Diabetic Feet: Health Issues, Treatments, and Prevention

From verywellhealth.com

Diabetes is a condition in which the body is unable to break down glucose (sugar) effectively. When glucose accumulates in the blood for an extended amount of time, it can damage nerves and blood vessels. As a result, various body parts and organs are impacted. People with diabetes are at increased risk of having problems with their feet.

Learn more about how diabetes affects the feet, common problems, signs, symptoms, prevention, and treatment. 

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How Can Diabetes Affect the Feet?

Prolonged high blood sugar (hyperglycaemia) can impair nerves and damage blood vessels. High blood sugar can disrupt the nerves' ability to transmit signals and can cause chemical damages. Sugar accumulation in the blood can also cause damage to the blood vessels that carry oxygen and nutrients to the nerves.

Chronically high blood sugars can increase the risk for peripheral neuropathy, which is nerve damage in the feet, legs, hands, and arms. This is the most common type of neuropathy. It affects about one-third to one-half of people with diabetes.

Diabetic Neuropathy

People who have had diabetes for a long time are at increased risk of developing neuropathy. Elevated blood glucose, age, smoking, comorbidities (coexisting health conditions), metabolic factors, and genetics also can increase the risk. There are different types of neuropathy, but the one that affects the feet is called peripheral neuropathy.

Diabetic peripheral neuropathy can increase the risk of foot complications by damaging nerves and blood vessels. Burning and tingling are common symptoms that occur when small nerves have been impacted. Loss of protective sensation (LOPS) occurs when large nerve fibres have been damaged. This can increase the risk of foot ulcers.

Many people who have neuropathy do not have symptoms, so the American Diabetes Association recommends that patients get an assessment when they are first diagnosed with type 2 diabetes and five years after being diagnosed with type 1 diabetes, and then every year afterward. However, if you have a history of neuropathy or a previous ulcer, you should have your feet examined at every healthcare provider visit.

There are various types of medications to treat the symptoms of diabetic neuropathy. In addition, smoking cessation, changing eating habits, weight loss (if indicated), and glycaemic control are important factors that can improve symptoms of neuropathy as well as reduce the progression. Unfortunately, for some people neuropathy can be permanent.

Therapeutic footwear is recommended for those who have severe neuropathy, foot deformities, ulcers, callus formation, poor peripheral circulation, or a history of amputation. Most insurance policies cover therapeutic footwear.

Gangrene

Gangrene is a necrosis (tissue death) of the skin that occurs when there is a disruption of blood flow to an area in the body. This can occur because of an injury or an infection. People with diabetes who have neuropathy, or a history of foot ulcers, are at an increased risk of developing gangrene.

The presence of gangrene warrants an immediate referral to see a specialist, such as a vascular surgeon, an interventional cardiologist, or a radiologist for evaluation and treatment.

Gangrene treatment in people with diabetes should take place right away to prevent the risk of amputation. Treatment will take a variety of forms. Debridement (surgery to remove damaged tissue) for the wound is important. Treating the infection and improving circulation to increase blood supply will also assist the healing process. Hyperbaric oxygen therapy might also be recommended.

Peripheral Vascular Disease

Peripheral vascular disease (PVD) is a term that is often used interchangeably with peripheral artery disease (PAD). Periphery refers to the vessels outside of the heart. PAD occurs when veins and arteries get clogged with fatty deposits (atherosclerosis).  In lower extremity PAD, arteries in the legs become clogged, which reduces blood flow and sensation to the legs and feet.

PAD is estimated to be present in as many as 50%–60% of patients with diabetic foot ulcers. Symptoms of PAD include:

• Dry skin
• Skin discoloration
• Poor nail growth
• Leg or foot wounds that are slow to heal
• Foot ulcers
• Pain or cramping in the legs (that starts when walking and stops at rest)

Treatment for PAD includes lifestyle modifications, such as smoking cessation, exercise, and a heart-healthy eating plan. Prescription medications aimed to prevent blood clots, reduce blood pressure, and improve cholesterol are also available. In addition, getting blood sugars in good control can also improve PAD.

