Diabetes - An Overview

Diabetes is a medical condition characterized by elevated blood sugar. Having diabetes has a number of important implications for foot and ankle problems. Diabetes occurs either because the pancreas does not produce enough insulin [type 1 diabetes.] In this situation, insulin is what helps to lower the blood sugar. The second and more common situation is when the cells of the body are resistant to insulin and, therefore, the effect of insulin does not serve to decrease the blood sugar the way that it normally would [type 2 diabetes].

Over time with elevated level of blood sugar, the tissues will often become stiff as they get saturated with the sugar. Tissues that get affected include muscles and tendons, which tend to make them stiffer, as well as nerves leading to nerve dysfunction and abnormal sensation. In addition, blood vessels can be damaged leading to decreased blood flow particularly to the small arteries.

The two main problems related to diabetes in the foot are decreased circulation, which can tend to occur with longstanding diabetes. The second problem is decreased sensation to the foot. This is the most the important problem that diabetes creates. Altered sensation to the foot means that individual cannot feel pressure and pain sensation on the foot normally. This can lead to repetitive microscopic and eventually macroscopic injuries such as diabetic ulcerations or stress fractures [Charcot arthropathy].

Treatment

Treatment of diabetes is very important. It is critical that patients maintain an appropriate blood sugar level. An appropriate treatment regimen should be developed in close consultation with the patient’s primary care physician. Treatment of type 2 diabetes might simply involve keeping a careful track of the patient’s diet so as to avoid excessive simple sugars and carbohydrates. If simple diet modifications are not enough, there are some oral medications [oral hypoglycemics].

If diet and oral medication is not enough to control the type 2 diabetes, then insulin may be required.

Treatment of type 1 diabetes usually requires regular insulin injections. Regardless of the type of the diabetes, it is critically important that patients work very closely with their primary care doctors, so as to maintain tight control of their blood sugar levels.