Diabetes is a disease characterised by inappropriately high blood sugar level resulting from either low levels of the insulin secretion or from resistance to insulin. It damages organs like kidneys, eyes, blood vessels, nerves and impairs the immune system of the body. It was over 110 years ago that PRYCE, a surgeon working in England, recognised the connection between diabetes and foot ulcer.
Long-standing or poorly controlled diabetes cause damage to the nerves in the feet, the medical term for which is diabetic peripheral neuropathy. Normal sweat secretion and oil production that lubricates the skin of the foot are impaired due to diabetes.
This leads to abnormal pressure on the skin, bones and joints of the foot during walking and can lead to breakdown of the skin. This condition also leads to not being able to feel minor injury to the feet. Symptoms like numbness, burning pain, pins and needle sensation, slipping of chapels, cotton wool appearance of the floor may be experienced. Poorly fitting shoes lead to red spots, sore spots, blisters and calluses. Foot abnormalities such as flat feet, hammer toes add to the problem. Poor circulation due to atherosclerosis (clogging of blood vessels and reduced blood flow to the foot) leads to impaired wound healing. This can be aggravated by smoking.
If the wounds or ulcers in the foot or legs become infected, they cause serious problems. The immune system, which is already impaired due to diabetes can not fight against the infection.
Severe infections can be life threatening and necessitate amputations. Approximately 40-72% of all foot or leg amputations are related to diabetes. Amputation is 15 times more likely in diabetic patients.
Self-Care at Home:
1) Regular foot examination: Examine your feet daily and also after any trauma. Use a water-based moisturizer every day (but not between your toes) to prevent dry skin and cracking. Wear cotton or wool socks. Avoid tight fitting elastic socks and hosiery because they may impair circulation.
2)Toe-nail trimming: Always cut your nails with a safety clipper, never a scissors. Cut them straight across and leave plenty of room out from the nail bed.
If you have difficulty with your vision or using your hands, let your doctor do it for you or train a family member to do it safely. If you have ingrown toe nails, consult your doctor.
3) Footwear: If you have flat feet, bunions, or hammer toes, you may need prescription shoes or shoe inserts. Do be sure your shoes fit properly.
4) Exercise: Regular exercise will improve bone and joint health and improve circulation to your legs and also stabilize your blood sugar levels.
5) Smoking: If you are smoker, it leads to poor blood circulation. So quit smoking.
Medical Treatment:
Treatment plans may include surgical debridement (removal of dead, damaged and infected tissue) of your wound, improvement of circulation through surgery or therapy, wound care and dressings and monitoring of your blood sugar. If your doctor determines that a wound or ulcer on your feet or legs is infected, antibiotics will be prescribed to treat the infection.
It is very important that you take the entire course of antibiotics as prescribed. For limb- or life-threatening infections, you will be admitted to the hospital and given intravenous antibiotics.
Referral to a podiatrist (specialist in foot disorders) or orthopaedics surgeon might be required if you have bone-related problems, corns and calluses, bunions, heel spurs, arthritis or have difficulty with finding shoes that fit. They create shoe inserts, prescribe appropriate shoes, remove calluses and have expertise in surgical solutions for bone problems.
Following a reasonable diet, taking your medications, checking your blood sugar regularly, exercising regularly and maintaining good communication with your physician are essential in keeping your diabetes under control. Yearly foot examinations with podioscan to see pressure points, biothesimeter to assess sensation and Doppler study to assess blood circulation is useful in preventing foot ulcers.
Dr.A.Arunagiri MD, PGDHS [Diabetes],
Consultant Physician And Diabetologist,Shifa Hospital,Tirunelveli.
The author can be contacted at
aagiri5a@gmail.comDiabetic Retinopathy
Diabetic retinopathy is a highly specific retinal vascular complication that is related to the duration of diabetes and control of diabetes. That would mean longer the diabetes and poorer the control more is the chance of retinopathy.
The importance of Diabetic retinopathy lies in the fact that it is irreversible and barely treatable. Second, it results in a severe to complete vision loss in a high proportion of eyes. Third, because it is painless and largely symptom free till late stages, it progresses silently, undetected, lending a large dose of complacence in the patient..
Diabetic retinopathy isdivided into two classes, Non Proliferative Diabetic Retinopathy (NPDR) and Proliferative Diabetic Retinopathy (PDR). In the early stages are generally detectable only by the eye doctor save a few occasions when vision is reduced because of localized fluid accumulation in the retinal tissue called macular edema. The importance of this stage is that the disease identifiable to the doctor and further progress can be retarded if properly treated.
The more advanced stage, which is PDR interrupts patients life by frequent and prolonged vision loss which, later becomes permanent. Vitreous hemorrhage, which is leakage of blood into transparent portions of the eye results in hazy vision. The leaked blood from the new vessels which lack the integrity and strength of the normal vessels takes several months to clear sometimes requiring surgical removal called vitrectomy.
From NPDR stage onwards through PDR stage, the risk of vision loss is greatly increased compared to normal population. Various modes of treatment are available according to the clinical circumstances.
The chief modality is application of LASER photocoagulation treatment, to arrest the progress of the new vessel growth.
There are several other pharmacological agents that are being used (through injections into the core of the eye) to arrest or control the new vessel growth. Macular edema can be treated by laser or by steroid injection into the eye. patients should first undergo eye examinations regularly . Control the blood sugar energetically and maintain healthy life style.
