with diabetes, you need to learn about your foot health and your particular risk factors for diabetic foot problems. It is not hyperbole; your life depends on it.

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.


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