When these interventions are not enough, a vascular doctor may suggest certain procedures. In severe cases, angioplasty, stents, or bypass is recommended to improve blood flow.

Charcot Foot

Charcot foot is a deformity that occurs when there is a weakening in the bones because of neuropathy. Sensory, motor, or autonomic neuropathy, trauma, and metabolic abnormalities all contribute to Charcot foot. Neuropathy can cause a decrease in sensation in the joints and the weakening of bones can result in fractures.

Repeated walking on the foot, worsens the condition, ultimately changing the shape of the foot. Charcot foot increases the risk of wounds and foot ulcers. This is a very serious condition that can result in amputation if not identified and treated.

Treatment of Charcot foot is complicated and includes a multidisciplinary team that specializes in diabetes. Treatment varies depending on many factors, including the phase of the disease process, location, severity of the disease, presence or absence of infection, and other comorbidities. Plans vary and can include basic shoe modification, treatment of infection, and limb amputation (removal).

Common Diabetic Foot Problems

People with diabetes are at increased risk of foot problems due to neuropathy or reduced blood flow. Some common types of foot conditions are:

• Athlete's foot: People with diabetes are at an increased risk of athlete's foot (tinea pedis), the most common fungal condition. People with diabetes who have autonomic neuropathy may have excess sweating, which can increase the risk of fungal growth.
• Blisters: Diabetic blisters (bullosis diabeticorum) can occur on the feet, legs, and backs of hands. Typically, they are a consequence of hyperglycaemia and will heal on their own when blood sugars return to normal levels. 
• Bunions: Bunions cause your big toe to lean toward your second toe and can cause the bone leading to the big toe to stick out. Bunions are typically the result of poorly fitting shoes.
• Calluses: Autonomic neuropathy can also decrease sweating, resulting in dry feet, which can increase callus formation. Calluses that are not taken care of increase the risk of foot ulcers.
• Corns: Corns are rough spots caused by too much rubbing or pressure on the same spot. These typically occur when a person with diabetes has neuropathy and is wearing ill-fitting shoes.
• Dry skin: Dry skin can be a result of hyperglycaemia. High blood sugar increases urination as a way to rid the body of excess glucose. Increased urination may lead to dehydration and dry the skin. This can also occur because of poor circulation, making dry skin itchy.
• Diabetic foot ulcers: A foot ulcer is an open sore in which partial skin is lost in a person who has diabetes. In addition, people with diabetes who have neuropathy and PAD are at increased risk of foot ulcers.
• Fungal infection of nails: Fungal infections can occur between the toes and also around the nail beds. People with diabetes are at increased risk of fungal infections due to decreased immunity and disruptions in sweat glands.
• Hammertoes: This foot deformity can be a result of muscle loss and neuropathy. They can be painful and can increase the risk of foot ulcers, especially if a person with diabetes is not wearing proper shoes.
• Ingrown toenails: Ingrown toenails often occur when toenails are not cut properly.
• Plantar warts: These skin-coloured warts on the bottom of the feet are more common in people with diabetes. Although aesthetically displeasing, typically they are not harmful.

Signs of Problems With Diabetic Feet

People with diabetes may not know that they are experiencing neuropathy. Up to 50% of diabetic peripheral neuropathy may be asymptomatic.

However, the most common symptoms of peripheral neuropathy include:

• Numbness
• Tingling
• Pain
• Burning/Stinging
• Foot weakness
• Loss of feeling
• Inability to feel hot and cold
• Changes to the shape of feet or toes

If you see any changes in your feet or have any physical symptoms, you should be examined by your healthcare provider. Early detection and treatment can prevent complications, such as injuries and ulcers.

Preventing Diabetic Foot Problems

It is possible to prevent diabetic foot problems by having your feet examined regularly. Proper hygiene and foot care, as well as understanding your risks, can assist you in having healthy feet.

Achieving good glycaemic control (maintaining healthy blood glucose levels) is a daily process that can be burdensome. If you are having difficulty getting your blood sugars in a healthy range, contact your healthcare team. They can help you simplify your diabetes regimen and provide you with treatment options that suit your needs.

