Diabetes and the Foot
The Highlights
Diabetes is a metabolic disorder characterised by chronically elevated blood sugar levels (hyperglycaemia) resulting in a complex series of problems in multiple body systems (as this rather long article would suggest!) including peripheral nerves and blood vessels - hence it's seriousness for foot health.
Type 2 Diabetes (which accounts for around 90% of cases in the UK) is a preventable condition primarily due to diet and lifestyle factors although some individuals (due to genetic factors) may be at greater risk of developing it.
As Podiatrists, we play a pivotal role in helping people with diabetes to monitor and manage their foot health through regular diabetic foot assessments. In our clinic, we pride ourselves in taking these assessments to a much higher standard and routinely have patients tell us it is the most comprehensive look at their foot health they have ever had.
Beyond our high standards of assessment, we help people with diabetes with treatment of the complications that can arise including skin and nail problems or more serious issues like foot ulcers and advise on strategies that ensure your feet are in good hands.
What is it and what are the symptoms?
Diabetes Mellitus (often just shortened to Diabetes) is a chronic metabolic disorder that involves excessively high blood sugar levels (hyperglycaemia). The condition can be broadly divided into:
Type 1 diabetes - where the body's own immune systems destroys the cells that produce insulin (the key hormone that tells cells to absorb sugar from the blood).
Type 2 diabetes - where, through damage, the cells that produce insulin aren't functioning properly and the body's cells won't respond properly to insulin (insulin resistance)
Gestational diabetes - where pregnant women experience heightened levels of blood sugar and cannot produce enough insulin to remove it.
In the UK, about 90% of people with diabetes have type 2.
In each form of diabetes, if poorly controlled, can affect many systems throughout the body but is particularly important for foot health as it can affect the small blood vessels and nerves, leading to poor circulation in the feet (peripheral vascular disease) and loss of sensation (diabetic neuropathy).
Diabetic Neuropathy does not generally occur in the early stages of diabetes but can develop in time if blood sugar control is not achieved; symptoms are wide and varied by may include sensory changes such as numbness and tingling or indeed increased sensitivity and discomfort. Skin issues like dryness can also occur due to the nerves' role in controlling skin moisture. Blood vessel changes can involve calcification (hardening) of arteries which disrupts normal blood flow; patients may experience difficult healing and coping with infections.
In more severe cases, it is possible to develop tissue breakdown known as diabetic foot ulcers - these CANNOT go without medical care as the consequences can be limb- or even life-threatening. Patients with diabetes who have ANY concern over their foot health should consult their Podiatrist, GP or other appropriately qualified health professional as soon as possible.
Why does it happen?
The full roadmap of all that goes on in Diabetes is incredibly intricate and complex but here is a basic outline:
Type 1 diabetes is an autoimmune condition where the body's immune cells essentially misinterpreted the beta cells in our pancreas (the ones that make insulin) as foreign entities and attack them, rendering our ability to make our own insulin destroyed. This usually begins in teenagers and younger adults. Genetic factors are thought to be involved but we still don't know a lot about exactly why this happens in the first place.
In Type 2 diabetes, too much sugar or foods that breakdown into sugar (fructose sugar probably being the worst) cause our beta cells to work overtime and start to break down, leading to decreased insulin production. Insulin is a signalling hormone that tells the cells throughout our body to "open the gates" to sugar in our blood, taking it on board and using it for energy. Bombarded with too much insulin, cells stop listening to these signals and become "insulin resistant". So the double whammy effect is a low level of insulin and cells that wont listen to it in the first place so these cells soon have too little energy to allow them to work properly. Blood sugars continue to rise further and the cycle gets worse. Moreover, the volume of sugar in the blood causes direct damage to blood vessels. These fundamental issues in our body's metabolism go a long way to explaining why diabetes is so globally damaging to our bodies.
What are the treatment options?
Gestational diabetes usually resolves on it's own after childbirth. Type 1 diabetes has no known cure although a lot can be done to improve the severity of the condition. Type 2 diabetes is somewhere in between - if dealt with early in the process, before more significant damage is done, it is possible to get one's blood sugar levels back into healthy range consistently and to the point that you may be classed as being in remission. The label however, especially here in the UK, is not often removed once its on. Diet and lifestyle factors are key at every stage of the diabetes journey (and we would always encourage you ask for support around this if unsure).
Beyond lifestyle and diet factors, some patients may also require medication. In the case of people with type 1 diabetes, this is a given as they require insulin injections to function effectively. Most people with type 2 diabetes (unless very severe) will not require insulin but may be on other medications that make their cells more sensitive to the insulin they have or encourage the body to secrete some of their glucose through their urine.
As Podiatrists, we play a pivotal role in helping people with diabetes to monitor and manage their foot health through regular diabetic foot assessments which every person with diabetes should have at least once a year. We pride ourselves in offering a level of assessment well above the standard approach taken; diabetic foot checks will often include the practitioner checking pulses with their fingers - we feel this is isn't sufficient as pulses are not always palpable and it is completely unknown if the pulse is actually a healthy one.
All patients receiving a diabetic foot assessment with us are given a Doppler ultrasound examination - this is a simple handheld device that uses ultrasound waves to listen to the flow of blood in the arteries - it provides much more useful information about the overall health of the artery and can help us determine if further investigation is needed, either by us or a referral to another department. We also have the ability to carry out more in-depth circulation tests including the ankle-brachial pressure index - which is even more sensitive to potential issues. We also take our neurological assessment further; as well as the Semmes-Monofilament tests (the little plastic rod your feet are poked with to check you have feeling) we can look at precise temperature levels at different points in your feet (because discrepancies here can be an early indicator of nerve damage) and use a digital skin moisture detector to know if you're skin is excessively dry or moist (this is in part also down to your autonomic nerves and whether they are working effectively).
