Diabetes experiences: diabetic foot problem

Showing posts with label diabetic foot problem. Show all posts

Tuesday, 21 July 2020

Diabetic foot : what is it and how to examine your foot ?

I'd like to talk to you about the diabetic foot. People with diabetes can get complications with the foot due to excess sugar in the blood.

One of the common ones is problems with the nerves. There are two different sets of nerve systems in your body.

One is called the somatic system, which controls the motor nerves to make your body move back and forth, and the sensory nerves. And that helps you feel things. And then the other type of system is the autonomic nervous system, and that controls the contracture of smooth muscles and the fight and flight instincts that you have when you're under stress. And when the sugar affects those nerves, you have decreased function and you can get complications. Also, when you have extra sugar in your blood, it goes onto the linings of your arteries and makes them more prone to close down, called atherosclerosis or peripheral vascular disease. And this, obviously having decreased circulation to your foot can be a problem.

Another problem is that when you have decreased autonomic nerves, it changes the ability of the capillaries to have flow. The capillaries are where the arteries turn into veins. The very smallest vessels in your body. So that's called microcirculation. So you get microcirculation problems as well. When you have too much sugar in your blood it also affects the white blood cells. So that affects your ability to heal and fight infections. When you have sores on your feet, you're not gonna heal as fast as if you had good blood sugar. When you have excess sugar in your body, in your blood, it affects the skin and the nails. It makes them less healthy. You're more prone to get cuts in them, infections like athlete's foot, and fungus toenails. We spend a lot of time work in' on fungus toenails because having the excess fungus toenails ends up causing more foot problems. In addition, when you have too much sugar in your blood, it creates other issues in your body, such as problems with your kidneys.

Again, the microcirculation. Problem with your eyes. And when you have excess sugar in your blood, you generally don't feel well and this can lead to decreased mental happiness and satisfaction. All these things can lead to foot problems.

So when you have diabetes you have to take really good care of your feet. And the way you do that keeps your blood sugar under excellent control, Keep your hemoglobin A1c less than seven, preferably even lower than that. Also, no smoking. If you smoke with diabetes, you double your chance of amputation. So smoking just is not a good thing. We need to have a regular prevention program for yourself. You've got to look at your feet and inspect your feet on a regular basis. You gotta take care of your feet with gentle techniques, and I don't encourage razorblades or anything like that. And then a visit to the podiatrist might be helpful at least annually. And he can also help you with proper shoes and socks. So, in summary, diabetes can have a vast effect on the foot, and by proper prevention, you can save yourself a lot of misery.

Here are some instructions about diabetic foot self-examination tips. The things that can lead to problems with diabetic feet include progressive numbness in your feet called neuropathy. Or circulatory changes that can make sores difficult to heal if they develop. A diabetic foot exam is important such that you can detect problems early on in the process and deal with them in a timely fashion so as to avoid some of the later problems that can be catastrophic.

Now when you inspect your feet, you want to make sure that you have a good light source. You want to make sure you use corrective lenses if needed. And you want to make sure that you evaluate each and every part of your foot. If we look specifically at those parts, we start with the toenails and looking around the edges of the nails in particular. In between the toes, you want to make sure that you're not seeing any sort of cracks or fissuring within the skin.

And then a complete exam along the bottom of your foot. Now for some of us, it's difficult to accurately contort yourself or look at the bottom of your foot such that you're going to get that information back. Using a mirror can sometimes be helpful. Some mirrors may be equipped with a handle that can make it easier for you to look and inspect the bottom of your foot accurately. If this is not realistic for you, reaching out to friends or family to help you inspect your feet is an important thing to consider as well.

In particular, when you'reinspecting your feet, keep an eye out for bony prominences from one end of the foot to the other. In particular, look for the bony areas around your ankle, around the back or underside of your heel, and especially around the ball of the foot and toes. These are areas that can be easily irritated just from pressure from shoe gear, or from either lying in bed from the pressure from the underlying mattress. As part of your foot exam, you should also make sure to inspect your shoe gear and to make sure that they're fitting you properly, looking for signs of wear and tear with the shoes, and also to reach inside the shoes to make sure there are no foreign objects that could cause problems for your feet.

Now along with daily inspection of your feet, you should also keep these other things in mind. Proper foot hygiene is a must for every diabetic patient. And you should also look to avoid walking barefoot at all times. Make sure that the shoes that you wear fit you properly. If a problem develops, there are different ways it may present. For example, around the toenails, sometimes it'll be thickness, discoloration, or redness. Sometimes drainage from underneath the nail can present as an early warning sign or problem. In between the toes, redness, fissuring, or drainage can also occur. Open wounds or thickened skin on the bottom of your foot that can be painless can also be an early sign of a bigger problem. Your skin acts as a barrier for your entire body, including your feet. It's important to maintain that barrier. Anytime there's a breakdown, that's an opportunity for bacteria to get in there and cause a serious problem. If you see any signs of skin breakdown, redness, or swelling, especially in the absence of pain, it is extremely important that you reach out to your healthcare professional immediately.

