Potentially lethal strokes and heart attacks deservedly receive the lion share of headlines occurring concurrently or as complications of diabetes; however, there are several other diabetes induced ailments on the upcurve which dictate that we raise the level of awareness. 15% of seniors over 65 in this country are diabetic and another 10% ages 50 to 65 are also afflicted. Health Canada planners believe these numbers will double by the year 2025. Equally important is the fact that pre-diabetic individuals are unaware of their status or have chosen for a variety of reasons not to be tested. Compounding this disturbing demographic are the feedback studies showing only about half of the known diabetics are adequately controlled. As we make progress managing the critical cardiac and brain events, patients will live longer and unfortunately become more predisposed to the chronic and disabling complications of diabetes.
Next to traumatic events that require amputation, complications of diabetes are now the number one cause of lower extremity amputation in seniors whether it be a toe, foot or even above knee. There are two major contributory factors to this clinical picture, peripheral arterial disease and peripheral neuropathy. The arterial vascular component has several origins including blood pressure problems, cholesterol related atheroma changes in the vessels and smoking. The silent partner in this condition is named peripheral neuropathy and it shows up in a variety of ways. Nerves to the extremities perform three basic functions…receiving sensations from the environment to pass to the brain, sending response messages to muscle groups to react, and a third continuous propioreceptor system reminding the body of the relative positioning of its various parts. Diabetic peripheral neuropathy has a range of symptoms involving all three from discernible pain to tingling, burning to actual numbness, even an inability to differentiate heat and cold. Under these conditions, even the smallest scratch or foreign body on the sole of the foot may go unnoticed. In some cases, the diabetes produces weakness leading to falls
Our feet are where “the rubber hits the road”. Women who have jammed their size eights in to high heels inevitably acquire bunions, calluses and hammer toes. Men tend to calluses and blisters. Combine these mechanical foot problems with a diabetes induced loss of normal sensation is a recipe for long term disaster and disability. The worst case scenario is the skin surface actually breaks down and ulcerates leading to infection in the underlying muscle and even bone.
Standards for diagnosing diabetes have been simplified. No more multi-hour needle stabs for sugar measure. The 2015 screening standard is a single hemoglobin a1c blood test indicating your average glucose for the past three months. Any Canadian with abnormal lower extremity sensations is urged to seek medical investigation. A positive screening result will require further testing, some by your family doctor, some by a neurologist to assess the degree of damage In the interim, a few cautions to the known diabetic. NEVER cut a callus. Wet the area and gently pumice every few days. NEVER drain a blister. Diabetics are predisposed to systemic infections. NEVER use chemical agents to burn corns. Skin with altered sensation is predisposed to ulceration. Got cold feet? Do not use heat. Wear thicker socks…and to bed. If you have already been diagnosed, get connected with a Podiatrist. You probably should be assessed for orthotic footwear to minimize, even prevent future changes. And finally, the most minuscule ulcer needs urgent assessment. There’s a new optimism regarding outcome when the diabetes is aggressively controlled but for those choosing to Ignore lower extremity diabetic warning signs could leave you without a leg to stand on
Written by: Dr. David Carll