Why Footcare Is So Important For People With Diabetes

The most recent Scottish Diabetes Survey estimates that there were over 304,000 people with a diagnosis of Diabetes in Scotland in 2018. But the wider implications of Diabetes stem much farther than having to regulate what you eat. Poorly managed Diabetes can have a knock on effect on your sensation, muscle operation, circulation, eyesight and kidney function. 

Progression of Diabetes in Scotland over the last decade - Scottish Diabetes Survey

There are 2 main types of Diabetes - Type 1 and Type 2

Type 1 Diabetes usually develops at a young age and is linked to an autoimmune response in the pancreas where insulin is produced. Insulin is an important enzyme that breaks down sugar into fatty acids once it has been absorbed into the blood which is then stored around the body in the form of fat. In Type 1 Diabetes, however, the body's own immune system starts to affect insulin producing cells causing an issue with the insulin synthesis process. The resultant effect of which is a persistent state of high blood sugar (hyperglycaemia).

Type 2 Diabetes is a little different, in that it can be acquired. A high carbohydrate and sugar rich diet over a prolonged period can lead to reduced levels of insulin production in the body. Though the body itself does still produce insulin it is not enough to manage the sugar intake.

But why is high blood sugar so bad?

Simply put sugar gets sticky when it's wet. Blood is made up of around 45% water by volume. The longer sugar stays in the blood, the greater the chance it is going to become sticky and attach to the proteins and fats in your blood vessels....and your blood vessels go everywhere in your body! Indeed the higher the sugar content, the more syrup-like the blood becomes. The sugar in the blood, due to the oxygen rich environment leads to the sugar being broken down and a number of by-products being produced. And it is these pesky by-products that cause the real damage. They have been implicated in a number of Diabetes related complications from nerve problems, kidney issues, retinal damage in the eyes and blood pressure related concerns like heart attacks, angina and strokes.

How does this affect my feet?

Increased blood pressure and high levels of cholesterol can cause crusty plaques to form on the inside of your blood vessels (arteries) that supply your feet. The narrowed artery not only increases your blood pressure further and puts a strain on your heart but it can also limit the supply to your feet, this can cause discolouration, coldness, dry skin and nail issues as well as pain in your legs when you walk due to the reduced oxygen supply to your muscles. Changes in nerve sensation and muscle function may also occur, which can lead to a diminished ability to feel things in your feet and modify the shape of toes and joints. These changes make patients who suffer from Diabetes more prone to wounds forming on high pressure areas or areas where circulation is poor and the skin is more compromised. 

How can podiatrists help?

Podiatrists are trained healthcare professionals that are specialists in the lower limb mechanics and circulatory system. Our main focus in the management of diabetes is to make sure that changes in foot and lower limb health are checked ensuring continued well being of the patient. We offer comprehensive assessments for all our patients with diabetes tailored to their risk category. Higher risk patients that have a propensity for wounds and ulcerations are seen regularly to make sure that issues are dealt with quickly, offloading areas of high pressure, antibiotics supplied when necessary and wound debridement and dressing. Preventative measures are highly important so that things don't spiral out of control as the results can be extreme: sepsis, gangrene and amputation. Our clinic has a number of highly skilled podiatrists that are capable of dealing with these issues along with the tools to properly assess our patients risk category. Sensation checks, vascular assessments using Doppler ultrasound, ankle and toe pressure reading and Kardia ECG are all used routinely on our patients with diabetes to ensure we stay ahead of any issues.