- by Dr Mamata S.H.
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- Apr 01 2017
Panic about Diabetes and its related complications-Why
Once you are diagnosed to have diabetes first thing that comes to mind is what is this? How and why did I get this? Can I take the medicine for someday, stop and see. The great blunder you are doing by stopping the treatment and worst part not to follow it up regularly. Oh what if I have to be on Insulin- get pricked daily? My that friend has lost the leg, my relative has lost the eyes, another lost his kidney functioning for which he is on dialysis. So many things strike our mind-these things matter a lot psychologically. Yes you need not have to be worried about Diabetes which is a nightmare if left untreated or if ignored. Diabetes itself will not cause any symptoms as such, until and unless one is aware and conscious about the variation noticed in the daily habits like drinking more water, eating more than u usually eat, frequent urination, loss of weight ,excess sweating etc.
Many a times the patients present to us with the related complications. Diabetes does not spare any part/organ of the body if not taken care and not treated promptly. Here I would like to precisely notify about the vascular and foot related problems that can be anticipated. Let me tell again the progress varies individually; every person’s body response is different.
Some complications of ignored diabetes treatment related to foot will be highlighted in this post. The important complications of diabetes affecting the leg (mainly foot) are:
3) Vasculopathy ( involving the small vessels of the foot)
5) Increased plantar foot pressure leading to ulceration(wound in the foot)
Neuropathy - affecting the nerves which help in sensation / movements ( polyneuropathy - affecting all the three i.e. sensory, motor, autonomic).
The incidence of clinical and subclinical neuropathy is about 37% or even more. Here there is loss of sensation due to progressive damage of the nerves that occurs in persistently elevated sugar levels. Presentations vary with severity
1) Pain (usually burning )
2) Parasthesia (varied sensation)
3) Muscle atrophy
4) Relief of symptoms –pain free state signifies further nerve damage
1) Weakness / atrophy of the muscles of the foot ( loss of shape of the foot)
2) Varied unequal pressure distribution ( shoes maladaption)
3) Keratosis and callous formation (overgrowth of the skin)
4) Ulcer formation below the callous (pressure being 20 times higher at this site)
A corn is thickened skin on the top or side of a toe. A callus is thickened skin on your hands or the soles of your feet. Calluses and corns are caused by repeated pressure or friction on an area of skin. The pressure causes the skin to die and form a hard, protective surface. A soft corn is formed in the same way, except that when sweat is trapped where the corn develops, the hard core softens. This generally occurs between toes.
1) Dry skin usually with cracked feet (dysfunction of the nerves supplying sweat glands which help in keeping feet moist)
2) Decreased blood flow at the wound site.
Increase frequency of bone fracture due to loss of calcium as a result of shunting of the blood through A-V shunts. Needs special mention about the foot deformity commonly seen–Charcot’s foot
Nails become hypertrophied with ulceration at the base ( subungual)
Deep calf pains at night might be extremely severe.
Pain in a painless ulcer is not a good sign –indicates infection/ impaired vascularity.
Bit about peripheral vascular disease.
In diabetes the impact is usually on the arteries below the trifurcation i.e. below the knee vessels.
Atherosclerosis can affect any part of the arterial system.
The term gangrene (blackish discoloration of the toe/toes or any part of the foot or leg)-means the dead part of the body which has to be sacrificed judiciously after evaluation and assessment of the vascularity. All the gangrene presentation do not end up with major amputation –it could be localized to a single /more toes which could be because of the local infection, atheroembolism , etc. In case of extensive infection / vascular compromise /neglected and delayed presentation major amputation of the leg (below or above the knee) becomes mandatory to save the life.
The gangrene with arterial compromise – Priority is to improve the blood flow by arterial reconstruction (either bypass or angioplasty/stent) then tackle the gangrene until and unless it’s infected. In case of infection, priority is to remove the infection (removal of gangrenous toe or toes/ cleaning up of the infection with or without the gangrene anywhere in the foot).
So the message is
- Keep checking your sugar levels and get evaluated for diabetes by your physician (if not a diabetic).
- Meet your diabetologist /physician for prompt control of sugar levels (if you are a diabetic).
- Long standing diabetics routinely check your feet and maintain hygiene.
- Never walk bare foot to avoid injuries, especially in severe neuropathy where in the sensation of prick/injury is lost.
- Never apply corn caps /or any creams to foot/leg which might act as an irritant.
- Visit the podiatrician (foot clinic) regularly to get examined thoroughly for the neuropathy status /bony deformity and also for a better supportive treatment.
- Never neglect a wound of the foot –it might be a source of infection and spread to the whole foot or the leg.
- Never neglect a wound which is not healing with regular treatment. Please seek vascular surgeon consultation. Limb is salvageable may not be 100% but definitely with appreciable results. If treated promptly at a right time the morbidity/mortality related to the vascular compromise is definitely creditable.As such any of the medical ailments cannot be assured with 100% recovery- If any such assurance is given God should pardon them. We are the mediator to give comfort to the patient with whatever knowledge we have attained.
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