People with a history of ulcers, neuropathy, or PAD, would benefit from a foot exam at every healthcare provider visit.

Diabetic Foot Care Tips

Understanding how to care for your feet is an important part of diabetes management. Adequate care can prevent, detect, and treat abnormalities as soon as they appear. It is always a good idea to check your feet daily in a mirror. Inspect between your toes and on the soles of your feet. Other self-care tips include:

• Wash your feet daily with warm, not hot, water.
• Do not soak your feet.
• Dry your feet well and moisturize, but do not apply lotion between your toes (this can increase the risk of fungus).
• Keep your toenails trim.
• Change your socks daily and wear moisture-wicking, cotton socks.
• Before putting on your shoes, shake them out well to remove objects that can cause injury.
• Do not walk around barefoot.
• Wear shoes that fit properly and do not cause rubbing.
• Avoid smoking.
• If you notice any new issues, contact your medical team.
  

Summary

Having a history of high blood sugar, neuropathy, and reduced circulation can increase your risk of a variety of foot conditions, some which are more severe than others. Making lifestyle changes, such as eating a heart-healthy diet, exercising, and quitting smoking can help prevent or slow down the progression of any foot issues. Understanding what types of things to look out for as well as important self-care habits can improve the health of your feet.

If you notice a change in the physical appearance or feeling in your feet, contact your medical team. You are not alone in your journey with diabetes. And there are many interventions that can improve your quality of life.

https://www.verywellhealth.com/diabetic-feet-5216003

Diabetes and the night-day cycle: What's the link?

From medicalnewstoday.com

• Researchers recently investigated how night-day variations in light intensity affected metabolism in people with insulin resistance.
• Metabolism was lower during sleep in those exposed to dim light during the day and bright light in the evening.
• The timing and intensity of light that humans experience daily has subtle effects on glucose and fat metabolism that can contribute to obesity and metabolic diseases.

More than 1 in 3Trusted Source adults in the United States may have prediabetes, according to the National Institutes of Health.

Insulin resistance is a disorder of metabolism that precedes prediabetes. If left unchecked, prediabetes can develop into type 2 diabetes. 

Recently, a team of researchers theorized that societal changes such as increased exposure to artificial light might be one factor linked to the global rise in people with insulin resistance.

As reported in the journal Diabetologia, Prof. Patrick Schrauwen, Jan-Frieder Harmsen and their colleagues tested their hypothesis by studying individuals who already had insulin resistance.

Insulin resistance occurs when cells do not respond to insulin as efficiently, reducing their ability to take in glucose from the blood.

With painstaking measurements, the researchers were able to determine if varied light exposures altered human metabolism.

usted SourceInsulin resistance occurs when cells do not respond to insulin as efficiently, reducing their ability to take in glucose from the blood.

What is insulin resistance?

Carbohydrates are complex sugar molecules that people consume through their diet. The body converts these into “simple” sugars in our blood, namely, glucose.

Insulin is a hormone that helps bring glucose from the blood into cells. The cells then convert glucose into an energy-storing molecule called ATP.

If cells are resistant to insulin, glucose remains in the bloodstream, causing a condition called hyperglycaemia — elevated blood glucose. Doctors consider this a precursor to developing type 2 diabetes.

Individuals who develop insulin resistance may:

• consume high calorie diets that are high in fats and sugars and low in fibre
• have an accumulation of centralised body fat
• have a genetic predisposition to insulin resistance
• have obesity or be physically inactive 

Scientists suggest that there has been a rise in insulin resistance concurrent with the advent of the industrial revolution fostering a less nutritious diet and decreased physical activity. Insulin resistance is a known risk factor for type 2 diabetes, high blood pressure, and heart disease. 

In the recent study, volunteers tested positively for any one of four common parameters that determine insulin resistance, such as an inability to normalize their blood glucose after consuming a sugar-laden drink.

‘Cue the lights’

The scientists based their new research on prior work that confirmed that light is a "zeitgeber," an important environmental cue that controls the body’s circadian rhythms.

