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.

What is HbA1c?

In the blood stream are the red blood cells, which are made of a chemical, haemoglobin. Sugar sticks to the haemoglobin to make a "glycosylated haemoglobin", called haemoglobin A1C or HbA1C. The more sugar in the blood, the more haemoglobin A1C or HbA1C will be present in the blood.

Red cells live for 8 -12 weeks before they are replaced. By measuring the HbA1C it can tell you how high your blood sugar has been on average over the last 8-12 weeks. A normal non-diabetic HbA1C is 3.5-5.5% (this varies between hospitals). In diabetes 4-6% is acceptable.

The HbA1C test is currently one of the best ways to check diabetes is under control; it is the blood test that gets sent to the laboratory, and it is done on the spot in some hospital clinics. Remember, the HbA1C is not the same as the sugar level.

Coincidentally the sugar/HbA1C numbers for good control are rather similar though: sugar levels 5.5-6.5 mmols/l half an hour before meals versus 7% HbA1C.

Diabetic Emergencies

A diabetic emergency occurs when there is a severe imbalance between the amount of insulin and sugar in the body.

Two conditions may result in a diabetic emergency:

  1. Not enough insulin, causing a high level of sugar or hyperglycemia. This could lead to diabetic coma.
    This may be caused by:
    • not taking enough insulin
    • eating too much food
    • doing less exercise than usual
  2. Too much insulin, causing a low level of sugar or hypoglycemia. This may lead to insulin shock.
    This may be caused by:
    • taking too much insulin
    • not eating enough food or vomiting
    • doing more exercise than usual

How to recognize a diabetic emergency

A conscious casualty with diabetes might be able to tell you what is wrong. However, keep in mind that the person may be confused.

An unconscious casualty may be wearing a medical alert bracelet or necklace that will tell you that he/she has diabetes.

If the casualty cannot tell you what he/she needs, look for the following signs & symptoms:

Sign/Symptom Insulin Shock (needs sugar) Diabetic Coma (needs insulin)
Pulse Strong and Rapid Weak and Rapid
Breathing Shallow Deep and Sighing
Skin Pale and Sweating Flushed, Dry and Warm
Breath Odor Odourless Like Musty Apple or Nail Polish
LOC Faintness to Unconsciousness Developing Quickly Gradual Onset of Unconsciousness
Other signs & Symptoms Headache, Trembling, Hunger Unsteady Walk, Nausea

First Aid for a diabetic emergency

The first aid for insulin shock and diabetic coma is the same:

  1. Begin scene survey
    • If the casualty is unresponsive, get medical help immediately.
    • Do a primary survey and give first aid for life-threatening conditions.
    • Place the unconscious person into the recovery position and monitor the ABC's until medical help can take over:
      Airway to ensure a clear airway
      Breathing- to ensure effective breathing
      Circulation- to ensure effective circulation)
    • Look for a medical alert device that will give you more information about the casualty's condition.
  2. If the casualty is conscious and knows what is wrong:
    • Assist him/her to take what is needed - sugar or her prescribed medication
  3. If the casualty is confused about what is required:
    • Give him/her something to eat or drink and get medical help.

All About Diabetes

It is estimated that 20-25% of Americans who have diabetes will suffer from foot problems. People with diabetes will usually have very poor blood circulation, dry heels, leg pain, open sores on the feet, develop neuropathy (damaged nerves causing a loss of sensation), or see changes in their skin color. It is very critical that you see a podiatrist as soon as you are diagnosed with diabetes so that he or she can do a complete evaluation.

What you can do to prevent Diabetic Foot Problems?

The following is a list of just a few things that you can do to reduce your risk:

  • Become educated on diabetic foot care
  • Wash and dry feet thoroughly
  • Inspect your feet daily (or have someone else do it for you)
  • Wear properly fitting shoes
  • Cut toenails straight across
  • Visit your podiatrist regularly

The number of Americans with diabetes has increased 50 percent in the last 10 years to about 17 million. At least 16 million more Americans have an increased risk of getting type 2 diabetes, but they can delay or prevent its onset by losing some weight from diet and exercise.

Proven research shows that brisk walking for 30 minutes a day, five days a week, could cut the chance of developing diabetes in half among people at increased risk.

Download White Paper [PDF - 21k]

Symptoms of Low Blood Glucose (Sugar) Levels

A low blood glucose level can occur when your blood glucose drops below a certain level (usually less than 4 mmol/L).

This may be caused by:

  • Not eating enough food
  • Missing or delaying a meal
  • Exercising without taking the necessary precautions
  • Taking too much insulin
  • Drinking alcohol.

Low blood glucose can happen quickly, so it is important to take care of it right away.

When you have signs of a low blood glucose level

Note the symptoms you are experiencing, this will help you to identify low blood sugar in the future.

You may feel:

  • Sudden severe hunger
  • Shaky or light-headed
  • Nervous or irritable
  • Sweaty
  • Weak
  • Your heart beats at a faster rate
  • Confused
  • A numbness or tingling in your tongue or lips.
  • Headache
  • Unusually sleepy
  • Mood changes or swings
  • Sudden anxiety and even unconsciousness or coma or seizures in extreme cases

IMPORTANT NOTE

Some people do not have early warning signs of hypoglycemia. People like this must check their blood sugar levels more often to avoid this condition. It is of utmost importance for all persons with diabetes to check their blood sugar levels before driving a motor vehicle.

How to treat low blood glucose

Check your blood glucose. If you do not have your meter with you treat the symptoms anyway.
It is better to be safe. Eat or drink a form of sugar such as:

  • 3 B-D Glucose Tablets or 5 Dextrose Tablets
  • 6 Life Savers TM
  • 3/4 cup (175mL) of juice or regular pop
  • 1 tablespoon (15mL) of honey.

Wait 10 to 15 minutes, then test your blood glucose again.

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