Your Physician’s Role

Because diabetes is a systemic disease affecting many different parts of the body, ideal case management requires a team approach. The podiatric physician, as an integral part of the treatment team, has documented success in the prevention of amputations. The key to amputation prevention in diabetic patients is early recognition and regular foot screenings, at least annually, from a podiatric physician.

In addition to these check ups, there are warning signs that you should be aware of so that they may be identified and called to the attention of the family physician or podiatrist.

They include:

  • Skin color changes
  • Elevation in skin temperature
  • Swelling of the foot or ankle
  • Pain in the legs
  • Open sores on the feet that are slow to heal
  • Ingrown and fungal calluses
  • Bleeding corns and calluses
  • Dry cracks in the skin, especially around the heel.

Diabetes – A Family Affair

Take the time to discuss these questions and answers with your family and loved ones:

Diabetes is a disease characterized by increased levels of sugar in the blood.
True. People with diabetes have increased blood sugar (blood glucose levels). High levels of glucose may build up in the blood, and as a result the body loses its main source of fuel. The normal level of sugar in the blood is below 126.

Insulin is a hormone naturally produced by your body to help regulate blood sugar.
True. People with diabetes lack insulin, have insufficient amounts of insulin, or are resistant to insulin's affects.

Diabetes is a chronic disease that if left uncontrolled may lead to other serious health problems.
True. Diabetes can affect the blood vessels, eyes, kidneys, nerves, gums, and teeth. It is the leading cause of adult blindness, lower limb amputations and kidney failure. People with diabetes also have a higher risk of heart disease and stroke. Keeping your blood sugar levels near normal can greatly reduce these risks.

Diabetes only affects older people.
False. Diabetes can affect both the young and the old. In fact, type I diabetes mostly affects children while type II diabetes affects adults. It is a disease that is widespread around the world and affects men and women, children and adults, and people of all ethnicity.

Diabetes is an embarrassing disease.
False. Diabetes is a common disease. It has no boundaries and afflicts all kinds of people, even many famous people.

I need to educate my family on the dangers of diabetes.
True. Diabetes is a family affair. Everyone in the family should be made aware of this disease and should be helping those with diabetes control it.

Diabetes is contagious.
False. You cannot contract diabetes through contact or socializing with a person who has diabetes.

I can't develop diabetes if my parents don't have it.
False. Though diabetes can run in families, it can also be associated with poor eating habits and lack of exercise.

People with diabetes have a more difficult time fighting off infections and healing wounds than people who don't have diabetes.
True. In general, people with diabetes may take longer to fight an infection and may experience more difficulty in mending open wounds and sores.

My feet are important.
True. Though at times some people may be embarrassed by their feet, it is important to take good care of them. Proper foot care is a valuable first step in keeping you healthy.

If You Have Diabetes

The following recommendations will help in your fight against diabetes:

  1. Wash feet daily.
    Using mild soap and lukewarm water, wash your feet in the mornings or before bed each evening. Dry carefully with a soft towel, especially between the toes, and dust your feet with talcum powder to wick away moisture. If the skin is dry, use a good moisturizing cream daily, but avoid getting it between the toes.
  2. Inspect feet and toes daily.
    Check your feet every day for cuts, bruises, sores or changes to the toenails, such as thickening or discoloration. If age or other factors hamper self-inspection, ask someone to help you, or use a mirror.
  3. Lose weight
    People with diabetes are commonly overweight, which nearly doubles the risk of complications.
  4. Wear thick, soft socks.
    Socks made of an acrylic blend are well suited, but avoid mended socks or those with seams, which could rub to cause blisters or other skin injuries.
  5. Stop smoking.
    Tobacco can contribute to circulatory problems, which can be especially troublesome in patients with diabetes.
  6. Cut toenails straight across.
    Never cut into the cornets, or taper, which could trigger an ingrown toenail. Use an emery board to gently file away sharp corners or snags. If your nails are hard to trim, ask your podiatrist for assistance.
  7. Exercise.
    As a means to keep weight down and improve circulation, walking is one of the best all-round exercises for the diabetic patient. Walking is also an excellent conditioner for your feet. Be sure to wear appropriate athletic shoes when exercising. Ask your podiatric physician what's best for you.
  8. See your podiatric Physician.
    Regular checkups by your podiatric physician-at least annually-are the best way to ensure that your feet remain healthy.
  9. Be properly measured and fitted every time you buy new shoes.
    Shoes are of supreme importance to diabetes sufferers because poorly fitted shoes are involved in as many as half of the problems that lead to amputations. Because foot size and shape may change over time, everyone should have their feet measured by an experienced shoe fitter whenever they buy a new pair of shoes.

    New shoes should be comfortable at the time they're purchased and should not require a "break-in" period, though it's a good idea to wear them for short periods of time at first. Shoes should have leather or canvas upper, fit both the length and width of the foot, and leave room for toes to wiggle freely, and be cushioned and sturdy.