Light cues humans via a specialized brain structure called the suprachiasmatic nucleus, located in the pineal gland. 

Dr. Victoria Salem, a senior clinical lecturer in bioengineering and an honorary consultant in diabetes, endocrinology, and internal medicine at Imperial College London, explained to Medical News Today:

“We all have natural body clocks. For example, babies often wake up earlier in the summer months when sunlight pours into the room. Light hitting the back of our eyes is sensed by the brain and our ‘master clock,’ which then sends signals via the nervous system or hormones to other parts of the body, such as the liver or muscle, to regulate digestion and the way we use fuel.”

“For example, the body becomes ‘primed’ in the morning to consume and metabolize the first meal after a long time without food. […] Related to this body clock is the release of the hormone melatonin. The production and release of melatonin are connected to the time of day — increasing when it’s dark and decreasing when it’s light.”

Specifically, the authors of the new study focused on how cycling bright and dim light affected people by measuring:

• frequent blood glucose levels
• insulin levels
• levels of melatonin, a hormone produced by the body to promote healthy sleep
• fats in the blood known as triglycerides
• daily energy expenditure
• sleeping metabolic rate

Life in a metabolic bubble

The researchers were able to make these measurements by asking volunteers to stay overnight, twice, in a respiration chamber while wearing an activity monitoring watch.

The special chamber allowed scientists to measure the amount of oxygen consumed and carbon monoxide produced, giving an accurate measure of the study participants’ metabolic rate.

The participants all ate similar meals and performed similar physical activities.

Next, the researchers exposed 14 participants to two variations of daylight and evening: 10 hours of bright light followed by 5 hours of dim light in the evening — a “normal” human day — or 10 hours of dim light during the daytime and 5 hours of bright light before sleep.

What they found

In these carefully controlled circumstances, the scientists discovered several interesting results:

• Melatonin release was significantly supressed in the dim day-bright evening scenario.
• Those who spent the day in bright light had lower glucose levels before dinner and higher metabolic rates at night.
• Metabolism slowed after dinner in individuals in the dim day-bright evening scenario.
• In people who spent the day in bright light with a dim night, melatonin levels were increased at night, which is helpful for inducing sleep.

The researchers concluded that the timing of light exposure can influence the body’s handling of glucose and fats, energy use and expenditure, and even temperature regulation in insulin-resistant individuals.

Natural Iight cycles are important to metabolism

Dr. Victoria Salem summarized the findings for MNT:

“The more natural light conditions were associated with subtle improvements in certain metabolic parameters. [M]ost interestingly, it aided a higher metabolic rate at night — good for burning calories!”

“This was associated with normal melatonin release compared to its inhibition with bright evening light,” Dr. Salem continued.

“The effect described here is probably small, but nonetheless important, since a holistic approach to improving well-being — which includes, amongst other things, healthy lighting, keeping the room cool at night, and good sleep hygiene — is rather good advice.”

The authors of the study recommend further research in two realms: more investigation into how light exposure affects energy expenditure and studies into how thoughtful lighting control in the home and office settings may improve health outcomes.

MNT asked Dr. Victoria Salem if any research supports the theory that sleeping better or natural light patterns can reduce metabolic disruptions. She replied:

“Yes, but not high quality [randomized controlled trials], and since the effect size is small it is going to be difficult to prove clinically. Having said that, I do believe that this study is telling us something important — that as part of a holistic approach to good metabolic health and general well-being, encouraging good sleep and evenings where we wind down and reduce bright screen time is a very good idea.”

https://www.medicalnewstoday.com/articles/mimicking-natural-light-cycles-may-influence-diabetes-risk

 

If You Notice This in Your Fingers, Get Checked for Diabetes

From bestlifeonline.com

You'RE far MORE LIKELY TO DEVELOP THIS HAND SYMPTOM IF DIABETES IS TO BLAME 

The connection between diabetes and foot health has been well established and broadly publicized by health outreach organizations, but fewer people are aware of the link between diabetes and your hands. Experts say that while these symptoms are less universally known, they can cause major disruptions in the lives of those already dealing with blood sugar imbalance. In particular, there's one symptom that causes cramping, pain, and an inability to grip—and you're far more likely to develop it if you've also got diabetes. Read on to find out which surprising problem in the fingers may signal a problem with your glucose levels, and what you can do about it.

