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DIABETES mellitus
Diabetes and the feet
This is a disorder of carbohydrate metabolism in which sugars in the body are not broken down to produce energy, due to a lack of the pancreatic hormone “Insulin”. This disorder is characterised by an inability to reabsorb water, which results in an increased urine production, excessive thirst and excessive eating. The accumulation of this sugar leads to its appearance in the bloodstream (hyperglycaemia), and then in the urine. As this sugar cannot be broken down to produce energy, the body utilises its fat storage as an energy source. This alternative source of energy leads to disturbances of the acid base balance and accumulation of ketones (Ketosis) in the blood, this eventually leads to convulsions, which precede diabetic coma.
Diabetes, which starts in childhood or adolescence (juvenile-onset diabetes), is more severe than that beginning in middle or old age (maturity-onset diabetes).
Insulin Dependent Diabetes In this condition patients have little or no ability to produce the hormone insulin and are entirely dependent on insulin injections for survival.
Non-Insulin Dependent Diabetes Usually occurs after the age of 40. The pancreas retains some ability to produce insulin but it is inadequate for the body’s needs. Patients may require advice on diet or treatment with oral hypoglycaemic drugs.
With both types of diabetes, diet must be carefully controlled with adequate carbohydrates for the body’s needs. Lack of balance in the diet, or in the amount of insulin taken, leads to hypoglycaemia. This is a deficiency of glucose in the bloodstream causing muscular weakness, in-coordination, mental confusion and sweating, which may lead to hypoglycaemic coma. Long-term complications of diabetes include thickening of the arteries, which can affect the eyes. It is therefore important that the eyes are checked regularly.
The Feet  Diabetes is a disease with widespread complications throughout the body, and the feet are one of the main areas in which complications occur.
Neuropathy  The complications of diabetes can seriously affect the feet. Neuropathy is a disease of the peripheral nerves causing weakness and numbness. All types of nerve fibres are involved and autonomic, motor and sensory functions are affected. Neuropathy may improve with control of diabetes.
Ischaemia  This is a vascular disease where there is inadequate flow of blood to a part caused by constriction of the blood vessels.
Diabetes may affect the nerves so that pain signals arising from the feet cannot reach the brain. This means that the diabetic loses the warning signals produced by injury. Similarly, if the blood flow to the feet is limited or absent, then the ability of the body to fight infection is removed. This allows the infection to spread.
This is the danger:
An infection may easily develop on the feet and the diabetic patient may be completely unaware of this problem due to lack of feeling!
Prevention is better than cure
Tests are available that offer a reliable and efficient indication of whether a diabetic is likely to develop the diabetic foot syndrome called Peripheral Neuropathy.
Peripheral Neuropathy is a disease of the sensory nerves, which often results in the insidious development of painless ulceration and gangrene of the toes and feet.
If you have been diagnosed as having diabetes then these tests are recommended every six months.
Have you been tested yet?
These tests are carried out here in our clinic.
Speak to your practitioners.
Care of the Diabetic feet
As a diabetic may experience a reduction in feeling, other senses must be used, especially the eyes and hands, to detect the earliest signs of injury or infection. If these signs are neglected serious problems may develop. The diabetic should follow these simple rules:
1. Wash feet daily in warm, not hot, water. (Test temperature first with the elbow or even a thermometer). Take care to remove debris from between the toes and dry the feet carefully and thoroughly. Apply moisturising cream to any dry areas.
2. Examine the feet carefully after each wash for any signs of cracks, corns, blisters etc. If you find anything unusual, however small, come to the Foot Clinic. If you cannot see the soles of your feet, sit on a bed or on the floor and view them through a large mirror. If your eyesight is poor, ask someone to examine them for you.
3. Always dress in roomy, woolly socks - two pairs if necessary. If your circulation is poor, wear slacks (women,) or long johns (men).
4 If you have had Neuropathy of the feet, and if you have them, always wear the special shoes that have been made for you. They will help you remain free of corns and callouses, and will protect your feet from injuries that you cannot feel, e.g. drawing pins in the sole of the feet etc.
5. Never walk about barefoot in the house, and wear slippers when you get out of bed during the night.
6. Try to remember to check your footwear each time you put your shoes on, in case hairgrips or other small objects have dropped into them.
7. Do not sit too close to a fire as you may burn your legs without realising it. Take hot water bottles out of the bed before you get in, and wear bed-socks if necessary.
8. Do not attempt to cut your own toe nails, and most certainly, do not under any circumstances use corn plasters, or any other form of substance which could damage your skin. Come to the Kirkintilloch Foot Clinic regularly for routine nail trimming and foot inspections.
Remember prevention is better than cure
 Visit the practitioners at the Kirkintilloch Foot Clinic
Copyright (c) 2006 Kirkintilloch Foot Clinic. All rights reserved.
4 Freeland Place, Kirkintilloch, Glasgow, G66 1ND  Tel: 0141-775-2932


Kirkintilloch foot clinic
Biomechanical Assessment and Orthotic Centre