Everyone with diabetes should have their feet checked by a Podiatrist at least every 12 months.
Diabetes increases your risk of having poor circulation to your feet or poor feeling in your feet.
Poor circulation and feeling in your feet increase your risk of developing an ulcer or having an amputation.
Foot checks help pick up problems early when they are easier and cheaper to manage, producing better health outcomes and improving your quality of life.
What is Diabetes?
Diabetes is a condition in which your body doesn't produce enough insulin (insulin deficiency) and or the action of insulin is reduced (insulin resistance) resulting in high levels of glucose (sugar) in your blood. Everything you eat and drink is made up of carbohydrate, protein, fat, fibre and water. All the carbohydrate you eat and drink is broken down by your body into a simple sugar called glucose. Glucose is used by the cells in your body as a source of energy. Insulin acts like a key to open the door of your cells allowing glucose to move from your blood into your cells. The pancreas (an organ in your abdomen) produces insulin.
Diabetes can broadly be split into 2 types:
Type 1 diabetes is a condition that develops due to your body's destruction of the insulin producing cells (beta cells) in your pancreas resulting in little or no insulin being produced.
Type 2 diabetes is a progressive condition in which the pancreas does not produce enough insulin (insulin deficiency) and the insulin produced does not open the door to your cells, like a broken key (insulin resistance).
How common is Diabetes?
Type 1 - approximately 0.5% of the Australian population (1 in 200 people)
Type 2 - approximately 5% of the Australian population (1 in 20 people). The percentage increases with age and Indigenous Australians have higher rates of diabetes than non-indigenous Australians.
What causes Diabetes?
Type 1 diabetes occurs in susceptible individuals due to an unknown trigger causing the immune system to attack and destroy the beta cells in the pancreas. Possible triggers for the immune system response include environmental, viral or dietary factors.
Type 2 diabetes occurs when you are genetically susceptible to diabetes (insulin resistance and relative insulin deficiency). Insulin resistance is made worse by being physically inactive and overweight or obese.
Would anything have helped prevent my Diabetes?
Type 1 diabetes - We don't know what causes type 1 diabetes so there are no evidence based guidelines on preventing the condition.
Type 2 diabetes - Reducing your weight within the normal range if you are overweight or obese and increasing your physical activity. Both of these lifestyle changes reduce your insulin resistance.
Diabetic Foot Complications
Both type 1 and type 2 diabetes may lead to complications affecting other organs of your body. High levels of glucose in your blood may cause macrovascular (large blood vessel) damage to your heart and brain and also your legs and feet (peripheral arterial disease). It may also cause microvascular (small blood vessel) damage to your eyes and kidneys and also the nerves in your legs and feet (peripheral neuropathy).
High levels of glucose in your blood may cause microvascular (small blood vessel) damage to your nerves resulting in your nerves not working properly or not working at all. Approximately 15% of people with diabetes have peripheral neuropathy (3 in 20 people with diabetes).
Peripheral neuropathy may cause pins and needles or numbness in your feet due to sensory nerve damage. Your feet are protected from injury or further injury by feeling pain. When you are unable to feel pain, an injury may go unnoticed or become worse resulting in an infection, ulceration or amputation.
Painful peripheral neuropathy is a burning pain or painful pins and needles in your feet. The damage to the nerves sometimes results in the nerves sending messages to the brain about pain that doesn't really exist.
Motor nerves (nerves that make your muscles contract) and autonomic nerves (automatic nerves eg nerves that control your sweating) can also be affected by peripheral neuropathy.
Peripheral Arterial Disease
High levels of glucose in your blood may cause macrovascular (large blood vessel) damage to the arteries in your legs and feet. Arteries carry blood from the heart to your feet and veins carry blood from the feet to your heart. Approximately 15% of people with diabetes have peripheral arterial disease (3 in 20 people with diabetes).
Peripheral arterial disease may cause cold feet which become red when standing and pale when laying down. Often there are no foot pulses and pain can occur in the foot or leg with walking (especially uphill) or when lying down.
Blood carries oxygen (red blood cells), glucose (sugar), cells to fight infection (white blood cells) and cells to promote the healing of an injury or wound. Peripheral arterial disease results in:
Not enough blood reaching your feet
Increased risk of foot infection
Delayed healing for foot wounds
Deformity in the foot is calculated by assessing the following 6 factors:
Muscle wasting (muscles becoming smaller) in the forefoot
Complete collapse of the arch in your foot (standing on the middle of your arch, not your heel and ball of your foot)
Prominent 1st or 5th metatarsal head (bunion)
Prominent metatarsal heads under the ball of your foot
Hammer or claw toes
Limited joint mobility in your big toe joint or your ankle joint
When you have 3 or more of these factors we define your foot as having a foot deformity. Foot deformities increase pressure on the skin and if the pressure is enough or in combination with peripheral neuropathy or peripheral arterial disease the skin over the deformity may break down and become an ulcer.
Ulceration and Amputations
Peripheral neuropathy, peripheral arterial disease and foot deformity all increase your risk of developing foot problems such as infection or an ulcer. 15% of people with diabetes will develop a foot ulcer during their lifetime (3 in 20 people with diabetes). An infection or ulcer may progress to an amputation.
In 2004-2005, approximately 3,400 diabetes-related lower limb amputations were reported by the Australian Institute of Health and Welfare. 50% of these amputations were major (below or above the knee) and 50% were minor (foot or toes). Of those who have an amputation, about half will experience a subsequent amputation on the other foot or leg.
How do I look after my feet?
Read my diabetic foot care blog post.
2011 NHMRC Prevention, identification and Management of Foot Complications in Diabetes.