Diabetes Mellitus

Information for Patients with Diabetes Mellitus

While diabetes mellitus is known as an abnormality of blood sugar control, resulting in abnormally high blood glucose, the condition can have an impact on many other bodily functions. Diabetes can impact the eyes, the kidneys, the circulation, and the nerves. Because of the effect of diabetes on the circulation and the nerves, it can seriously impact the feet.

Circulation problems associated with diabetes include:

1. Gangrene.
2. intermittent claudication – pain in the muscles of the foot, calf, thigh, or buttocks due to impaired supply of circulation to these areas only during walking, but not at rest.
3. ischemic rest pain – pain in the feet when the are elevated for a period of time, with some relief when they are down.
4. ischemic ulcers – open sores on the toes or heels due to insufficient supply of circulation.

Nerve problems associated with diabetes include:

1. peripheral neuropathy paresthesias – burning, tingling, numbness, pins & needles felt in the toes and forefoot that is worse at rest or at night than with activities.
2. neuropathic ulcers – open sores on the toes or ball of the foot due to the presence of pressure spots on skin that has inadequate sensation.
3. Charcot arthropathy – collapse and fractures of major foot joints (across the arch / midfoot is most common) resulting in a disfigured foot that is prone to neuropathic ulceration.
4. weakness of the muscles of the foot or leg, resulting in claw toes or drop foot.

As a result of these problems, patients with diabetes are at a higher risk of serious foot infections and limb loss. Furthermore, nerve and circulation problems may exist in a patient's feet silently before erupting into a more serious manifestation. However, the majority of diabetic foot problems can be prevented with early detection and preventive efforts. Therefore, your feet need to be examined by your doctor for circulation and sensation at least yearly - if its not happening, insist. If a problem is detected, then your feet will need to be watched more carefully by both you and your doctor, and perhaps a podiatrist.

What can I do to prevent circulation problems?

• Don't smoke!
• Perform aerobic exercise at least 20 minutes, 5 days per week (brisk walking, for example).
• Maintain a diet low in fat and cholesterol.
• Control your blood glucose.

What can I do to prevent nerve problems?

• Control your blood glucose.
• Avoid excess consumption of alcohol.

What should I do to prevent further problems if my doctor detects sensation or circulation impairment?

• Open this document: Preventive Care for Patients with Sensation or Circulation Loss in the Feet - read it, print it for future reference, and follow the instructions religiously.

What footwear recommendations do you have for someone with diabetes?

• The most common shoe that I recommend is the SAS brand - Freetime model (for women) and Timeout model (for men). These shoes are soft, have plenty of toe room, and have a removable insole (see below).
• Recommended walking shoes include Reebok DMX walking shoes and New Balance brand shoes - but make sure that the shoe that you buy has a removable insole (see below).
• You should purchase a pair of Spenco Polysorb Crosstrainer insoles from the Kaiser Santa Rosa over-the-counter pharmacy store and replace the insoles in the shoes that you wear with these insoles.
• In some cases, custom made shoes and insoles may be prescribed for you, if you have a critical level of circulation or sensation loss and have previously developed some of the complications listed above.

I need help caring for my nails/corns/calluses - can Kaiser help?

• If your feet are found to have a critical level of either circulation or sensation impairment, then you are covered for nail/corn/callus care in Kaiser Santa Rosa's podiatry department.
• If your feet fail to meet the criteria for critical circulation or sensation loss, and you need help with this type of care, we recommend that you see a trained professional (such as a podiatrist or foot care nurse) on a fee for service basis.

Recommended Links:

• Preventive Care for Patients with Sensation or Circulation Loss in the Feet
• The American Podiatric Medical Association's Diabetic Foot Education Page
• Home Page of the American Diabetes Association

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