  10. Don't go barefoot.
    Not even in your own home. Barefoot walking outside is particularly dangerous because of the possibility of cuts, falls, and infection. When at home, wear slippers. Never go barefoot.
  11. Don't wear high heels, sandals and shoes with pointed toes.
    Those types of footwear can put undue pressure on parts of the foot and contribute to bone and joint disorders, as well as diabetic ulcers. In addition, open toed shoes and sandals with straps between the first two toes should also be avoided.
  12. Don't drink in excess.
    Alcohol can contribute to neuropathy (nerve damage), which is one of the consequences of diabetes. Drinking can speed up the damage associated with the disease, deaden more nerves, and increase the possibility of overlooking a seemingly minor cut or injury.
  13. Don't wear anything that is too tight around the legs.
    Panty hose, panty girdles, thigh-highs or knee-highs can constrict circulation to your legs and feet, so can men's dress socks if the elastic is too tight.
  14. Never try to remove calluses, corns or warts by yourself.
    Commercial, over-the-counter preparations that remove warts or corns should be avoided because they can burn the skin and cause irreplaceable damage to the foot of a diabetic sufferer. Never try to cut calluses with a razor blade or any other instrument because the risk of cutting yourself is too high, and such wounds can often lead to more serious ulcers and lacerations. See your podiatric physician for assistance in these cases.

Diabetes Self Management

Diabetes is a very serious disease which may cause damage to the blood vessels and nerves leading to the brain, eyes, heart, kidneys, toes and feet.

You the patient, are the most important person to manage your diabetes.
footDrHorsley will guide you and offer support as you manage your diabetes.
The following goals will help you gain and maintain diabetic control to reduce damage to your blood vessels and nerves.

Goals & Objectives

  1. I will work hard to keep my HbA1c below 7
  2. I will exercise (walk) 30 minutes _____ days per week.
    If I notice chest pain, shortness if breath or chest tightness, I will seek medical attention.
  3. I will check my feet daily. If I notice a sore or irritation I will seek medical attention.
    I will visit the Podiatrist yearly, or as instructed.
  4. I will follow my diabetic and low fat diet to reduce my blood sugar and cholesterol
  5. I will try to obtain my ideal body weight.
    I will lose _____ pounds by my next office visit.
  6. I will take a baby aspirin or enteric coated aspirin every day.
  7. I will stop smoking.
  8. I will have an eye exam every year or as indicated.
  9. I will check my blood sugar as instructed and will call if the results are consistently below 70 or above 180.
  10. I will talk about how I feel about having diabetes to family, friends, & or chaplain. I will attend a Diabetes Support Group.

Diabetic Ulcers

Non-traumatic lower extremity amputation most often occurs as a result of a diabetic foot problem, skin ulcers. The development of skin ulcerations on a patient with diabetes can be caused by any number of things. Some include, pressure from poorly fitted shoes and trauma to the foot and toes. Patients with Peripheral Neuropathy are more likely to develop ulcers because they have loss the sensation in their feet. Most times they will simply notice stains on their socks and footwear.

Unfortunately, even those diabetic patients who take all the proper steps in maintaining their foot care can still get an ulcer. An ulcer is the primary opening for infection that can affect both the soft tissue and the bone. It is very important to stay off your feet once you notice your ulcer. Continuing to walk on it will cause the infection to spread and penetrate deeper into your foot. Delayed treatment of diabetic ulcers can lead to amputation and even mortality

Debridement of the wound is the first steps in treating this condition. Thick layers of skin (corns and calluses), which should be carefully removed until a satisfactory border is present, may cover ulcers. Your podiatrist may require that you wear special footwear, have a culture done, or get x-rays.

Additional treatments for ulcers other than local wound care include hyperbaric oxygen (HBO), growth factors, and electrical stimulation. Even after successful treatment, there is a very high probability of reoccurrence. Continue to thoroughly inspect your feet and see your podiatrist on a regular basis.

Dr. Horsley recommends that all diabetics:

  1. Become educated on diabetic foot care
  2. Wash and dry feet thoroughly
  3. Inspect your feet daily (or have someone else do it for you)
  4. Wear properly fitting shoes
  5. Wear seamless socks
  6. Do NOT walk around barefoot
  7. Visit your podiatrist regularly

If you are experiencing any of the symptoms addressed, we strongly recommend that you seek the advice of your podiatrist for proper diagnosis.

Startling Statistics

Diabetes mellitus is a chronic disease that affects the lives of about 16 million people in the United States, 5.4 million 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 a physician without delay.

Part of keeping your diabetes in control is testing your blood sugar often. Ask your doctor how often you should test, and what your blood sugar levels should be. Testing your blood and then treating high blood sugar early will help your to prevent complications.

