Diabetes is becoming more and more common with a significant number of Bahamians currently living with the disease. A recent STEPS survey revealed that 6.6 percent of persons self-reported having diabetes; however some 23.9 percent of persons surveyed had raised fasting blood glucose. With the increasing numbers of obesity and poor lifestyle choices, the World Health Organization estimates that the prevalence of diabetes worldwide is projected to increase exponentially, and that death due to diabetes will double by 2030.
Uncontrolled diabetes can have detrimental effects on the feet and many other organs in the body including the heart, eyes and kidneys. High blood sugar levels can damage blood vessels and nerves causing decreased circulation to the leg and foot as well as loss of feeling in the feet. Diabetes can also cause the feet and toes to be deformed and change shape and it can make the skin become dry and cracked. These changes put all diabetics at high risk for foot complications, such as ulcers that take a long time to heal or never heal, leading to infections and amputations.
Diabetic foot complications are the most common cause of hospitalizations and deaths in persons with diabetes. All diabetics have a 25 percent chance of developing a foot ulcer in their lifetime. Most of the amputations performed worldwide are done on persons with diabetes -- and one is performed every 30 seconds.
Eighty five percent of these amputations are done on persons who had a foot ulcer or open sore that did not heal. Having an amputation (part of the foot or leg cut off) is a devastating life-changing event from which most people never recover because it increases the chance of more amputations and death. The International Diabetes Federation estimates that 45 to 85 percent of all amputations can be prevented.
Preventing ulcers and amputations is vital to ensuring that diabetics live a long, healthy life. While there is no cure for diabetes, there is hope. With proper diet, exercise, comprehensive medical care and careful self-management, people with diabetes can prevent complications and enjoy a full, active life with both feet intact. The keys to preventing amputations are regular routine foot examinations by a podiatrist and early recognition and treatment of all conditions that put the feet at risk for amputations.
Podiatrists are an integral part of the diabetes management team and are effective in preventing amputations. A recent study by the American Podiatric Medical Association showed that persons with diabetes who received care from a podiatrist had a nearly 30 percent lower risk of a lower leg/foot amputation and a 24 percent lower risk of hospitalization than those who did not see a podiatrist. The bottom line is that seeing a podiatrist saves limbs, lives and money.
The person with diabetes is indeed the central figure in preventing complications. He or she must ensure that glucose levels are well controlled to prevent developing complications. Do not smoke, because nicotine further decreases blood flow to the feet and toes which stops ulcers from healing.
These four strategies can help all diabetics prevent foot complications and amputations:
o Prevent injury to your feet: Never walk barefoot inside or outside. Avoid extremely hot or cold temperatures on your feet and do not soak your feet. Never use razor blades, scissors, pins or other sharp objects on your feet. Never try to remove calluses, corns, warts or ingrown toenails by yourself. Do not use over-the-counter corn removers as they can burn the skin and cause ulcers to the foot that may not heal.
o Wear proper footwear: Wear sensible, supportive, well-fitting shoes at all times. Wear the appropriate shoes for sporting activities. Have your feet measured and buy your new shoes in the afternoon when the feet are slightly swollen. Avoid thong sandals or flip flops, and wear a sandal that goes over the top of the foot instead. Persons with foot deformities (hammer toes, flat feet, bunions, etc.) will need to wear specially-made diabetic shoes that accommodate and better protect your feet, preventing ulcers and amputations.
o Preventive foot care: For good foot hygiene, wash your feet every day, dry them well, especially between your toes, and apply lotion or moisturizing cream. Inspect your feet and between the toes daily for cuts, bruises, sores, or any changes to the skin and nails on the toes or feet. Cut your nails straight across, avoiding the corners and smooth the sharp edges with an emery board file. Wear comfortable, seamless, light-colored socks.
o See a podiatrist to have your feet examined: All diabetics should routinely have their feet examined by a podiatrist at least once per year or more often if they have complications such as ulcers, deformities, loss of feeling or poor circulation. Diabetics should also see the podiatrist urgently if they have an injury or any sudden changes to the feet such as an open wound (ulcer), drainage or odor from the foot, swelling in the feet, changes in the color, shape or temperature of the feet (red, hot swollen), ingrown toe nails, fallen arches, corns and calluses or any other concerns.
If persons with diabetes follow these simple recommendations, they greatly increase their chance of preventing complications and preserving their feet for a lifetime.
o For more information email foothealth242@gmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820, or Lucayan Medical Centre on East Sunrise Highway, Freeport Grand Bahama, telephone 373-7400.
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