There is no doubt that managing diabetes can be challenging, but it doesn’t have to be insurmountable. Unlike the past, there are a lot of resources available today to empower those living with diabetes to live fulfilling and active lives, including new medications that many of which my patients with diabetes have responded to well. However, early intervention is key.
Controlling blood sugars through diet, exercise and medications is paramount. After all, the higher your blood sugar levels, the more damage is done in your body. In the early stages of diabetes, these effects are not as easily seen, but the longer sugar levels remain too high, the more damage is done to organs like the heart, kidneys, nerves, eyes, teeth, ability to fight infection and the ability to heal wounds.
As a foot specialist, I’ve treated my fair share of foot conditions caused by diabetes. Our feet are our best means of transportation and diabetes can affect our feet in several ways including the nerves of the foot. Often, I have patients say that they feel like they have tingling, burning or numbness in their feet. At first, it may only be occasional, but then they notice that “the feeling” stays longer and longer and eventually can become permanent. This is the beginning of what's called diabetic neuropathy.
Sometimes medications can help with the neuropathic pain, but the longer blood sugars stay elevated the more damage is done and the harder it is to control. It’s important that patients with diabetes understand that eventually there is a point of no return to normal and no magic pill will work. Early intervention is key.
In severe cases, sensations are completely lost and patients can literally walk until they have a hole in their foot, aka diabetic ulcer, or even break multiple bones in their foot. This breaking of bones is called Charcot neuroarthropathy, and if not caught in time, can actually change the structure of the foot, which is usually permanent. Charcot makes it extremely difficult to walk. This is why it is so important to keep your blood sugar under control and inspect your feet at least twice a day; before putting on your shoes in the morning and again when you take them off. This is an excellent habit to start if you are diagnosed with diabetes.
Circulation also can be affected in people living with diabetes. Unfortunately, diabetes can naturally cause the blood vessels and arteries to constrict, causing blood circulated to your feet to become blocked. When this happens, your feet may feel cold, lower legs and feet could lose their hair, skin becomes tight and shiny and toenails become thick. Even the slightest scratch, blister or cut can be limb-threatening because wounds are harder to heal when diabetes is present.
However, there are tests that can be done to quickly check circulation that are simple and often only require the use of a blood pressure cuff and doppler ultrasound. This is referred to as ankle/brachial indices or ABI. In the past, these blockages meant that very invasive surgeries needed to be performed, however now most blockages can be opened by a vascular surgeon using only a very small opening and fiber optics, and patients usually go home the same day.
To help prevent circulation issues, exercise is always a good idea when done properly and under medical supervision. Some of my patients love aqua therapy because there is no stress on their feet and they get a very good work out. Others, who still have good feeling in their feet, like to go on long walks and still others like to ride a bike. Before embarking on a new activity, always check first with your primary care physician and podiatrist.
The good news is that having diabetes doesn’t have to slow you down. Knowledge is power and the more you know about diabetes, how to manage it daily, what to look out for and the importance of keeping those regular checkups with your doctors, the more active your life can be! The next step is up to you.