Diabetes is a chronic lifelong condition. If blood glucose is uncontrolled, the nerves and blood vessels that supply the feet will be damaged. This is called peripheral neuropathy. Optimizing glucose control can effectively prevent or delay the development of peripheral neuropathy in patients with type 1 diabetes and slow its progression in patients with type 2 diabetes.
The Diagnosis
All patients with type 1 diabetes for 5 or more years and all the patients with type 2 diabetes since diagnosis should be assessed annually for peripheral neuropathy.
Usually, the early symptoms include pain and the sensation of burning and tingling. If other kinds of large nerve fibers are involved, this may cause numbness and loss of sensation which is a risk factor for diabetic foot ulceration.
It is essential to do a foot screening and assessment to notice changes in the skin or any deformities. The entire foot should be examined including the heels, between toes and nails. During the exam, the feet may also be tested for numbness or changes in sensation with a fine plastic strand called monofilament. The circulation of the feet must be assessed by the presence of regular colour of the members, presence of regular hair patterns, and a strong pedal pulse by an additional exam called ankle – brachial index. Poor circulation (ischaemia), if seen in these tests, confirms the diagnosis of Peripheral Arterial Disease and it is often the cause of ulcers, gangrene and amputations.
The Treatment
A multidisciplinary approach is recommended for individuals with foot ulcers and high-risk feet to provide general self-care education to all patients. The use of specialized therapeutic footwear is recommended for high-risk patients with diabetes including those with severe neuropathy, foot deformities, calluses or history of amputation. In addition, pain can be severe, impacting the quality of life, limit mobility and contribute to depression and social isolation. Therefore, in addition to glycaemic control and lifestyle management, some therapies include pharmaceutical interventions to avoid complications.
The Prevention
Good control of diabetes, cholesterol, blood pressure and eliminating smoking will minimize the appearance of wounds that can lead to osteomyelitis and amputation.
Some advice on keeping the feet healthy include:
- Check your feet every day
- Wash and moisturise every day
- Tops of socks should not be elasticised
- Avoid walking barefoot
- Check your shoes to make sure that nothing sharp or stones have fallen in
- Wear proper fitting shoes
- Cut toenails properly
Early recognition and treatment of patients with Diabetic Neuropathy can delay or prevent adverse outcomes. The GluCare team is able to offer continuous diabetes treatment by having a multidisciplinary approach that supports the patient and identifies those who are at high risk of diabetes complication.
