National Diabetes Awareness Month

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For most people, November is the time of year to begin preparing for the holiday season, but November is also National Diabetes Month.  In the United States alone, 25.8 million children and adults have diabetes.  This makes up about 8.3% of the population, and is projected to reach 21% by the year 2050.  There are millions of Americans with undiagnosed diabetes.

Many more who will eat candied apples, canned cranberries, apple and pumpkin pie, and all the turkey and stuffing they can handle; and may likely be precipitating their diabetes and obesity even further without even being aware that they have the signs/symptoms of diabetes in the first place. 

Early warning signs of the disease:

• Increased thirst
• Increased hunger (especially after eating)
• Dry mouth
• Frequent urination or urine infections
• Unexplained weight loss (even though you are eating and feel hungry)
• Fatigue (weak, tired feeling)
• Blurred vision
• Headaches

Diabetes can affect the entire body, including the foot and ankle.  Neuropathy is one of the most common complaints of diabetic patients.  Neuropathy results in damage to nerves, specifically the peripheral nerves, or nerves outside of the brain and spinal cord. Peripheral Neuropathy causes a burning or tingling sensation usually on the feet and legs, or on the arms.  This damage to the nerves is caused by excess blood glucose, or high blood sugar.  Over time excess glucose injures the walls of blood vessels that supply the nerves.  As neuropathy worsens, the ability to feel the lower extremity becomes diminished, which makes diabetics more prone to injuries that go unnoticed.  Neuropathy is the leading cause of diabetic foot ulcers.  Diabetic foot ulcers are caused from a combination of neuropathy, trauma, and deformity.  Deformities such as hammertoes, equinus (limited upward bending of the ankle), or bunions in diabetic patients are more problematic than in non-diabetic patients because of the other complications that come with diabetes.  If diabetic foot ulcers are left untreated they may end up getting infected, and even result in amputation.  Diabetic patients often have decreased circulation in the extremities due to hardening of the arteries or vessels, and this may slow healing time, which is why it’s vital for diabetic patients to take extra precautions when it comes to caring for their feet. 

Although diabetes is a life altering disease keeping a tight control on blood glucose levels can minimize complications.  Other ways to protect the feet in individuals with diabetes are by wearing special shoes made for diabetics, examining the feet daily, washing the feet and making sure to dry them completely, avoiding smoking, wearing clean, dry socks that are changed daily, and never walking barefoot.  Management of diabetes is the key to preventing complications, and for those that do not have diabetes the key to prevention is exercise, maintaining a healthy weight, and eating a well balanced diet.

Brian Timm, DPM, FACFAS

Board Certified by the American Board of Foot and Ankle Surgery in Foot and Reconstructive Rearfoot and Ankle surgery

Diabetics who smoke cigarettes beware

Smoking releases a molecule known as norepinephrine, which triggers blood vessels to constrict, or narrow. When the already small vessels in the foot constrict, oxygen and the cells that fight infection and aid in healing are unable to reach tissues. Each cigarette smoked has been shown to cause oxygen levels to fall and remain low for 30 to 50 minutes. This is of great concern in those with a foot wound or incision after surgery, in which blood flow and oxygen are vital to skin healing.    

Each cigarette contains more than 4,000 natural and synthetic chemicals. Some of these chemicals include carbon monoxide, methanol (which is found in rocket fuel), ammonia, and nicotine.  Nicotine has been shown to decrease the molecules that are responsible for growth of new blood vessels and development of osteoblasts, or bone building cells. Carbon monoxide further contributes to the decrease in tissue oxygen caused by vessel constriction, by taking oxygen away from the molecule it is normally transported in in the blood. It is for these reasons that quitting smoking is imperative for individuals with foot problems. Studies have shown that there is a 2.7 times higher risk of bone not healing in smokers compared to non-smokers undergoing foot surgery.  

Prior to foot surgery involving bone, smoking should be stopped at least 6 weeks prior to the procedure if possible and then take that opportunity to stop smoking indefinitely. 

In individuals with diabetes or other disorders affecting their blood vessels, smoking is even more dangerous.  Pressure ulcers develop when sensation is diminished and the normal feeling of pain associated with a wound is not present. Tissue healing is impaired and there is a heightened risk of infection developing. Combined with smoking, such risks are furthered increased. Individuals with diabetes who notice a foot wound, whether they are smokers or not, should contact their podiatrist immediately. Early treatment can prevent infection and worsening of the wound that can potentially lead to a need for amputation.  Bill’s story in the smoking ad is a scary one, but by sharing it he may be able to prevent others from suffering a similar fate of amputation. 

4 Tips to Reduce Diabetes Risk

Diabetes Mellitus affects more than 230 million people worldwide!  

That is equivalent to approximately 10 times the number of people living in the state of Florida alone.  

One out of every three people with diabetes is unaware they have the disease.  

There are three types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes.  The number of Americans with diabetes is expected to double or triple by the year 2050.  While these statistics are grim, there are many things that can be done to prevent type 2 diabetes. 

Here are some simple lifestyle changes that can prevent diabetes:

• Stay at a healthy weight.  Type 2 diabetes and obesity are closely linked, and maintaining a healthy weight can really make a difference!  The goal is to maintain a BMI less than 25.
• Eating well is also important in prevention.  Surprisingly, studies have shown that women that consume processed red meat are at increased risk of developing type 2 diabetes.  Eating less meat may be preventative as well as avoiding foods high in saturated fats, cholesterol, and sugar.  Eating whole grains, nuts and citrus fruits have also shown to be preventative.  Having a diet high in fiber can also help control blood sugar, thus lowering the risk of developing diabetes.  Stay away from fad diets, and make it a goal to simply make healthier choices.
• Ditch the soda for coffee!  Drinking soda can increase your diabetes risk by 26%, but drinking more than 1 cup of coffee a day can be preventative. 
• Be active.  Walking for just a few minutes about half an hour after dinner has shown to be helpful by lowering blood sugar levels.  Weight lifting can also lower blood sugar better than aerobic exercise can, while maintaining muscle mass and speeding metabolism.  However, a good mix of aerobic exercise and weight training is ideal for maximum benefit.

These are just a few tips for a healthier lifestyle that may aid in the prevention of developing type 2 diabetes.  Type 2 diabetes has some genetic components, but developing the disease is greatly affected by lifestyle.  It is never too late to start living a healthier lifestyle, and if you are at increased risk of developing diabetes it is important to talk to your doctor and get screened for diabetes.

-Dr Timm