Diabetes in Canada
Research predicts that by 2017, 9 out of every 100 Canadians will have diabetes. It is one of the most significant threats to the health of people living in developed countries. Diabetes is a disease that will cripple our society, both physically and economically, if we don't take steps to improve the health of our citizens. Foot problems in diabetics are much more serious because they can lead to serious complications if not detected early enough and treated correctly.
Three main types of Diabetes
Type 1 diabetes
This usually affects children and adolescents. It occurs when the pancreas is unable to produce insulin which is a hormone that controls the amount of glucose (sugar) in the blood. Approximately 10 per cent of diabetics are type 1 diabetes.
Type 2 diabetes
This occurs in the remaining 90 per cent of diabetics. Type 2 diabetes occurs when the pancreas does not produce enough insulin or when the body does not effectively use the insulin that is produced. Type 2 diabetes usually develops in adults.
This is a temporary condition that occurs during pregnancy. It affects approximately 2 to 4 per cent of all pregnancies (in the non-Aboriginal population) and involves an increased risk of developing diabetes for both mother and child.
Is a condition where a person’s blood glucose levels are elevated but not high enough to be diagnosed as a type 2 diabetic.
Risk factors for developing diabetes
If you are aged 40 or older, you are at risk for type 2 diabetes and should be tested at least every three years. If any of the following risks factors apply, you should be tested earlier and/or more often.
- A member of a high-risk group (Aboriginal, Hispanic, Asian, South Asian or African descent)
- Overweight (especially if you carry most of your weight around your middle)
- A parent, brother or sister with diabetes
- Health complications that are associated with diabetes
- Given birth to a baby that weighed more than 4 kg (9 lb)
- Had gestational diabetes (diabetes during pregnancy)
- Impaired glucose tolerance or impaired fasting glucose
- High blood pressure
- High cholesterol or other fats in the blood
- Been diagnosed with polycystic ovary syndrome, acanthosis nigricans (darkened patches of skin), or schizophrenia
What are the signs and symptoms of diabetes?
Signs and symptoms of diabetes include the following:
- Unusual thirst
- Frequent urination
- Weight change (gain or loss)
- Extreme fatigue or lack of energy
- Blurred vision
- Frequent or recurring infections
- Cuts and bruises that are slow to heal
- Tingling or numbness in the hands or feet
It is important to recognize, however, that many people who have type 2 diabetes may display no symptoms.
Approximately 15% of all diabetics will develop a serious foot problem which can ultimately lead to the loss of a limb or death. The most common foot problems seen in diabetics are infection, ulceration, or gangrene which may potentially lead to the amputation of a toe, a foot or leg.
Most of these serious problems can be prevented through regular visits to a chiropodist or podiatrist, diabetic education, daily foot inspections, proper footwear and early recognition and treatment of any minor problems.
Diabetics can develop a range of foot problems. Even simple problems can become worse and lead to serious complications. Foot problems most often happen in diabetics who have nerve damage in the feet (neuropathy) or poor circulation.
What Causes Foot Problems in Diabetes?
Generally, the longer a person has diabetes the more at risk they are for developing complications from diabetes. Foot problems in diabetics are generally caused by neuropathy (decreased sensation), poor circulation, and a poor immune system causing a decreased resistance to infection.
Diabetes can damage the nerves in the feet and legs. This is a condition known as neuropathy. Neuropathy causes a loss or decrease in sensation or feeling in the feet and legs. This loss of feeling can cause you to not feel things such as scalding water in the bath, tightness of shoes or something as severe as a piece of glass or a nail in your foot. On the contrary, neuropathy can also be quite painful and can cause burning or sharp shooting pains in the feet and legs. Some diabetics have a combination of both painful neuropathy and complete loss of sensation or feeling in their feet. Neuropathy can also cause muscle weakness in the legs and feet as well as damage to the sweat glands resulting in very dry skin.
Diabetes can cause poor circulation or reduced blood flow to the feet and legs resulting in symptoms such as cramping in the legs, thigh or buttocks and temperature and colour changes as well as loss of hair and thick toenails. Poor circulation is a problem for diabetics since proper blood flow is necessary to help heal injuries, infection and ulcerations that can occur in diabetics.
Elevated blood glucose levels can interfere with the body’s ability to fight infection caused by bacteria that enter the skin from cuts, abrasions and wounds resulting in overwhelming foot infections. You can reduce your risk of infection by keeping your blood glucose under proper control.
Most people with diabetes can care for their own feet, however, diabetics with poor eyesight or neuropathy (loss of feeling) should be seen on a regular basis for an evaluation and foot care.
Guidelines for Diabetic Self Care
- Inspect your heels and the tops and bottoms of your feet every day. Look for sores, cuts, cracks between the toes and blisters. Make sure your feet feel warm and there are no hot, red or swollen spots.
- Use a mirror to see the bottom of the foot and heel.
- Wash daily with warm, soapy water and be sure to dry them well, especially between the toes.
- Do not soak your feet longer than 5 minutes as this tends to dry the skin. Always check the temperature of the water with your hand or elbow before putting your feet in the water.
- Do not use hot water bottles or heating pads. If you have poor sensation you could burn the skin on your feet.
- Use a moisturizing cream or lotion daily. Never put the cream between your toes or on open sores.
- Do not use acids or chemical corn removers.
- Trim your toenails straight across and file them to prevent sharp edges from cutting into adjacent toes. See a chiropodist or podiatrist regularly if you cannot trim them yourself especially if you have decreased sensation or poor eyesight.
- Never attempt to remove a corn, callus or ingrown toenail yourself. Always seek professional care
- Call your chiropodist or podiatrist right away if your foot becomes swollen, red or painful.
Diabetic Footwear Guidelines
- Check the bottom of your shoes before putting them on to make sure that nothing sharp such as a nail or a piece of glass has pierced the sole. Check inside your shoes with your hand to make sure that no small objects such as a stone have gotten inside.
- Never wear other people’s shoes. Always buy new shoes and make sure you have your feet measured and your new shoes fitted properly.
- Make sure your shoes are long enough, deep enough, and wide enough for your feet. If your shoes are too tight they may put too much pressure on your toes.
- When buying new shoes, always try on both shoes. Most people's feet are slightly different sizes.
- Do not ask someone else to buy your shoes. You should go to the shoe store to ensure you get a proper fit.
- Always wear new shoes around the house for short periods of time (15 minutes) and then check your feet for signs of redness caused by rubbing or pressure.
- Where possible the uppers (top) of your shoes should be made from a natural material such as soft leather. Leather tends to adapt to your feet over time without causing any pressure. Leather is breathable and will help to prevent your feet from sweating.
- Check your shoes for signs of wear. This includes rough edges in seams or linings, and worn soles or heels. Always wear shoes that are in good condition and replace them whenever there are signs of wear and tear.
- You should always change your socks or nylons every day. Diabetic socks are recommended as they have no seams around the toes and no elastic around the top of the sock
- Do not walk barefooted. Avoid wearing open-toed shoes or sandals until you have discussed this with your chiropodist or podiatrist. These might be alright for the beach or pool.
- Athletic shoes such as jogging shoes are usually a good choice as long as they are properly fitted. Your chiropodist or podiatrist may recommend shoes made for diabetics known as diabetic shoes or orthopedic shoes. They have a little extra width, depth and no seams inside the shoes. Diabetic shoes are recommended for diabetics who have loss of feeling in their feet or have unusually misshapen or wide feet. Also, diabetic insoles or custom foot orthotics may be prescribed for extra support or cushioning.