Diabetes is becoming more and more common, with more than 20 percent of Bahamians currently living with the disease. It is also one of the top leading causes of death in The Bahamas and worldwide. With the increasing numbers of obesity and poor lifestyle choices, the World Health Organization (WHO) estimates that the number of people with diabetes worldwide is projected to increase exponentially and that deaths due to diabetes and its complications will double by 2030. During November, we highlight diabetes for World Diabetes Day which was recognized on November 14.
Uncontrolled 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, leading to infections, amputations and possibly death. In five years, more people die after having diabetic foot ulcers or lower limb amputation than persons with prostate cancer, breast cancer or Hodgkin’s lymphoma.
Diabetes can damage blood vessels and nerves causing a loss of feeling in both feet. Diabetes can also cause the feet and toes to be deformed and change their shape and the skin can become very dry and cracked. These changes put all diabetics at high risk for foot complications such as ulcers that take a long time or never to heal, leading to infections and even amputations.
Damage to the blood vessels can lead to peripheral arterial disease (PAD), or poor blood flow to the feet. This decreased circulation or 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 and result in an amputation.
Chronic high sugar levels can cause nerve damage that interferes with the ability to sense pain and temperature. This damage to the nerves can lead to diabetic peripheral neuropathy, loss of feeling and numbness, tingling and burning in the feet. Loss of feeling to the foot puts them at risk for injury especially if they walk barefoot. Further, the person may not feel when their foot was injured, allowing the wound or puncture to get infected. There is also decreased ability to feel temperature changes with neuropathy. This is the reason why diabetics should never walk barefoot or soak their feet in hot water.
High sugar goes into the tendons and ligaments making them tight and joints stiff. Changes in the structure of the bones can lead to deformities or changes in the shape of your feet. When the arch collapses and bone protrudes under the foot this is called Charcot foot. The toes can also change shape forming hammer toes and bunions. All these increase pressure on the foot and the risk of developing foot ulcers. Nerve damage can also affect the function of foot muscles, leading to improper alignment and injury.
Damage to temperature control mechanisms and decreased sweating can lead to very dry, cracked skin that can become deep, develop into ulcers and get infected.
Neuropathy (loss of feeling) and PAD (loss of blood flow) are the most common reasons why persons with diabetes develop ulcers. Often persons will have some type of injury to the foot that causes the downhill spiral toward ulcers and amputation. Diabetic foot complications are one of the most common causes of hospitalizations and deaths in persons with diabetes. All diabetics have a 25 percent chance of developing a foot ulcer in their lifetime. Most of the amputations performed worldwide are done on persons with diabetes and one is performed every 20 seconds. Eighty five percent of these amputations are done on persons who had a foot ulcer or open sore that did not heal. Having an amputation (part of the foot or leg cut off) is a devastating life changing event from which most people never recover because it increases the chance of more amputations and death. The International Diabetes Federation estimates that 45 percent to 85 percent of all amputations can be prevented.
Just recognizing that diabetes puts the feet at high risk for injury, infection and amputation, encourages diabetics and their families to pay attention and take special care of their feet. It is encouraging to know that with a little help and awareness persons with diabetes can prevent these devastating complications and truly believe their feet can last a lifetime.
• For more information email us at firstname.lastname@example.org, or to see a podiatrist visit Bahamas Foot Centre, Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates Centre, Hilltop Medical Centre, East Terrace Centreville or telephone 394-5820; or Lucayan Medical Centre, East Sunrise Highway, Freeport, Grand Bahama, every first and third Thursday, telephone 373-7400.