Diabetes is becoming one of the most common, expensive and devastating chronic diseases locally and globally. Worldwide, over 460 million people are living with diabetes. With the increasing numbers of obesity and poor lifestyle choices, the World Health Organization (WHO) estimates that these numbers are projected to increase greatly and that deaths due to diabetes and its complications will double by 2030. That’s 10 short years! During November, I will highlight diabetes, and bring awareness to World Diabetes Day – November 14.
In The Bahamas, there are approximately 46,400 or 11.6 percent of the population living with diabetes, and an additional 27,200 or 6.8 percent with pre-diabetes. The 2019 STEPS survey also tells us that most or 55.3 percent of people diagnosed with diabetes, do not take their medication regularly. This is of grave concern, because we know uncontrolled diabetes often results in detrimental complications such as blindness, kidney failure, amputations and early death. In the past year, 32.7 percent of diabetics had their eyes examined, while 23.9 percent had their feet examined. Diabetes remains one of the top leading causes of death and disability in The Bahamas. It is estimated that more than 1,000 amputations are performed annually and countless others have non-healing ulcers that steal their time, joy and quality of life.
How diabetes affects your feet
Uncontrolled or poorly controlled diabetes leads to high blood sugar levels over time, which can have detrimental effects on the feet and many other organs in the body including the heart, eyes, and kidneys. All diabetics are at high risk for foot ulcers that take a long time or never heal, possibly leading to infections, amputations and even death. In the past five years, more people died after having diabetic foot ulcers or lower limb amputation, than they did from prostate cancer, breast cancer or Hodgkin’s lymphoma.
Diabetes affects all aspects of the foot – its skin, its structure (shape) and how it works. These changes put all diabetics at high risk for foot complications such as ulcers that take a long time or never heal – leading to infections and even amputations. That’s why we always say diabetic foot = high risk foot.
Damage to the blood vessels can lead to peripheral arterial disease (PAD) or poor blood flow to the feet. This decreased blood flow to the leg and foot will cause poor healing if there is a cut or sore on the foot. If there is an infection, it will take a long time to treat because there is not enough blood to take the medicine down to the foot to kill the bacteria. Low blood flow can also lead to gangrene (the decaying of an organ and/or tissue) and result in an amputation.
Chronic high sugar levels can cause nerve damage that interferes with its ability to sense pain and temperature. This damage to the nerves can lead to diabetic peripheral neuropathy (diabetic nerve pain), loss of feeling and numbness, tingling and burning in the feet. Loss of feeling to the feet puts them at risk for injury and people may not feel that their foot was injured – allowing the wound to progress and get infected. There is also decreased ability to feel temperature changes with neuropathy. This is the reason why diabetics should never walk bare foot or soak their feet in hot water to prevent burns and injury.
High sugar also gets into the tendons and ligaments making them tight, making joints stiff and not move as freely. The shape of the foot can also change, leading to deformities such as hammer toes and bunions. A more serious change is when the middle part of the foot (arch) collapses and the bone can push under the foot; this is called Charcot foot. All these changes increase pressure on the foot and the risk of developing foot ulcers.
The temperature control on the feet do not work well either causing decreased sweating, leading to very dry cracked skin that can become deeper, develop into ulcers and get infected.
Diabetic foot complications are one of the most common causes of hospitalizations and deaths in persons with diabetes. Neuropathy (loss of feeling) and PAD (loss of blood flow) are the most common reasons why persons with diabetes develop ulcers.
Most times, people will have some type of injury to the foot, even a small one, that causes the downhill spiral toward ulcers and amputation. It is estimated that 45 to 85 percent of all these amputations can be prevented.
An important first step in doing that is understanding how uncontrolled diabetes affects the feet and making a commitment to getting your diabetes under control. People with controlled diabetes and HbA1c below seven percent have very low risk of complications. Recognizing that diabetes puts the feet at high risk for injury, infection and amputation is sobering but knowing that they can be prevented, should encourage diabetics and their families to take control of their diabetes and take special care of their feet.
• For more information on foot conditions, visit www.apma.org, healthcentral.com, or email us at email@example.com. To see a podiatrist, visit Bahamas Foot Centre, Rosetta Street, or telephone 325-2996 for an appointment at Bahamas Surgical Associates Centre, Hilltop Medical, or call 394-5820 for an appointment. You can also visit Lucayan Medical Centre in Freeport, Grand Bahama, or telephone 373-7400 for an appointment.