Shutterstock

The connection between diabetes and foot health has been well established and broadly publicized by health outreach organizations, but fewer people are aware of the link between diabetes and your hands. Experts say that while these symptoms are less universally known, they can cause major disruptions in the lives of those already dealing with blood sugar imbalance. In particular, there's one symptom that causes cramping, pain, and an inability to grip—and you're far more likely to develop it if you've also got diabetes. Read on to find out which surprising problem in the fingers may signal a problem with your glucose levels, and what you can do about it.

If you develop "trigger finger," get checked for diabetes.

Shutterstock

Trigger finger (TF), also known as stenosing tenosynovitis, occurs when the flexor tendon in the hand is obstructed due to inflammation in the tendon sheath. In severe cases, this causes a locking phenomenon in which the finger becomes bent and can only be extended with external force or manipulation. For some patients, this can be painful to do.

While just two to three percent of the general population will develop TF, the condition affects 10 percent of people with type 1 or type 2 diabetes, says a 2008 study published in the journal Current Reviews in Musculoskeletal Medicine (CRMM). According to a 2021 study published in Frontiers in Clinical Diabetes & Healthcare (FCDH), some evidence suggests that number could be closer to 20 percent, "depending on the group studied."

But just what, exactly, does diabetes have to do with the tendons in your hands? "It is thought that chronically elevated blood glucose levels cause the connective tissue to become glycated, meaning that irreversible bonds between glucose and proteins form in the tissue, damaging it," says the health site Diabetes Self-Management. For this reason, the longer you've lived with diabetes, the more likely you are to develop this symptom.

Look out for these symptoms of trigger finger.

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According to the Mayo Clinic, you may have trigger finger if you notice stiffness in your fingers, "particularly in the morning." Their site explains that you may also experience a "popping or clicking sensation as you move your finger," tenderness in the palm near the affected finger, finger locking in a bent position, or rigid movement in which your finger suddenly "pops straight."

Trigger finger may affect one finger or several, and any finger can develop the condition, including the thumb. "Trigger finger in diabetics is also more likely to present in both hands and in multiple digits," writes the Merivale Hand Clinic, a group of hand therapy specialists based in New Zealand. 

Regardless of the severity of your condition, it's important to mention any abnormalities to your medical provider. "If you have any stiffness, catching, numbness or pain in a finger joint, or if you can't straighten or bend a finger, make an appointment with your doctor," the Mayo Clinic advises.

These other factors also influence your risk level.

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Having diabetes can significantly raise your chances of developing TF. However, other factors such as your age and sex can also increase your odds of experiencing this particular symptom.

According to the CRMM study, women are six times more likely to develop trigger finger than their male counterparts. Additionally, trigger finger symptoms typically appear in patients in their 40s, 50s, and 60s, experts say. The average age of onset symptoms is 58, says a 2019 study in the journal Plastic and Reconstructive Surgery (PRS).

Finally, people with certain other conditions may be at heightened risk of trigger finger, writes Healthline. These can include carpal tunnel syndrome, hypothyroidism, rheumatoid arthritis, renal disease, amyloidosis, among others.

There are several treatment options available.

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Those with TF may have both surgical and non-surgical options for treatment. "Corticosteroid injections decrease the thickness of the A1 pulley and are considered a first-line treatment," explains the PRS study. "However, corticosteroids are only moderately effective, especially for people with diabetes. Patients may elect for surgery if nonoperative treatments prove ineffective; some may choose immediate surgical release instead," the researchers explain.

If you do develop trigger finger, you should bring it to your doctor's attention, both to identify any underlying causes, and to learn about the full range of treatment options which may be available to you.

https://bestlifeonline.com/trigger-finger-diabetes-news/