It’s a statement we hear all too often as podiatrists when a patient presents with a history of diabetes:
“My GP told me that I have diabetes and that I need to start seeing a podiatrist, but I don’t understand why”.
It is estimated that approximately 5% of the Australian population has been diagnosed with either Type 1 or Type 2 diabetes, and unfortunately that number seems to be rising.
Diabetes is associated with other diseases such as cardiovascular disease and has a number of risk factors including genetics, diet, a sedentary lifestyle and many more.
- Diabetes affects the feet due to increased sugar levels in the blood, which can impact blood flow and nerves in the extremities.
- People with diabetes can be categorized into Type 1 (absent or decreased insulin production), Type 2 (lack of insulin but not completely absent), and gestational diabetes (develops during pregnancy).
- Reduced blood flow to the feet can lead to various foot problems, such as ulcers, slow healing, and increased risk of infections.
- Nerve damage caused by diabetes can result in decreased sensation in the feet, leading to a lack of awareness of skin lesions and injuries.
- Podiatrists play a crucial role in managing foot health for individuals with diabetes, offering comprehensive assessments, treatment of foot conditions, and prioritising foot care to maintain overall well-being. Regular foot health checks are recommended for diabetic patients.
Insulin is a hormone produced by the beta cells in the pancreas that is responsible for helping transport the glucose (sugar) in our bloodstream to our body cells to be used as energy after we’ve eaten.
When there is an absent or decreased production of insulin, the amount of glucose in our blood rises and therefore results in diabetes.
Types of Diabetes
People with diabetes are usually either split into Type 1 or Type 2, however Gestational diabetes can arise during pregnancy:
Type 1: Insulin production is absent or extremely decreased.
There is damage to the beta cells in the pancreas that are responsible for insulin production due to a number of factors.
Insulin replacement therapy is needed in order to make up for the lack of insulin produced.
Type 2: There is a lack of insulin, but it is not completely absent.
This type of diabetes is more common than type 1, and is usually associated with genetics (an immediate family member also has diabetes).
People can have insulin therapy, however it is not always needed as it can often be controlled with diet changes and monitoring.
Gestational diabetes: affects pregnant women and presents similarly to Type 2.
It can remain after pregnancy but usually disappears when the baby is born.
It occurs due to the hormones produced by the placenta to allow the baby to grow and develop, which inhibits the action of insulin in the body to combat high sugar levels in the blood.
Women who suffer from gestational diabetes are then at an increased risk of developing Type 2 diabetes later in life.
Some women will require medication or insulin injections, however management often involves diet modification and participation in physical activity.
Your Feet & Diabetes
As podiatrists, we are concerned with maintaining your foot health if you have any form of diabetes.
When there is an increased amount of sugar in the blood, it can affect both your blood flow and your nerves.
Your feet are the furthest body part away from both your heart and your brain, meaning that they are the first to change.
The blood vessels:
The body relies on a complex web of blood vessels to transport blood to and from the heart. There are 2 vessels that are responsible for this, the arteries and the veins.
The arteries transport the blood from your heart to the rest of the body, and the veins transport blood back to the heart.
Arteries are a hollow tube which expand and contract with every heartbeat.
As discussed earlier, there is an increased amount of sugar in the blood in people with diabetes.
These glucose molecules can attach to the walls of the arteries and cause what we call atherosclerosis.
This results in narrowing of the artery walls and a reduction in their ability to expand and contract, meaning that the amount of blood being sent through those arteries to the rest of the body decreases.
Your feet are the furthest away from your heart, meaning that the arteries to your feet are the longest in your body.
Your skin, nails, hair and your ability to heal from trauma all require adequate blood flow.
A reduced blood flow becomes a problem particularly when you injure your feet, as your healing ability will also be reduced, which in some cases can cause ulceration.
Nerves are responsible for a lot of bodily functions, including movements, sensations and even your blood pressure and heart rate.
Diabetes can affect all of these nerves, however the one we concentrate on most in the feet are the sensory nerves which allow us to feel touch, temperature and vibration.
The nerve cells are surrounded by a type of insulation called a myelin sheath to protect the nerve fibres.
In patients with diabetes, these ‘insulating’ cells will absorb more sugar than they are used to.
When a diabetic patient constantly has high blood glucose readings, the ‘insulation’ becomes damaged which exposes the nerve fibres, causing them to be desensitised.
The nerves lose their ability to transmit signals efficiently, therefore resulting in decreased sensation.
If sensation is lost in the feet, patients may not be able to feel lesions on their skin including blisters, corns, callus and warts and may not seek proper treatment.
These lesions can lead to breakdown in the skin integrity, and when coupled with poor blood flow, can lead to ulceration.
Other parts of the body that can be affected by diabetes include the eyes and the kidneys.
Therefore it is important that these are regularly checked by the appropriate health professionals as well.
How Can We help?
For diabetic patients, we can conduct a comprehensive assessment of the diabetic foot and address any potential or current problems.
The aim of our treatment is to keep your feet happy, healthy and functioning properly to allow you to go from day to day as smoothly as possible. Your feet are our priority!
If you or someone you know suffers from diabetes, make an appointment for a foot health check by calling 9432 2689, or book online.