Some diabetic foot problems can be treated fairly quickly and easily without too much interference in one's lifestyle. However, some problems can lead to more significant issues that can result in open sores with your feet. It can also lead to infection, hospitalization, or in the worst-case scenario, it could result in surgery or loss of limb. So in order to avoid this, you want to stay on top of things on a regular basis.

Hope you liked the article and from now onwards you will take care of your foot.

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Monday, 20 July 2020

Complication that you as a diabetic can face !!

Diabetes is a group of metabolic diseases characterized by hyperglycemia (high blood sugar) that results from defects in insulin secretion, insulin action, or both, and affects multiple systems of the body. Uncontrolled diabetes can cause metabolic imbalance leading to acute complications, requiring immediate medical attention. Ongoing hyperglycemia will then develop into chronic complications.

Let’s start by looking at the acute complications that require immediate medical intervention. Hypo glycemia, or a blood glucose level of less than 60 mg/dL, is a potential complication of insulin therapy or oral hypoglycemic agents. It can also be caused by skipping a meal, inconsistent carbohydrate intake, over-exercising, or alcohol consumption. Common signs and symptoms of hypoglycemia may be adrenergic (caused by activation of the sympathetic nervous system) or neuroglycopenic(which is caused by depression of central nervous system acts as the brain receives an insufficient supply of glucose).

Adrenergic symptoms usually result from a rapid drop in glucose and occur first, including being pale, sweaty, having tachycardia, palpitations, nervousness, irritability, feeling cold, weak, trembling, and hungry. The particular signs and symptoms vary depending on the blood glucose level, how fast the glucose level dropped, and the duration of hypoglycemia. When hypoglycemia is slow-developing, as with long-acting insulin or with oral hypoglycemic agents, the central nervous system signs and symptoms predominate. Those signs include headache, mental confusion, numbness around the mouth, incoherent speech, double vision, fatigue, emotional lability, convulsions, and coma. If a rapid drop in blood sugar occurs and is allowed to persist, both the sympathetic and central nervous system signs usually occur.

The diabetic patient should be educated about recognizing signs of hypoglycemia and how to treat it. As long as the patient is conscious, they should self-treat with 15 g of quick-acting carbohydrates, such as 4 oz of juice (no added sugar), 3-4 glucose tablets, or 3 hard candies. Recheck the fingerstick blood glucose in 15minutes and if it remains below 60, the patient should self-treat again. In an unconscious patient, never try to give oral glucose. In the hospital setting, one ampule of 50% dextrose is given IV push. In the outpatient setting a friend or family member can inject 1mg of glucagon subcutaneously, which causes the liver to release its glycogen store. The patient will usually regain consciousness within 10-20 minutes, and should then eat a snack of 45g carbohydrates to aid in replacing glycogen stores. Patients are often nauseated after receiving glucagon and may vomit.

When hypoglycemia is severe, seizures may also occur. Diabetic ketoacidosis (DKA) is another serious acute complication when excess blood acids, called ketones, build up in the body. Ketones are formed when the body burns fat for fuel instead of glucose. This can occur when there is not enough insulin in the body to process sugars. DKA is triggered by illness or not taking insulin. The progressive hyperglycemia causes glucose to spill out into the urine, resulting in water and electrolyte losses, causing dehydration and an increase in thirst. The lack of insulin and the corresponding elevation of glucagon leads to increased release of glucose by the liver as well as ketone bodies, which are acidic and must be cleared from the circulation. DKA can occur in patients with type 1 or type2 diabetes, but it’s rare with type 2. The risk for DKA is increased with type 1 diabetes, under age 19, stress, physical or emotional trauma, high fever, heart attack, stroke, smoking, or drugs/alcohol. Signs and symptoms of DKA include high blood sugar levels, high levels of ketones in urine, fruity-smelling breath, flushed face, nausea and vomiting, abdominal pain, rapid deep gasping breaths, frequent urination, extreme thirst, dry mouth and skin, weakness, confusion, and loss of consciousness. If left untreated, DKA can lead to coma or death. Treatment involves rehydration with IV fluids, insulin therapy, and electrolyte replacement. Hyperglycemic Hyperosmolar Nonketotic Syndrome(HHNS) has some similarities to DKA but is an acute complication of type 2 diabetes. The differences include profound dehydration, with the fluid deficit as high as 8-9 liters. Blood sugar levels are higher, with serum glucose levels in the range of 600 to 2000. Ketosis is absent because patients with type2 diabetes have insulin secretion to prevent ketosis. The kidneys try to get rid of the extra blood sugar by putting more glucose into the urine, which increases urination and loss of body fluid, causing dehydration.

