FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

CONTROLLING BLOOD SUGAR KEY TO PREVENTING DIABETIC FOOT PROBLEMS

Question: I have diabetes, but I don't need insulin. I watch my diet and take the "diabetic pills" my doctor prescribes. Do I have to be concerned about foot problems like diabetics that require insulin do?

Answer: Though "diabetes mellitus," as we doctors call it, can often be controlled, it should never by taken lightly. Diabetes is the 7th leading cause of death in the U.S., according to a recently published report by the Centers for Disease Control and Prevention. This figure underestimates the devastating role of this disease, because diabetes causes a number of health problems including the foot disorders you are asking about.

Diabetic foot troubles result from two abnormalities caused by the disease poor circulation and decreased sensation.

In diabetes, poor circulation is a result of the damage to blood vessels that the disease produces. People taking "diabetic pills" and those on insulin are both vulnerable to this complication. The key to reducing the risk of blood vessel damage is keeping the blood sugar at normal levels all the time. Some diabetics can keep their sugar at less than 110 when they are fasting and never over 180 after meals the same levels as individuals without diabetes by strictly following a diabetic diet. Others, like you, need medication taken by mouth, along with the ever-important diabetic diet. And, those with the type of diabetes that is the most difficult to control need to use insulin. Currently, the only effective method for taking insulin is by shot, and it must be given one or more times each day.

In short, vigilance in keeping blood sugar levels under control is the crucial factor. When this is not done, poor circulation to the feet can develop and increase susceptibility to infection and in the most severe cases to tissue death from lack of blood supply. This is a condition you probably know as "gangrene."

As I mentioned, the second condition that contributes to a diabetic's foot troubles is a diminished sense of touch in the feet and legs. This makes the individual less likely to notice and take care of small cuts, blisters or sores; and, therefore, these minor injuries are more likely to develop into infections and ulcers.

Question: Are there special things I should do to protect my feet in addition to watching my diet and taking my medicine?

Answer: Yes, the idea is to prevent trouble or to spot it before a really big problem develops. I recommend that you wash your feet in warm, not hot, water every day. Look at them for signs of sores from tight or rubbing shoes. Make sure the skin appears healthy all over. Pat, don't rub, your feet dry, and then apply a moisturizing lotion. Check your toenails to be sure they are neatly trimmed, cut straight across and filed smooth. Wear clean socks each day. Also, be sure that your shoes are in good condition and fit snugly without being tight. A substantial cushion in the insole is also a good idea to spread out the pressure produced by the weight of your body when you stand or walk.

There are some other steps you can take (pun intended) to protect your feet. Take your shoes off and put your feet up during the day whenever it is practical. Don't go barefoot! And don't try and treat corns, calluses or problem toenails yourself see your family doctor or podiatrist instead. I know that this may seem like I'm advocating unnecessary trips to the doctor for minor problems you could handle yourself. However, my experience as a family physician has given me a different perspective. I've, unfortunately, had to hospitalize too many individuals because they followed their own "good sense" instead of this simple advice for taking care of their feet.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.