Diabetes is a disease where the blood sugar is higher than normal. In the UK alone, 1.6 million people have been diagnosed with diabetes and it is thought that thousands more remain undiagnosed.
More than three-quarters of people with diabetes have what is called type 2 diabetes. This used to be known as non-insulin dependent diabetes (NIDDM) or maturity-onset diabetes.
The remainder have type 1 diabetes, which used to be known as insulin-dependent diabetes mellitus.
What's the difference?
- In type 1, the body is unable to produce any insulin. This usually starts in childhood or young adulthood. It's treated with diet control and insulin injections
- In type 2, not enough insulin is produced or the insulin that is made by the body doesn't work properly. This tends to affect people as they get older, and usually appears after the age of 40
All diabetics are advised to see a qualified podiatrist for a foot check at least once a year, regardless of how good their control.
How does diabetes affect my feet?
- An increase in blood sugar can affect the small blood vessels in the feet causing changes to the circulation and resulting in poor healing. Poor healing can be very serious and result in breakdown of the skin and the underlying tissue (ulceration) and in serious cases, gangrene
- The nerves are also affected by changes in blood sugar levels and can cause numbness, tingling and loss of sensation in the feet. A loss of sensation can mean that you will lose your ability to feel pain which will result in injuring yourself without realising
Both of these complications can have very serious consequences for the health of your feet.
What can I do to look after my feet?
- Good glucose control is known to reduce the risk of developing complications, which means keeping the blood sugar as close to normal as possible
- A basic foot care routine is essential (see Top tips for healthy feet), taking care to wash your feet daily, dry them properly and apply moisturising cream to prevent the skin from drying and cracking
- Don't cut toenails too short, if you are nervous of cutting the skin, file the nails with an emery board instead
- Additionally, diabetics should inspect their feet daily, especially if you know that your circulation and sensation are affected. If you have trouble reaching your feet to examine them properly, use a mirror or ask your partner or check them for you
- Look out for any unusual marks, cuts or bruises on the feet and always cover them with a plaster or dry dressing to prevent infection. Look for signs of inflammation and infection - redness, swelling, heat, discharge and see your podiatrist or GP immediately if the wound isn't healing or you are at all concerned
- Good footwear that fits properly can prevent many foot problems from developing (see Footwear guide) and it is essential to have your feet measured regularly
- Don't walk barefoot, even in your own home. If your sensation is even slightly reduced, you may injure the skin without realising
- Do not attempt to remove hard skin (see callus and corns) with scissors, blades or other sharp instruments and do not use corn plasters. They contain strong acids that can burn the skin. They should NEVER be used by a diabetic
- See a podiatrist regularly - even if you think there is nothing wrong with your feet, they should be checked at least once a year
What can a Podiatrist do?
Podiatrists are very experienced in dealing with diabetic feet and all diabetics should visit a podiatrist at least once a year, more often if you have known foot problems or a history of foot problems. A podiatrist will -
- Assess the blood supply to your feet by checking the foot pulses, and checking for discolouration and temperature changes to the skin
- Test the sensation in your feet and make you aware of the quality of sensation that you have
- Advise on how to look after your feet and what to look out for when checking your feet daily
- Check your footwear and advise on what shoes are best for you
- Check your skin for changes - dryness, cracking, callus and corns and treat accordingly
- Check your nails for changes - thickening, splitting or ingrown and treat accordingly
- Manage ulceration and skin breakdowns
- Assess foot alignment and identify areas of high pressure. Prescribe orthotics (shoe inserts) to correct the foot position and stretching exercises (see Biomechanics and orthotics)
- Liaise with other members of your diabetic team such as your GP, practice nurse, diabetic specialist doctor or nurse to ensure you are given the best possible care
For expert care and attention, go to find a podiatrist