Problems & Amputation
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.
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
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.
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
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
you have any of the following, you are at risk for
foot ulcers and amputations.
feeling in your feet
pain in legs
the shape of your feet
than 10 years and over age 60
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
(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
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.
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.
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.
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.
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.
Plan For Foot Care And Foot Protection. Your
nurse can help you create this plan, which will
help prevent future foot ulcers.
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.
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
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
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.
Barefoot. Injuries while barefoot are the
second most common cause of ulceration and
amputation. Protect your feet by wearing shoes
all the time.
Feet And Between Your Toes After Bathing.
Wetness between the toes may allow bacteria and
fungus to grow, which may lead to serious
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
Use Moisturizing Lotion Daily But
Not Between The Toes.
Call Your Doctor or Diabetic Specialist
See your doctor or a foot-care specialist promptly
if you have any of the following.
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
no matter how small
calluses with skin discoloration
lack of hair
growth on the foot
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