Diabetes-related Diseases

Diabetic Foot:
Diabetic patients have many problems in their feet, even minor problems may develop and cause serious complications, diabetic foot problems often occur when feet nerves are damaged (Diabetic Neuropathy).
Diabetic Foot Risk Factors:
Over time, poorly managed diabetes can lead to foot complications and the risk of foot problems increases if the patient has:

• Foot Ulcers in the past.
• Damage to the feet nerves.
• Foot deformities.
• Circulatory Insufficiency.

Symptoms and Signs of Diabetic Neuropathy in the Limbs:
Often it affects the feet and legs first then they are followed by the hands and arms, including:

• Tingling, (loss of pain and temperature sensation).
• Feeling of Tingling.
• The painful sensation may become more severe (such as not bearing the bedspread weight when the feet are covered).
• Muscle weakness.
• Loss of flexibility (especially of the foot joint).
• Loss of balance.
• Problems in the feet, such as: ulcers, infection, deformity, pain in bones and joints.
• Skin Discoloration.

When to see a doctor:

• when ulcers occur even if they are minor.
• When wounds do not heal or are in poor condition.
• When tingling, weakness and pain affect daily life.

The effect of diabetes on the blood vessels and nerves of the feet:
When blood glucose is high in people with diabetes, blood vessels and nerves are affected over time. The affected nerves lead to a loss of pain sensation in the feet, i.e., not feeling the wounds and sores that affect the foot, which leads to inflammation. The blood vessels may not deliver enough oxygen-laden blood to the feet, as well as making it difficult to heal wounds or change the shape of the foot.

Impact of Diabetes on the Feet:
Loss of pain sensation:

• Sensation of pain, (cold and heat): When the patient's foot is injured, he will not be able to know this, for example when stones enter the shoe, the patient will not be able to know, the stones remain inside the shoe and hurt the foot.
• Foot deformity: The feet and toes shape has changed.

Over time, the foot may begin to dry out, resulting in peeling and cracking.

Foot Ulcers:
They often occur in the front-lower leg or the toe soles, and ulcers appear on both sides of the foot often due to improper shoe size.

Circulatory Insufficiency:
This causes the foot inability to fight and cure the infection.

Gangrene:
It is a condition that occurs when tissues die.

Amputations:
It occurs in the advanced stages of Sores Infections.
Cause: loss of sensation, Circulatory Insufficiency.

Treatment of foot ulcers:
Superficial ulcers affect only the upper layers of the skin and treatment includes:

• Cleaning of ulcers, removing of dead skin and tissue by a healthcare provider.
• Covering the area with a bandage to keep it hygienic and moist.
• The doctor may prescribe antibiotics if the foot is injured.
• The ulcer should be cleaned, and a clean bandage applied twice daily or as instructed by the healthcare provider.
• Raising the foot with the ulcer above the ground level as much as possible.
• The ulcer should be checked at least once a week by a doctor to make sure it has healed properly.

Deep ulcers are those that extend to the deeper layers of the foot, including the muscles and bones, which usually require hospitalization. Treatment includes:

• Laboratory tests and X-rays are often performed, antibiotics are administered intravenously as well as removing dead skin and tissue.
• Surgery may be necessary to remove the affected bone.
• If part of the toes or foot is severely damaged, causing dead tissue areas (gangrene), partial or complete amputation may be required.

Prevention and care of the feet:

• Controlling blood glucose levels.
• Smoking Cessation.
• Self-examination of the foot on a daily basis, by:

• Searching for traces of cuts, bruises, pressure areas, redness and nail problems, the mirror can be used when examining.
• Feel (Find by touching) each foot and how swollen it is (swelling).
• Interhalogen check. (Between-fingers examination)
• Checking the sensation in each foot.
• Focusing on the following six areas in the soles of each foot: thumb tip, little finger soles (pinky), middle finger soles, heel, and front-part of foot.
• Avoid trying to treat anything without consulting a doctor.

Foot care, by:

• Wash daily with warm soapy water and check the water temperature before using.
• It is recommended to dry them by using a towel chamfer, to focus on drying between the fingers.
• Moisturize with moisturizing creams, avoiding putting the cream between the fingers.
• Trim nails straight and avoid cutting nail corners to avoid cuts.
• Immediately report any problem with the nails to the doctor.
• Avoid using sterilizers, ointments, hot compresses, and sharp objects for feet.
• Keeping them warm by wearing socks and avoid exposing them to any heat source (such as heaters).
• Wear wide socks when sleeping.
• Do not expose them directly to snow and rain.
• Avoid placing one foot over the other for a long time, as it prevents blood flow to the feet.
• Avoid walking with bare feet to avoid foot wounds.
• Maintaining blood flow to the feet by raising the feet slightly when sitting.
• Moving toes and ankles up and down for 5 minutes two to three times a day.

When wearing socks and shoes:

• Avoid walking barefoot.
• Avoid wearing open shoes.
• Choose shoes carefully and try on their size at the end of the day as foot size increases.
• Make sure the shoes are comfortable before buying them, and check that they fit well.
• Avoid shoes with a pointed tip as well as with high heels and choose shoes with a wide tip.
• Avoid wearing the same shoes every day.
• Feel (Find by touching) the inside of the shoe by hand before wearing it.
• Tighten the shoelace in moderation way.
• Wear clean, dry cotton socks, and change them every day, avoid wearing perforated socks.