Diabetic Foot Care
Diabetes: Startling Statistics
Diabetes mellitus is a chronic disease that affects the lives of many people in the United Kingdom, many of whom are unaware that they even have the disease. Every day, 2,200 new cases of diabetes are diagnosed, and an estimated 780,000 new cases are identified each year. The disease is marked by the inability to manufacture or properly use insulin, and impairs the body’s ability to convert sugars, starches, and other foods into energy. The long-term effects of elevated blood sugar (hyperglycemia) are damage to the eyes, heart, feet, kidneys, nerves, and blood vessels.
Symptoms of hyperglycemia may include frequent urination, excessive thirst, extreme hunger, unexplained weight loss, tingling or numbness of the feet or hands, blurred vision, fatigue, slow-to-heal wounds, and susceptibility to certain infections. People who have any of these symptoms and have not been tested for diabetes are putting themselves at considerable risk and should see their without delay.
Diabetes is the sixth leading cause of death by disease in the United Kingdom, and individuals with diabetes are two to four times as likely to experience heart disease and stroke.
The growth of the disease worldwide is especially alarming. The World Health Organization (WHO) expects the number of new diabetes cases to double in the next 25 years from 135 million to nearly 300 million. Much of this growth will occur in developing countries where aging, unhealthy diets, obesity, and sedentary lifestyles will contribute to the onset of the disease.
- According to a recent survey, about 20,000 lower limbs are amputated annually due to complications from diabetes.
- Diabetes is the leading cause of end-stage kidney disease, accounting for about 40% of new cases.
- Diabetes is the leading cause of new cases of blindness among adults, age 20 to 74.
While there is no known cure for diabetes, there is hope. With a proper diet, exercise, medical care, and careful management at home, a person with diabetes can keep the most serious of the consequences at bay and enjoy a long, full life.
How Do You Get Diabetes?
No one knows why people develop diabetes, but once diagnosed, the disease is present for life. It is a hereditary disorder, and certain genetic indicators are known to increase the risk of developing diabetes.
Type 1, previously known as insulin-dependent diabetes mellitus or juvenile-onset diabetes, afflicts five to 10% of diagnosed cases of diabetes. This type occurs most frequently in children and adolescents, and is caused by the inability of the pancreas to produce the insulin needed for survival.
Type 2, previously called non-insulin-dependent diabetes mellitus or adult-onset diabetes, affects the other 90-95% of all diagnosed cases of diabetes, many of whom use oral medication or injectable insulin to control the disease. The vast majority of those people (80% or more) are overweight; many of them obese, as obesity itself can cause insulin resistance.
Certain characteristics put people at a higher risk for developing Type 2 diabetes.
- A family history of the disease
- Prior history of developing diabetes while pregnant
- Being over the age of 40
Of all the risk factors, weight is the most important, with more than 80% of diabetes sufferers classified as overweight.
Diabetic Wound Care
What is a Diabetic Foot Ulcer?
A diabetic foot ulcer is an open sore or wound that most commonly occurs on the bottom of the foot in approximately 15% of patients with diabetes. Of those who develop a foot ulcer, 6% will be hospitalised due to infection or other ulcer-related complication.
Diabetes is the leading cause of non-traumatic lower extremity amputations in the United Kingdom, and approximately 14 to 24% of patients with diabetes who develop a foot ulcer have an amputation. Research, however, has shown that the development of a foot ulcer is preventable.
Who Can Get a Diabetic Foot Ulcer?
Anyone who has diabetes can develop a foot ulcer. older men are more likely to develop ulcers. People who use insulin are at a higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease.
How do Diabetic Foot Ulcers Form?
Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of feeling in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain and one may not even be aware of the problem. Your podiatrist can test feet for neuropathy with a simple and painless tool called a monofilament.
Vascular disease can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also retard healing.
What is the Value of Treating a Diabetic Foot Ulcer?
Once an ulcer is noticed, contact your podiatrist immediately. Foot ulcers in patients with diabetes should be treated for several reasons such as, reducing the risk of infection, improving function and quality of life.
How Should a Diabetic Foot Ulcer be Treated?
The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.
There are several key factors in the appropriate treatment of a diabetic foot ulcer:
- Prevention of infection.
- Taking the pressure off the area, called “off-loading.” via Orthotics/insoles
- Removing dead skin and tissue, called “debridement.”
- Applying medication or dressings to the ulcer
- Managing blood glucose problems.
There are several important factors to keep an ulcer from becoming infected:
- Keep blood glucose levels under tight control.
- Keep the ulcer clean and bandaged.
- Cleanse the wound daily, using a wound dressing or bandage.
- Do not walk barefoot.
For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” Patients may be asked to wear insoles/orthotics, special footgear or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.
The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.
Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.
For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with non-invasive tests.
Controlling Blood Glucose
Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with your GP to accomplish this will enhance healing and reduce the risk of complications.
Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.
How Can a Foot Ulcer be Prevented?
The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis. They can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.
You are at high risk if you:
- have neuropathy
- have poor circulation
- have a foot deformity (i.e. bunion, hammer toe)
- wear inappropriate shoes
- have uncontrolled blood sugar
Wearing the appropriate shoes and socks will go a long way in reducing risks. Your podiatrist can provide guidance in selecting the proper shoes.
Learning how to check your feet is crucial in noticing a potential problem as early as possible. Inspect your feet every day, especially between the toes and the sole, for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality. Any problems that are discovered should be reported to your podiatrist as soon as possible, no matter how “simple” it may seem to you.
The old saying, “an ounce of prevention is worth a pound of cure” was never as true as it is when preventing a diabetic foot ulcer