Serious complications associated with diabetes include stroke, heart disease, blindness, kidney disease, high blood pressure, nervous system diseases, and amputations. There are many factors which contribute to the development of ulcerations in the feet. Let’s start by looking at the two main effects of diabetes on the feet: the impact of the elevated blood sugar on the circulation and the nervous system.
When we talk about circulation, we are referring to the blood circulating in the body through the blood vessels. The arteries carry blood with oxygen and nutrients from the heart to the tissues. The veins carry blood with CO2 and other waste products back to the heart and lungs to be excreted. By far, the worst circulation problem is caused when the blood, oxygen and nutrients can’t get to the lower extremities. High blood sugar can contribute to hardening of the arteries, making blood flow and nutrient transfer to tissues difficult. Without vital nutrients and oxygen, the feet and toes can become cold and painful, the skin changes color and even the smallest cut or scrape or infection will be difficult to heal. Smoking also causes problems with circulation to the feet and in combination with diabetes, usually results in disaster.
Your nerves tell you what types of sensations you are feeling, whether you are feeling something that is hot, cold or painful. The nerves control movement in your body and also control functions like breathing, heart rate and sweating. We typically don’t think of pain as a good thing, but pain tells your body something is wrong. For example, if you were to step on a sharp object, the pain signal would be sent to the brain and in response to this pain, you would pick your foot up, off the sharp object.
In diabetics, the nerves can lose their ability to sense pain. There are many theories for why this happens:
Regardless, the result is the same. There is a loss of sensation in the feet and sometimes in the hands. This is called Diabetic peripheral neuropathy.
Diabetics develop ulcerations because of the lack of feeling in their feet due to diabetic peripheral neuropathy. The ulcerations don’t heal because of the constant pressure and rubbing on the ulcer or because of poor circulation. For this reason, treating diabetic ulcers is difficult. Preventing diabetic ulcers is not.
Take these steps to help prevent diabetic foot complications:
As a general rule Diabetics should have a vascular and neurological assessment every 6 months by a podiatrist.