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| diabetes |
Diabetes was discovered as early as 1500BC and written about by the
Egyptians. The medical name Diabetes Mellitus comes from two roots.
Diabetes comes from ancient Greek, meaning 'to flow through' or
'fountain', and Mellitus comes from Latin, referring to 'sweetened' or
'honey-like'.
Diabetes is largely a hereditary disease. Sugar, in the form of glucose
is required for body cells to function and survive. Muscle and fat cells
require insulin to receive glucose. In diabetes, the body is unable to
properly metabolize glucose either because of insufficient insulin
production (IDDM) or the tissues being resistant to insulin, so that the
glucose is unable to reach the cells (NIDDM). When glucose is unable to
reach fat and muscle, it remains in the blood causing high blood sugar
levels. The excess sugar is passed out of the body by the kidneys. This
places undue stress on protein and fat breaking down to provide energy.
An estimated 20 million Americans, and 2 million Canadians suffer from
diabetes.
At least half will need foot care and would also benefit from orthotics.
One of the most frequent problems is diabetic foot infections, and 15%
will develop subsequent leg or foot ulcers. Diabetes accounts form more
than half of all lower limb amputations. So you can see, care and
management of the diabetic foot offers the greatest challenge to our
profession.
Loss of sensation in the foot caused by diabetic complications
(neuropathy) poses a serious problem in. Lacking feeling, the foot is
unable to protect itself and the individual is unaware not only of acute
injury, but, more seriously, of ongoing repeated small injuries.
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| two main types of diabetes mellitus |
TYPE 1: (IDDM)
- Formerly known as juvenile-onset diabetes
- The pancreas fails to secrete enough, or any insulin
- Usually has its onset in childhood or early adulthood
(before 30), and never goes away, requiring the individual to inject
insulin to maintain acceptable blood sugar levels.
- Diet and exercise are also key in managing the condition
- Onset of the disease occurs very quickly (excessive
thirst, frequent urination, hunger, blurred vision, dizziness, fatigue,
irritability, numbness or tingling in hands or feet)
- The deficiency of insulin quickens the breakdown of fat
resulting in the making of KETONES which causes KETOSIS (a lowering in
the pH of blood, which can result in death if not managed)
- The body's using of stored fats and proteins increases
weight loss
- Cardiovascular, nerve, kidney and visual problems are
common complications
- 40% develop significant diabetic neuropathy - problems
with sensation
TYPE 2: (NIDDM)
- Accounts for 80%-90% of all diabetics, and affects 1 in
10 over the age of 65
- Often referred to as adult or mature onset diabetes
- Caused by impaired insulin secretion of cellular
resistance to insulin
- Most common in people who are over weight, and over 40
- People do not show symptoms for a long time. The
condition is most often picked up in a routine medical screening, or,
more often, following the development of complications
- The condition is usually controlled with oral
medications such as Glyburide or Metformin, although insulin may be
required at some point
- Diet and exercise also play a key roll in managing this
condition
- Gestational diabetes occurs when sugar is in the urine
during pregnancy (most gestational mothers have a very high risk of
becoming a Type 2 diabetic within 10 years of childbirth, the incidence
increases with successive pregnancies
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| foot complications |
Common foot conditions associated with diabetes include: neuropathy,
structural deformities, nail changes including fungal infections, foot
ulcers, skin changes and vascular disease.
Damage to the soft tissues of the foot can lead to stiffness and loss of
toe function, making a less accommodative foot with weight bearing. The
diabetic foot involves two associated, but independent challenges. The
first common problem we see in clients is the development of skin ulcers
from excessive pressure or injury. Micro-vascular changes cause a
decrease in the blood supply to the skin in general, as well as to the
soft tissue beneath calluses, which makes the foot especially vulnerable
to pressure. The protective fat is lost and skin growth fails with age,
so the tissue breaks down and ulcers develop. Decreased circulation also
allows the slightest break in the skin to be an easy point of entry for
bacteria causing foot infections. Due to decreased blood supply, wound
healing is impaired. The mechanical forces of weight bearing then can
lead to even further damage.
The second common condition that we see causing foot problems is
peripheral neuropathy, which is the destruction of peripheral nerves
leading to sensory loss, principally in the lower extremities and feet.
There is a great risk of foot ulcers. With the loss of sensation to
pain, temperature and touch, positional sense and proprioception, the
foot loses its ability to adjust to stress demands such as sprains and
strains. Without pain, the person is often not aware of trauma and soft
tissue injuries, which may fail to heal. With decreased sensation, the
person is also not aware of ongoing pressure on the foot caused by an
object in the shoe, or even a crease in the sock.
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