Diabetes and The Foot

Diabetes is a huge public health problem for Australia. The chronic disease characterized by the inability to produce the hormone insulin or the body being unable to adequately utilize the insulin it does produce, costs the country over 6 Billion dollars annually. There is currently no cure for diabetes and impact of the condition becomes more prevalent to the individual the longer it is present. There are a number of different types oshutterstock_309584594.jpgf diabetes but over an extended duration they condition will affect the body in similar ways.

Type 1 is an auto-immune condition, presenting itself in early childhood or adolescents. It is important that good habits related to food and exercise are established early as people with this condition will have it for their entire life and risk serious complications if not managed appropriately.

Type 2 – is an inability for the body to utilize the insulin it produces. The condition has been defined as a lifestyle disease and is typically associated with obesity and poor cardiovascular health.

Gestational Diabetes – is first diagnosed during pregnancy and typically disappears once the baby is born. However, there is an increased risk of the development of Type 2 diabetes in following years.

As Type 2 diabetes is a lifestyle disorder associated with individual choices, it will be the primary focus of this article due to it being able to be prevented and treated with relatively simple interventions. Developing a good balanced and portioned diet like that of the CSRIO helps to reduce sugar intake and increase both soluble and insoluble fibre, while improving cardiovascular and general health. Due to the portion control and the increase of fibre into the diet, weight loss will generally occur as a by-product.

Additionally, completing regular moderate intensity exercise will also aid in weight loss and both aerobic and anaerobic fitness.

Neurological Impact
The nerves are the motor way of the body, responsible for delivering messages from inside and outside the body to the brain for processing. Unfortunately, the peripheral nerves (ending in the extremities like the toes) are most likely to be affected by diabetes. The damaging of nerves via diabetes can contribute to painful, numb or insensitive feet. This is of concern as injury to the foot can occur without an individual being aware and lead to continued ulceration. It should be mentioned that in many cases, nerve damage my display no signs or symptoms and go undetected for some time.
There are many practical implications due to peripheral neuropathy which affect individuals, most of which goes without consideration until it may be considered too late. These include your ability to drive (can’t drive if you can’t feel your feet), regular falls and restrictions on barefoot or uncovered footwear.

Vascular Impact

Diabetes can cause a reduction in blood supply to an individual’s feet as a result of poor circulation from the narrowing or hardening of arteries. This issue is further contributed to by increases in blood sugar levels, smoking and high blood fats (cholesterol).
The inability to supply blood to the legs and feet can lead to issues such as delayed healing, further complicating the presence of ulceration. A wound which is unable to heal in an efficient manner becomes susceptible to infection, necrosis (gangrene) and eventually amputation.
signs and symptoms of poor blood supply include; cold feet, discolouration of the skin, delayed healing, swelling around the ankles, reduction in hair/nail growth and painful calves during exercise.

Ulceration/Amputation
Diabetes is the leading cause of non-traumatic lower limb amputation in the world. Those who have suffered from lower limb ulceration or amputation have a lower quality of life than their non-diabetic counter parts.
Amputation is a major issue for individuals and creates great stress. Finding appropriate shoes becomes the least of their worries as they battle with pain, increased chances of further amputation, balance and a reduction in their independence.

The impact of diabetes on not only Australia but the World is undeniable. The Global costs of managing diabetes is astronomical and will not continue to be sustainable unless serious changes take place. But it cannot take place through a Government initiative, yes they can help, but changes need to occur at an individual and familial level. They need to occur through community participation and encouragement, not just the subsidisation of healthcare products or services for those who are not willing to aid their management of a chronic lifestyle disease.

Until Next Time

Jackson McCosker
Director/Chief Editor

 

References

Diabetes – Foot Care. (2016, July 31). Retrieved from Better Health Channel: http://www.betterhealth.vic.gov.au

(2012). Diabetes: The Silent Pandemic and Its Impact on Australia. Baulkham Hills: Novo Nordick Pharmaceuticals.

(2016). Global Report On Diabetes. Geneva: World Health Organization.

(2014). Prevent Diabetes Problems. Bethseda: National Institute of Diabetes and Digestive and Kidney Diseases.

Tennvall, G., & Apelqvist, J. (2000). Health – Related Quality of Life in Patients with Diabetes Mellitus and Foot Ulcers. Journal of Diabetes and Its Complications, 235 – 241.

Wallace, Q., Sullivan, K., Reiber, G., Hayes, S., LeMaster, J., Vath, C., & Smith, D. (2002). Incidence of Falls, Risk Factors for Falls and Fall Related Fractures in Individuals with Diabetes and a Prior Foot Ulcer. Diabetes Care, 1983 – 1986.

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