What is Diabetic Neuropathy?

In 2002, according to the National Institute of Diabetes and Digestive and Kidney Disease, approximately 65% of those living with Diabetes also had some degree of correlated neuropathy. In many cases it is the symptoms of neuropathy that lead to the diagnosis of diabetes, because these symptoms indicate to the patient that there may be a larger disease process occurring.

Neuropathy by definition is disease or dysfunction of one or more peripheral nerves that typically causes numbness, weakness, or both. It is thought that a combination of factors adds to the incidence of neuropathy in diabetic patients, but it is directly related to poor sugar control. Nerves are very sensitive to change and when blood sugars are high, the sugar molecules tend to glycosylate both the small blood vessels and the small nerves. This glycosylation compresses the nerve to some degree and results in the symptomatic representation of neuropathy.

Several categories of neuropathy affect the diabetic population, but the most common type is Peripheral Neuropathy. Peripheral Neuropathy is also known as distal symmetric neuropathy, meaning symptoms present first in the toes and fingers on both the right and left sides of the body. As the neuropathy progresses it continues along the foot and hand towards the arms and legs. The sensory changes are minimal and at first may go unnoticed, but as the neuropathy progresses symptoms become more discernable. The best was to prevent and control the progression of diabetic neuropathy is to keep your blood glucose levels within normal range, thus protecting your nerves from glycosylating.

Comprehensive foot examinations by your Podiatrist can help diagnose peripheral neuropathies in the early stages and it is important to remember that if you are experiencing any changes in sensation to your toes or feet, you see your doctor immediately. Your Podiatrist will look for changes in light and sharp touch, vibration, reflexes and your ulceration risk. All of these components can hold clues to an early diagnosis of peripheral neuropathy.

If you have already been diagnosed with neuropathy it is still very important to follow-up with your Podiatrist for routine care, but more importantly to be doing your part at home. You must check your feet on a daily basis for any open areas, especially between the toes and for any color changes that may indicate problems. The largest complication associated with having diabetic neuropathy is the patients inability to feel, thus injuries that would be painful in a non-diabetic go unnoticed in a diabetic and can lead to ulceration, infection, and loss of digits. If you notice something unusual or different from the previous day, contact your Podiatrist for an appointment.

5 Daily Steps to Decrease Your Risk of Diabetic Foot Complications

Prevention is by far the best option patients have in protecting themselves from diabetic foot complications. The nature of the disease predisposes patients to decreased neurovascular signs (decreased blood flow and decreased sensation) in the small vessels and nerves. Through daily management, many of the complications of Diabetes in the lower extremity can be prevented and/or minimized. So, what things can you do on a daily basis to decrease your diabetic foot complication risks?

1. Proper Nutrition and Exercise: Maintaining a healthy diet and exercise routine (30 minutes 3 times per week) not only makes you feel good, but also keeps your weight down, and ensures that you are taking in all the necessary nutrients. There are many vitamins in your healthy diet, including A, C and D, that will increase the integrity of your skin decreasing your chances of breakdown and increasing your chances of healing.
2. Checking your blood glucose levels at least once, if not twice daily: It is important to maintain your blood glucose levels within a healthy range to prevent complications of Diabetes. You want to ensure that your pre-meal glucose levels are between 90-130 mg/dl and your post-meal glucose levels are less than 180 mg/dl.
3. Take your medications as directed: Medications prescribed by your doctors are important in controlling your co-morbidities, which may have a tendency to increase your diabetic complication risks. By maintaining your cholesterol, blood pressure, and glucose levels through prescription medications, diet and exercise, you can decrease your risk of ulceration and future complications related to Diabetes.
4. Daily examinations of your feet: You are your best resource for catching early signs of skin breakdown, ulceration, and infection. The earlier you detect areas of concern and make an appointment with your Podiatrist, the faster you will receive treatment and the less likely you are to have an increased risk of associated complications. Make sure you are never walking around the house without supportive shoes, you are washing all areas of your feet, including in between your toes, and drying those same areas thoroughly. Do not soak your feet in warm or hot baths, as this increases the chance that bacterial will grown on your feet and in between your toes, leading to future complications. Do not attempt to perform "bathroom surgery" for trimming of corns, calluses or nails. Leave the trimming and nail care to your Podiatrist.
5. Quit smoking: Smoking has a tendency to increase your heart rate and your blood pressure, while decreasing the amount of oxygen traveling with your blood cells to your extremities. The decreased flow of oxygen to your extremities decreases healing and increases your risk of complications should an ulceration arise.

Be sure to follow-up with your Primary Care Physician every 3 to 6 months for monitoring of blood glucose levels, HbA1c levels, and of your cholesterol and blood pressure. Make sure you check in with your Podiatrists every 6 months, or every year if you are a low-risk Diabetic patient, for prevention and management of any complications that may present in the lower extremity.