Many people have heard of diabetes and think of it as an insulin problem; that diabetics are either resistant to insulin or they do not produce enough leading to high blood sugar. Their knowledge of diabetes stops there. What many people don’t hear about is the system-wide problems that can result from uncontrolled diabetes.
Diabetes is a chronic condition that affects 37.3 million people in the United States. Although it is primarily an endocrine issue, diabetes can impact the eyes, nerves, and feet. There are many side effects that can occur from uncontrolled diabetes that may seem concerning and scary, but the reality is these complications can be avoided or at least controlled through healthy lifestyle habits, regular inspection, and even seeing a physical therapist. Lifestyle modifications, such as exercise, diet control, and proper utilization of medications can help you improve your health and ability to enjoy life fully.
Why are diabetics more prone to foot issues?
Many diabetic-related foot problems are due to complications from poor blood flow and nerve damage (neuropathy). Diabetes has been known to cause hardening and narrowing of blood vessels, which leads to difficulties fighting infections as the body struggles to deliver the proper regulating and healing compounds needed. Infections of the feet that are hard or impossible for a patient to recover from are one of the main reasons why many people with diabetes receive amputations. Vascular changes can often lead to another common problem with uncontrolled diabetes: neuropathy. Typically, neuropathy starts in the hands and feet, as they are furthest from the heart. It often presents as a lack of sensation as the nerves lose their ability to transmit information to the central nervous system. For example, if someone with sensation loss has a pebble in their shoe, they may not feel it. The irritation from the pebble might cause a sore, callus, or ulcer to develop and progress further to infection. Decreased blood flow and neuropathy can also present as tingling, pain or weakness in the feet, and have multi-system effects.
Foot care and diabetes
Proper foot inspection, care, and hygiene can further prevent infection and the effects that follow. The American College of Foot and Ankle Surgeons (ACFAS) provides a variety of guidelines regarding personal foot care. During your inspection be on the lookout for any cuts, blisters, sores, and swelling throughout the ankle, foot, toes, and nails. Note that even small amounts of redness can be an indication of infection. If you notice anything unusual, it is recommended to see your primary care provider. ACFAS also offers recommendations for foot care include regular moisturizing of the feet (not between the toes as it can promote fungal infections), wearing clean, dry socks, and cleaning your feet daily with lukewarm water using either a soft sponge or washcloth. Keeping your feet healthy is important for the prevention of infections among other systemic complications. These are some simple strategies to maintain healthy feet. If you find you have any questions or concerns regarding your foot health, your primary care provider is a great start, but many other health professions—such as physical therapy—have expertise to help you stay healthy.
Healthy diets for diabetics
Developing a lifestyle with a healthy diet is one of the most effective strategies to developing a healthy vascular system, especially alongside a regular exercise routine. This means diabetics can limit the development of neuropathy in addition to optimizing their ability to fight infection. What does a proper diet look like for a diabetic? A simple method to base your meals on is using what the CDC refers to as the Diabetic Plate Method. This utilizes the orientation of your plate to help you visualize what your plate should look like. Starting with a 9-inch plate, half of the plate should be filled with non-starchy vegetables like lettuce, spinach, broccoli, and carrots as opposed starchy potatoes, corn, and peas. Next, a quarter of the plate should be filled with a lean protein like poultry, fish, tofu, beans, or eggs. The last quarter of the plate is where you can get your grain or starchy foods as well as fruits. Grains include foods like rice, pasta, or bread, and fruits include things comparable to apples, oranges, bananas, and berries.
Physical therapy for diabetes
Physical therapy can help in the management of foot care through multiple treatment methods with the goal of injury prevention. A common source of injury is falling, which can cause superficial tissue injuries like cuts and bruises, as well as more deep injuries like sprains and fractures. While physical therapy can help promote healthier mechanics by improving strength and range of motion to reduce the risk of falls, balance is often something physical therapists consider when assessing risk of falling. There are three main systems that make up our balance: somatosensory, vision, and vestibular. Somatosensory refers to the bodily sensation through our feet of where we are in space. Vision helps us plan and prepare for the different changes in obstacles that are coming our way. The vestibular system, our inner ear, senses, motion, changes in head position and spatial orientation. It helps us feel balanced during common activities including turning our head, looking up and down, position changes, and walking. The cerebellum in the brain calibrates and adapts balance based on inputs from these three systems. Deficits in just one of them can lead to greater risk of fall. Diabetes, particularly when uncontrolled, can affect all these systems because of the way it can damage the nerves associated with them. A physical therapist can prescribe exercises to recalibrate each one of these systems to function at their highest potential – reducing your risk of fall and the injuries associated.
There is more to diabetes than high blood sugar and a problem with insulin. The effects of uncontrolled diabetes discussed like poor blood flow, neuropathy, infections, and amputations can be scary and painful. However, a diabetes diagnosis doesn’t mean these have to be your reality. Controlling your diabetes through healthy diet, regular inspection, and physical therapy can help keep your feet healthy.
The DMU Family Medicine clinic can assist you in managing your diabetes along with the Foot and Ankle and Physical Therapy clinics for managing any complications you may have with diabetes. The expert family medicine providers, physical therapists and podiatrists at the Des Moines University Clinic can help you manage complications from diabetes and provide you with exceptional care. For more information or to make an appointment, visit the DMU Clinic website or call 515-271-1710.
