Diabetes

WHAT IS DIABETES?
Diabetes is a metabolic disorder affecting about 3% of the population. It disturbs the body's ability to utilise glucose, fat & protein and is caused by insulin resistance or deficiency.

The main problem in diabetes is hyperglycaemia (high blood sugar levels).

Symptoms of hyperglycaemia are classically:

1. Polyuria (excessive urination)
2. Nocturia (nocturnal urination)
3. Polydipsia (excessive thirst)
4. Lethargy
5. Weight Loss

TYPE 1 DIABETES
An autoimmune disease predominantly in children and young adults with a genetic susceptibility. Type 1 Diabetes is due to a deficiency of insulin. Treatment includes diet changes, oral medication and insulin.

TYPE 2 DIABETES
Generally seen in adults and often associated with obesity. Weight reduction often improves control of blood sugar levels. Type 2 Diabetes is due to resistance to insulin and a relative insulin deficiency. Type 2 diabetes is mostly controlled with diet changes and/or oral medication.

THE FOOT AND DIABETES
Diabetes affects the whole body with the eyes, heart, kidneys and feet at greatest risk. Affects on the feet include:

LOSS OF PROTECTIVE SENSATION
• Unusual sensations such as pain, tingling, burning and numbness which begin at the ends of your feet and hands and may progress up the limbs (peripheral neuropathy)
• Lack of feeling leaving the foot susceptible to trauma including cuts and burns that the patient is unaware of doing
• Contributes to ulcer formation

POOR CIRCULATION
• Cramping in the back of the leg
• Slow healing time
• Dry and cracked skin
• Thinner skin which is more susceptible to trauma
• Tinea
• Colour changes (blue) & cold feet
• Contributes to ulcer formation

OTHER FOOT COMPLICATIONS
• Changes in foot shape
• Abnormal pressure distribution
• Callus, pain, ulcers
• Increased likelihood of infection
• Loss of reflexes
• Charcot's neuroarthropathy
• A relatively painless and progressive series of fractures, dislocations and deformity of the foot with resulting complications.

CARING FOR YOUR FEET
• Complications of diabetes are reduced by strict control of blood sugar levels
• Wash your feet daily and dry carefully between your toes
• Use a small hand mirror to check daily for any unusual colouring or wounds. Contact your podiatrist if you find anything abnormal
• Cut your toenails straight across. Do not cut down or poke at the sides of your nails. If you have difficulty reaching your toes or your eyesight is affected, have your nails safely attended to by your podiatrist
• Protect your feet by avoiding walking barefoot and checking inside your shoes for foreign objects (e.g. stones) that you may not be able to feel
• Ensure your shoes fit properly. Remember you may not be able to determine if your shoes are too tight or rubbing. Poor fitting shoes contribute to ulcer formation. If you are unsure, ask your podiatrist to check your shoes
• See a podiatrist for the treatment of corns, callus and ingrown toenails
• Use moisturiser to hydrate dry skin. Sorbolene cream, available from the supermarket, is ideal.

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