If there's one thing people with diabetes are good at, it's educating them. And that's great news because understanding all the effects of high blood sugar is a key part of managing the disease.

Like the more familiar neuropathy associated with burning or numbness in the feet and hands, autonomic neuropathy is also the result of nerve damage caused by high levels of sugar in your bloodstream (which is why frequent testing and solid blood sugar control is still your first and best line of defense). But autonomic neuropathy specifically affects the nerves that manage your automatic or unconscious functions, such as your heartbeat, digestion, and sweat glands.

Often, because the internal organs are involved, there are no obvious symptoms. In fact, autonomic neuropathy is dangerous for precisely that reason—it's what you don't feel. Because it diminishes sensitivity to pain, advanced autonomic neuropathy can make it difficult to recognize a heart attack or blood-sugar low.

That explains why autonomic neuropathy is responsible for the high rate of heart disease in people with diabetes, not to mention bladder problems, kidney failure, gastrointestinal discomfort, and sexual dysfunction. Half the amputations performed each year are in people with diabetes, resulting most often from foot ulcers that don't heal. At least half of these can be eliminated through preventative foot care.

Luckily, there are a variety of noninvasive tests your doctor can perform to detect these problems early, while you're in a better position to reverse the damage. Your doctor can use ultrasound, blood pressure measurements and other screening methods to identify symptom-free autonomic neuropathy throughout your body.

The tests don't hurt and can often be performed in your doctor's office. So what's stopping you? Make sure your doctor is watching for neuropathy in all your internal organs too.

Risk Factors of Foot Problems

If you have any of the following, you are at risk for foot ulcers and amputations.

• loss of feeling in your feet

• pain in legs while walking

• changes in the shape of your feet

• previous foot ulcers

• diabetes more than 10 years and over age 60

• poor diabetes control

Causes of Foot Problems

Foot problems in people with diabetes are usually caused by the following four factors. All of these can lead to injuries that result in amputation if left untreated.

Nerve Damage (Neuropathy). Sensory neuropathy causes a loss of feeling in the feet and legs. Symptoms include numbness or tingling in the feet or legs, or the inability to feel your feet at all. Neuropathy allows injuries (such as stepping on a tack) to go unnoticed.

Poor Circulation. People with diabetes frequently have poor circulation in their legs and feet. Reduced blood flow means the feet don't get the oxygen and nutrients needed, causing injured feet to heal slowly or not at all.

Infection. People with diabetes are more susceptible to infections than people without diabetes, and they're less able to fight off their infections due to a weakened immune response. Infections can quickly escalate and/or go undetected until they are quite serious. This can lead to ulceration of the skin and tissues-a very serious condition.

Foot Deformities. When a person with diabetes has neuropathy or poor circulation, foot deformities such as hammertoes or bunions can cause lesions. These lesions (such as corns, calluses, blisters, or ulcers) can lead to serious infections while putting stress on other parts of the foot.

Prevention

• Examine Your Feet. The most important thing you can do to prevent foot ulcers and amputation is to examine your feet every day for sores, cuts, bruises or injury.

• Find Out If You Have Normal Sensation In Your Feet. You may have lost the ability to feel normal sensation in your feet. This is sometimes called “loss of protective sensation.” In other words, you've lost the warning signals in your feet that protect you from injury. You can use a simple test to determine if you have lost any sensation in your feet.

• Develop A Plan For Foot Care And Foot Protection. Your nurse can help you create this plan, which will help prevent future foot ulcers.

• Make Sure Your Doctor Examines Your Bare Feet During Each Visit. And make sure your doctor checks the circulation in your feet at least once a year.

• Wear Appropriate Shoes. Poorly fitting shoes can quickly lead to injury. Avoid wearing high heels and shoes with pointed or open toes. Socks provide a protective barrier around your feet to decrease the chance of irritation. Wear them at all times.

• Check Your Shoes For Rough Spots Or Loose Objects. Before putting on your shoes, check for rough or worn edges and loose items that don't belong in your shoes, such as pebbles. These things can quickly cause irritation, injury and foot ulcers.

• Avoid Heating Pads, Hot Water Bottles, And Hot Bath Or Tub Water On Your Feet. If you have less feeling in your feet, you may not feel something if it's too hot. And with less feeling, burns can occur without pain.

• Don't Go Barefoot. Injuries while barefoot are the second most common cause of ulceration and amputation. Protect your feet by wearing shoes all the time.

• Dry Your Feet And Between Your Toes After Bathing. Wetness between the toes may allow bacteria and fungus to grow, which may lead to serious infection.

• Trim Toenails Carefully. Injuries from cutting your toenails can lead to infection, foot ulcers and amputation. Be sure to trim your toenails straight across, using only a nail clipper. Don't cut into the corners of the nails. If you can't care for your own toenails, have a family member, friend or podiatrist/nurse assist with the trimming.

• Use Moisturizing Lotion Daily But Not Between The Toes.

When to Call Your Doctor or Diabetic Specialist

See your doctor or a foot-care specialist promptly if you have any of the following.

• redness or swelling of the foot or ankle
• change in the size or shape of the foot or ankle
• pain in the legs at rest or while walking
• open sores, no matter how small
• non-healing wounds
• ingrown toenails
• corns or calluses with skin discoloration
• lack of hair growth on the foot

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