The socioeconomic costs of diabetes are enormous. The costs have been estimated at $98 billion annually, about $44 billion of which are direct costs from the disease with $54 billion indirectly related. Diabetes is the sixth leading cause of death by disease in the United States, 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 the recent survey, about 86,000 lower limbs are amputated annually due to complications from diabetes.
  • Diabetes is the leading cause of end-stage kidney disease, accounting for about 40 percent of new cases.
  • Diabetes is the leading cause of new cases of blindness among adults, age 20 and 74.

While there is no 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 Does One 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 ten percent 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 percent 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 percent 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.
These include:

  1. A family history of the disease
  2. Obesity
  3. Prior history of developing diabetes while pregnant
  4. Being over the age of 40
  5. Being a member of one of the following ethnic groups:
    • African American
    • Native American
    • Latino American
    • Asian American
    • Pacific Islander
  6. African Americans are 1.7 times more likely to have diabetes than the general population, with 25 percent of African Americans between the ages of 65 and 74 diagnosed with the disease.
  7. Hispanic Americans are almost twice as likely to develop type 2 diabetes, which affects 10.6 percent of that population group.
  8. Native Americans are at a significantly increased risk for developing diabetes and 12.2 percent of the population suffers from the disease. In some tribes, as many as 50 percent of its members have diabetes.

Of all the risk factors, weight is the most important, with more that 80 percent of diabetes sufferers classified as overweight.

Tips for your Diabetic Child in School

If your child has diabetes and will be starting or is currently in school, please consider these helpful tips to insure that he or she will receive suitable diabetes treatment while at school.

  • There should be at least one adult available at all times who is trained in the important diabetes procedures and responses.
  • Be sure your child has the necessary equipment and supplies at school. (The school should provide adequate storage for the medications.)
  • Be sure your child is able to test his or her blood glucose level, eat a snack, or have access to fluids at anytime (including on field trips and school buses).
  • Be sure your child is permitted to use the restroom as required.
  • In case of a question or emergency, be sure the school has current emergency phone numbers for all parents or guardians.
  • Let an adult know about any special eating instructions for younger children during school parties or activities.

Federal laws mandating that he or she be able to fully participate in all school activities are in place to protect your child. All schools receiving federal funding must comply with these laws.

We strongly encourage all parents to meet with the teachers and other staff member at their child's school to establish a diabetes care plan. If everyone works together to help your child manage his or her diabetes, there is no reason they should not be able to participate 100% in the school experience.

Wound Healing

Ulceration is a common occurrence with the diabetic foot, and should be carefully treated and monitored by a podiatrist to avoid amputations. Poorly fitted shoes or something as trivial as a stocking seam, can create a wound that may not be felt by someone whose skin sensation is diminished. Left unattended, such ulcers can quickly become infected and lead to more serious consequences. Your podiatric physician knows how to treat and prevent these wounds and can be an important factor in keeping your feet healthy and strong. New to the science of wound healing are remarkable products that have the appearance and handling characteristics of human skin. These living, skin-like products are applied to wounds that are properly prepared by the podiatric physician. Clinical trials have shown impressive success rates

Your Feet and Diabetes

Diabetic Peripheral Neuropathy is an irreversible nerve condition suffered by many people with diabetes. Patients with diabetes have an abnormal acceleration of their blood sugar. This condition could be caused by: the body resisting insulin, producing too little insulin, or both. As a result of the high blood glucose levels, nerve damage can occur.

At the start of diabetic peripheral neuropathy, a patient would experience pain and a tingling sensation. After time, the patient loses his or her ability to sense the difference between such things as hot and cold, and sharp and dull. Some patients describe a burning feeling in their feet, or feel as though they are wearing socks when they are not. As the condition continues to progress, the feet will eventually become numb.

Neuropathy is normally divided into acute forms, which usually occur within the first three years of diagnosis and chronic forms, which occur after an average of eight to nine years.
Maintaining normal blood glucose levels can help slow the advancement of the condition.

The development of skin ulcerations and infections on a patient with diabetes can be caused by any number of things. Areas on the foot where there are corns and calluses are of concern because of the friction caused when wearing shoes. Ingrown toenails can also be very dangerous to a diabetic because they can progress into infections. For this reason, it is recommended that a foot doctor trim toenails. This will decrease the risk of accidentally cutting the skin around the nail and not knowing it.

Those who suffer from neuropathy must be sure to thoroughly inspect their feet, or have someone else do it -on a daily basis. They should also avoid soaking their feet in hot water, (this could burn the skin), and walking around without shoes.

The doctors at Dr. Horsley's Foot and Ankle Care are specially trained to treat, and carry out procedures for patients with diabetic foot injuries.

If you are experiencing any of the symptoms addressed, we strongly recommend that you seek the advice of your podiatrist for proper diagnosis.