Of all, it is possible to maintain vision of diabetics for long periods of time by regular eye examinations and immediate treatment of complications. Dr N Sirish Kumar, MD (AIIMS), DNB, FRCS Ed,
Senior Consultant – Optholmologist
MMHRC, Madurai.
Diabetes during pregnancy
Diabetes during pregnancy can be of two types, one occurs only during pregnancy (Gestational Diabetes Mellitus) and the other one is diabetic people becoming pregnant.
GDM is a type of diabetes that arises during pregnancy in the later half. The risk factors that can make more likely to have the gestational diabetes are
• obesity, • a family history of Type 2 diabetes
• an unexplained stillbirth or neonatal death in a previous pregnancy, and/or • a very large infant in a previous pregnancy.
Gestational diabetes comes to light during the second trimester of pregnancy. Since the baby’s major organs are fairly well developed at this stage, the risk to the baby is lower than for women with Type 1 or Type 2 diabetes. During antenatal checkup blood test and urine test will be done to diagnose GDM. 30% to 40% need insulin and for rest of the patients diet control is enough. 30% of people with GDM & PCOD (Polycystic Ovarian Disease) are prone to develop type II diabetes later. These people are recommended for GTT after 6 months of delivery.
Type 1 or Type 2 diabetics are at a higher risk of losing their baby or having a baby with a congenital abnormality. This is due to fluctuating blood glucose levels. Infertility patients should have their blood glucose levels in strict control before they go for medical treatment IUI or IVF. Glycosolated haemoglobin test should be done before becoming pregnant. Diabetic patients are prone to develop hypertension, so they should have regular antenatal check up and early scan to rule out birth defects.
Dr. Saleema
Dindigul Fertility and Research Centre
Diabetes in childrenThe prevalence of diabetes is increasing throughout the globe at an alarming rate with India being the Diabetes Capital of the world. Diabetes is now not a disease of the elderly as it was 30 yrs ago. More & more of children are getting diabetes at a very young age.
Types of Diabetes in children
Type 1 Dm(caused by a defect in immune system which leads to destruction of the insulin producing Beta cells of the pancreas) has classically always been considered the only type of diabetes in children except in rare instances. Indeed type1 Dm was called Juvenile diabetes. However some recent findings suggest that somewhere between 8-45% of newly diagnosed children with diabetes, may indeed have type 2 diabetes(interplay of insulin resistance and relative insulin deficiency.) Other types of Dm in children
1. FCPD (Fibro Calcific Pancreatic Diabetes)
2. MODY(Maturity Onset Diabetes of the Young)
It results from genetic defect in insulin producing cells. Several varieties
exist in this type of diabetes.
It is sometimes difficult for the clinicians to properly classify children with diabetes. In the event that specific classification is warranted, additional testing may be necessary. Some of these tests include, fasting insulin or C-peptide levels, antibody measurements and genetic testing.
Reasons for increasing prevalence of type2 Dm in children:
Easy availability of energy rich foods, lack of exercises, watching TV and playing games in the computer for long hours lead to obesity and overweight in children. Obesity interferes with the action of insulin which is the vital harmone in glucose disposal.
Prevention of diabetes in children Primary prevention should involve a public health approach that involves school and community based programmes directed at improving overall nutrition and physical activity in children. The population of children with type2 diabetes is growing perhaps to epidemic proportions. Our children should be taught about the importance of healthy life style to have a better quality of life in future.
Dr. K. Krishnamoorthy M.D.,DNB.,
Diabetologist,
M.V DIABETES Clinic, Madurai
Skin problems in DiabetesSkin is the mirror to ones health. Most of the problems in the body reflects on the skin. Excessive glucose ( sugar) in the system can directly and indirectly affect the skin.
The most commonest are skin infections:
FOLLICULLITIS: (Infection around the hair ) can occur in any patch of the body. These infections will spread faster and are more severe in diabetics. Fungal infections are also very common especially in body creases like underarm & inner thigh. High glucose levels in saliva leads to infection in the mouth like candidiasis. This causes white patches in the mouth.
Diabetes can affect the blood vessels the smaller and larger ones. These changes are responsible for kidney & eye problems too. Darkening of the toes & eventually death of a toe called gangrene can also occur.
Diabetic Ulcer: Uncontrolled diabetes over a period of time can cause neuropathy. This can present with numbness, tingling, aching and burning. Burning feet and restless legs are common complaints which will usually intensity at night.
Necrobiosis lipoidica diabeticorcum is a yellow colored patch developed on the leg which may ulcerate later is mostly a tell tale of diabetes. Itching can occurs once in a way & is extremely distressing. If it occurs in the private parts one has to surely rule out fungal infections.
Finger Pebbles: Pebbly appearance of the frequent injury due to lesser sensation or due to thickening of the skin which happens from within.
Skin Tags: these are small round skin coloured growth usually around the neck and arm pits.
In cases of late onset diabetes 4.5% cases have been associated with Vitiligo ( white patches ).
Diabetes is a world wide problemBut it is mandatory to keep diabetes under control to do treat and avoid skin problems.
Dr. Hema Sathish, M.B.B.S.,D.D. (UK)
Cosmetic Dermatologist.
