Tuesday 18 September 2018

Ask the doctor: Lifelong diabetes is causing extreme pain in my feet

The foot is particularly vulnerable in diabetes
The foot is particularly vulnerable in diabetes

Nina Byrnes

Q I've suffered from diabetes all my adult life and as I've grown older, my feet bother me increasingly. They are extremely painful, and I've had several bad ulcers. I often have a tingling sensation in them and sometimes lose all feeling. I visit the chiropodist frequently but I still suffer with the pain. What can I do to help myself?

A. Type 1 diabetes accounts for about 10pc of cases of diabetes. It is an autoimmune condition and usually starts in childhood or adolescence. The exact cause is unknown, but the result is that the cells that normally produce insulin are destroyed and unable to function. People diagnosed with type 1 diabetes need lifelong insulin injections to survive.

In type 2 diabetes, the body becomes resistant to the effects of insulin or does not produce enough. It is usually treated by diet, lifestyle modification and medications that increase the body's sensitivity to insulin. In some cases this is not enough and some people do end up requiring insulin therapy.

In uncontrolled diabetes, blood glucose levels remain high. This causes damage to virtually every cell in the body. The risk of heart and vascular disease doubles in the first five years after diagnosis. High blood pressure is common in diabetics. It can also lead to kidney failure, nerve damage, erectile difficulties, eye damage and foot and limb damage.

The foot is particularly vulnerable in diabetes. Damage to blood vessels, nerves and tissue leads to a complication referred to as diabetic foot. This condition affects nearly 6pc of people with diabetes. It can result in infection, ulcers and destruction of foot tissue. Ulcers may develop and, at its worst, diabetic foot may be so severe that amputation is the only option. Between 0.03pc and 1.5pc of patients with diabetic foot require an amputation.

The good news is that proper management of diabetes - good foot care and a healthy lifestyle - can help to reduce the risk of developing diabetic foot. Even in those with the condition, if blood glucose levels are monitored and maintained at normal levels through lifestyle and medication, the progression of complications is greatly reduced.

Good foot care is essential. Inspect both your feet daily, including between your toes, or get someone to do this for you. Wash the feet daily and dry carefully, especially between toes. Moisturise dry skin but not between toes. Keep nails trimmed cutting straight across. Avoid any sources of foot friction. Wear socks with shoes. Ensure shoes are not too tight and that no part of the inside is irritating the foot. Avoid walking barefoot.

If you have any corns, callouses, blisters or sores, have these checked early. Have regular checks with a chiropodist or other healthcare provider trained in the management of diabetic foot.

The symptoms you describe are very typical of diabetic foot. It is concerning that you have altered sensation, pain and had ulcers previously. It is extremely important that this is addressed. A chiropodist is well-trained to care for the tissue of your foot but it is also absolutely essential that you are attending a doctor for care of your diabetes.

It sounds like you need urgent review with a diabetic and vascular specialist. The blood-flow to your feet and the nerve supply to them needs to be checked and a treatment and action plan need to be in place. Good control of your sugar levels is extremely important or amputation becomes a serious risk.

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