Dehydration makes the blood thicker and the blood sugar level is too high for the kidneys to be able to fix. This also causes an imbalance of minerals in the blood, especially sodium and potassium. This imbalance of fluids, glucose, and minerals in the body can lead to severe problems, such as brain swelling, abnormal heart rhythms, seizures, coma, or organ failure. Without rapid treatment, HHNS can cause death. Primary treatment involves IV rehydration, which resolves the hyperglycemia, so IV insulin is usually not needed.

Ok, now let’s look at the chronic complications of diabetes, that develop from ongoing hyperglycemia. They are classified as microvascular or macrovascular. These complications are a result of the length and degree of hyperglycemia. Microvascular complications affect the smaller blood vessels, such as the eyes (leading to diabetic retinopathy), kidneys (leading to diabetic nephropathy), and nerves (leading to neuropathy). The effects of high blood glucose as well as high blood pressure can damage eye blood vessels, causing retinopathy, cataracts, and glaucoma. Diabetic retinopathy is the leading cause of new blindness among adults 20 to 74 years old in the United States. High blood pressure also accelerates the development and progression of retinopathy. Diabetic nephropathy is the leading cause of end-stage renal disease in the US, with 20% of all diabetic patients having nephropathy.

Excess blood glucose overworks the kidneys and high blood pressure damages the small blood vessels. Microscopic amounts of albumin in the urine is the earliest lab abnormality, which may then progress to albuminuria (clinical proteinuria). Aggressive blood pressure control lessens the albuminuria, decreases the rate of deterioration of the kidneys, and improves survival. Diabetic neuropathy affects 60-70% of diabetic patients and involves damage to nerves in the peripheral nervous system. The most common symptoms involve numbness in the legs or feet; but depending on the nerves affected, it can also cause shooting pains; problems with the digestive system, urinary tract, blood vessels, and the heart. The microvascular disease may also impair skin healing, so that even minor breaks in the skin can develop into a major infection and deep ulcer, especially in the lower extremities. Control of blood glucose can prevent or delay many of these complications, but may not reverse them once established. Macrovascular complications involve atherosclerosis of large blood vessels, such as those supplying the heart, brain, and extremities. This can lead to angina, myocardial infarction, transient ischemic attacks, strokes, and peripheral arterial disease.

Cardiovascular disease is 2 to 4 times more prevalent in diabetic patients and is responsible for approximately 75% of diabetes-related deaths. Diabetic foot syndrome is common among diabetics due to the atherosclerosis of the blood vessels to the extremities. It results from 3 factors: neuropathy, ischemia, and sepsis. Loss of sensory nerves in the feet leads to painless trauma and potential ulcer formation. The lack of blood supply (ischemia) results in slower healing and possible sepsis. These events can result in gangrene and ultimately amputation.

Blood sugar control is so important, as well as IV antibiotics to limit the spread of infection. Foot care is an important aspect of diabetic teaching, with proper toenail trimming and the use of orthotic shoes to prevent ongoing trauma associated with a diabetic foot. Immune dysfunction is another major complication, developing from the direct effects of hyperglycemia on cellular immunity. Therefore, diabetic patients are especially susceptible to bacterial and fungal infections. In order to prevent and avoid the complications associated with diabetes, achieving and maintaining adequate control of blood sugar, diet, exercise, medications, monitoring, and education is a must.

Let’s go over a couple of questions for review: A patient presents with a blood glucose of 425, positive ketones in their urine sample, weakness, vomiting, and fruity-smelling breath.

What complications of diabetes are they exhibiting?

A. Hypoglycemia

B. Nephropathy

C. Diabetic ketoacidosis

D. Hyperosmolar Hyperglycemic State

If you chose C, diabetic ketoacidosis, you’re right!

Those are all signs and symptoms of the acute complication of DKA.

Here’s another one - Microvascular chronic complications include which of the following?

A. Diabetic retinopathy and peripheral vascular disease

B. Diabetic nephropathy and diabetic neuropathy

C. Cerebrovascular disease and coronary artery disease

D. All of the above

If you chose B, diabetic nephropathy, and diabetic neuropathy, you’re correct! Microvascular complications affect the smaller blood vessels leading to neuropathy, nephropathy, and retinopathy.

Thank you for reading this article about the complications of diabetes!