Diabetes and Feet — What's the Deal?

Why and how to take that extra care

Joy Pape By Joy Pape, RN, BSN, CDE, WOCN, CFCN

You have diabetes. You understand having diabetes means you have a problem with glucose (sugar) in your blood. You may have heard that people with diabetes have to take extra good care of their feet, but do you know why? Do you know what to do?

It's always easier to do something when you understand why you are doing it, so let's first look at how and why diabetes can affect your feet. Start off by thinking of some basics, your blood glucose, your nerves, and your circulation. Understanding these three aspects of diabetes will get you pretty well on your way to understanding the relationship of diabetes and your feet.

Blood glucose levels above the normal range can affect your nerves and your circulation, causing damage to either or both systems.

Nerves – Your nerves help you feel. If you touch something hot, it's your nerves that communicate with your brain to tell you to back off or you'll hurt yourself. You may not hear it in words, but you have experienced what seems to be automatic movements. Your fingers touch something hot, and you quickly remove your hand from the hot item so as not to burn your fingers. You can relate to this when it comes to pricking your finger for your blood glucose. You have a lot of nerves in your fingertips, so it may be more painful to prick your finger than other areas of your body. Many people avoid checking their blood glucose often enough because they say it hurts. This is also one of the reasons we seek alternative blood glucose monitoring sites and for more non-invasive (no skin prick) ways to check your glucose levels. When your nerves have been exposed to blood glucose levels above normal, your nerves can become damaged or not work as they should. The nerves of your hands and feet are usually the first to be affected because they are furthest away from your heart. That is why when speaking of your fingers and feet we use the word peripheral which means the outer boundary or outermost part from your center, your heart. Neuropathy means nerve damage. Hence, the term peripheral neuropathy, damage to the nerves farthest from the center.

Circulatory System – Your heart and blood vessels make up your circulatory system. Your blood travels through your vessels to feed all parts of your body. Your nervous system and circulatory system are closely related. Again, this is where we get the term peripheral neuropathy.

When working correctly, your nerves and circulation can protect you from pain and injury. For example, if all is working as it should, you would not normally have foot pain. If you did, it would usually be a sign for you to take note of. For example, if you have a pebble in your shoe, you would feel it and know to take your shoe off and get rid of the pebble. In this way pain is a protective mechanism.

When you have peripheral neuropathy caused by high blood glucose levels, you might have weird feelings in your fingers and/or feet like tingling, hot or cold sensations, irritation when anything touches your sensitive area, pain all the time, or no feeling whatsoever. These feelings are uncomfortable, painful and can cause severe injury and illness.

Although weird feelings and pain are problems – big problems – health care providers are most concerned when peripheral neuropathy causes a lack of feeling. Think about that pebble-in-your-shoe scenario again. If you have this type of peripheral neuropathy you won't feel that pebble, so you'll continue to walk on it rather than remove it. The prolonged pressure from the pebble will most likely cause a sore you may not be aware of. Then, due to circulation problems, and elevated blood glucose, it may not heal. If it doesn't heal, this open area can become infected. Many people who have no feeling aren't even aware of an infected wound like this because they can't even feel the pain of an infection. Once detected, many times it is too late for the wound to heal, so the infected area plus the surrounding area must be surgically removed. This is why people with diabetes have an increased rate of amputations. They have lost the protection that would have told them trouble is brewing. This is the bad news. The good news is that foot problems and amputations for the most part can be prevented. Visit the American Podiatric Medical Association for a checklist to start keeping your feet healthy for life.

Read Joy's bio here.

Read more of Joy Pape's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

Last Modified Date: July 08, 2013

All content on dLife.com is created and reviewed in compliance with our editorial policy.

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by Brenda Bell
Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...
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