Diabetes is a chronic disease that consists of the pancreas not producing insulin or a reduced sensitivity of the cells to the effects of this hormone. Insulin is needed for cells to absorb glucose; if the disease is not treated, the constant hyperglycemia damages organs and nerves, especially the small peripheral nerve endings that reach the eyes, feet and hands. According to the US Department of Health and Human Services, 60-70% of diabetic patients also suffer from some form of neuropathy. The feet are often the areas that show symptoms first, so learning what symptoms to look for and regularly monitoring your extremities helps you prevent irreversible damage and disability.
Steps
Part 1 of 3: Look for Sensitivity Changes in the Feet
Step 1. Be aware of the feeling of numbness
One of the initial and most common symptoms of peripheral neuropathy complained of by diabetics is loss of sensation and numbness in the feet. The disorder can start at the fingertips and then spread to the rest of the extremity up to the leg, a bit like a sock. Typically, both feet are affected, although one may show symptoms first or be more numb than the other.
- As a result of this phenomenon, the patient has difficulty in perceiving pain or excessive temperatures (both very high and very low); for this reason, it runs serious risk of getting burned while bathing or developing chilblains in winter.
- Chronic loss of sensation prevents the diabetic from knowing when he has a cut, blister or other damage to the foot; it is a very common phenomenon that can also lead to an infection. In some cases, the neuropathy is so severe that the extremity remains infected for a long time before the person notices it, bacteria can even reach deep tissues and bones. This serious complication requires a course of intravenous antibiotics and could even be fatal.
- Symptoms of peripheral neuropathy, such as numbness, are typically worse at night while in bed.
Step 2. Pay attention to the warning signs, such as tingling and burning sensation
Another common symptom is a series of annoying tactile perceptions, such as tingling, burning or stinging pain; they are sensations similar to those experienced when circulation returns to the foot after "falling asleep". This range of unpleasant perceptions, defined by the term paresthesia, varies in intensity, can be severe or mild, and generally does not affect both feet in the same way.
- The burning and tingling usually originates in the sole of the foot, although it can extend to the leg.
- These strange sensations are sometimes confused with symptoms of a mycosis (athlete's foot) or an insect bite, although diabetic foot is generally not itchy.
- Peripheral foot neuropathy develops because there is too much glucose in the blood which is toxic and harmful to small nerve fibers.
Step 3. Observe an increase in sensitivity, called hyperesthesia
This is another alteration of tactile perception which occurs in a minority of diabetics and which is exactly the opposite of paresthesia. The patient therefore, instead of complaining of a numb and insensitive foot, reports that the extremities are too receptive to touch or even hypersensitive; for example, the weight of the sheets in bed can be unbearable.
- This type of complication can present with the same characteristics as gout and even be confused with gout or severe inflammatory arthritis.
- The patient describes pain of an electrical or burning nature.
Step 4. Watch out for cramps or painful pangs
As peripheral neuropathy progresses, it begins to affect the muscles of the feet as well; one of the first signs of this development is represented by cramps or painful pangs, especially in the soles of the feet. These symptoms can be severe enough to prevent the patient from walking and can become very intense during the night when the person lies down.
- Contracting muscle fibers cannot be seen with the naked eye during diabetic cramps, unlike normal cramps.
- Furthermore, suffering does not seem to improve or go away with walking.
- This symptomatology can be confused with that of a stress microfracture or restless legs syndrome.
Part 2 of 3: Look for Other Changes in Feet
Step 1. Be aware of muscle weakness
When glucose enters the nerves, water follows it by osmosis; as a result, the nerves swell and die a little. If the affected nerve ending controls a muscle, it no longer receives any stimulation; it follows that the muscle fibers atrophy (reduce in diameter) and the foot becomes a little smaller. Extremity weakness affects gait which becomes unstable or wobbly; It is not uncommon to see longtime diabetics walking with a cane or using a wheelchair.
- At the same time as the foot and ankle weakness, the nerves carry the signal to the brain that coordination and balance are altered, thus walking becomes a real undertaking.
- Nerve damage and muscle / tendon weakness lead to reduced reflexes; at best, stimulation of the Achilles tendon produces a weak reaction (a slight tremor of the foot).
Step 2. Inspect fingers for deformities
If your muscles are weak and your gait is impaired, you are likely to walk abnormally and put more weight on your toes. this extra pressure and unnatural weight distribution trigger structural changes, such as hammer toe. In this case, one of the three middle fingers changes its shape at the distal joint, bending and taking on a hammer-like appearance. In addition to these anatomical changes, the uneven gait and lack of balance put some areas of the foot under more pressure than usual, with the probable development of ulcers which in turn can become infected and trigger a chain reaction of complications.
- Hammer toe typically resolves spontaneously over time, but corrective action may be required.
- Another deformation typical of diabetic people is hallux valgus, which develops when the toe is constantly pressed from the shoe towards the other toes.
- It is very important that diabetic patients wear loose footwear to avoid the risk of anatomical alterations of the feet; women in particular should never use high heels.
Step 3. Be very careful with any signs of injury or infection
In addition to the risk of falling and suffering a fracture while walking, the most serious complication a diabetic faces is a foot injury. Many times, the person does not perceive minor injuries, such as abrasions, small cuts, blisters or insect bites, precisely because of the reduced tactile sensitivity; as a result, these trivial injuries become infected and can lead to the loss of the toes or the entire foot if not treated promptly.
- Visual indications of an infection are significant swelling, dark skin color (red or bluish), presence of whitish purulent secretions and other fluids from the wound.
- Infections typically start to smell when the wound oozes pus and blood.
- Chronic diabetics also have difficulty healing wounds because the immune system is compromised; therefore, even small minor lesions can last a very long time increasing the risk of infections.
- If a small cut becomes a troubling open ulcer (such as a large sore), see your doctor right away.
- Diabetics are advised to check their soles of their feet once a week or ask their doctor to carefully inspect their lower extremities at each visit.
Part 3 of 3: Looking for Other Signs of Neuropathy
Step 1. Look for similar signals in the hands
Although neurological disease typically begins in the lower extremities, especially the feet, it eventually spreads to other peripheral nerves that control the fingers, hands, and arms. For this reason, you need to be vigilant and also inspect the upper body for the same clues and complications as described above.
- Just as the symptoms of the feet evolve down the leg like a sock, those that affect the hands spread like a glove (from the fingertips to the arms).
- Diabetes-related symptoms that occur in the upper limbs may be similar or confused with those of carpal tunnel or Raynaud's syndrome (arteries narrow more than normal when exposed to cold).
- It is much easier to check the hands regularly than the feet, as the feet are often hidden by socks and shoes.
Step 2. Monitor yourself for signs of autonomy
In this case, the disease affects the nerves that control automatic functions, such as the heartbeat, bladder, lungs, stomach, intestines, eyes and genitals. Diabetes alters these nerves by triggering a number of different complications, such as tachycardia, hypotension, urinary retention or incontinence, constipation, bloating, loss of appetite, difficulty swallowing, erectile dysfunction, and vaginal dryness.
- Uncontrolled sweating (or its complete absence) in the feet and other parts of the body is an indication of dysautonomia.
- The spread of this condition eventually causes organ dysfunction, such as heart disease and kidney failure.
Step 3. Pay close attention to impaired vision
Both peripheral neuropathy and dysautonomia can affect the eyes, as small blood vessels are destroyed by glucose toxicity. In addition to the risks of infections and the fear of a possible foot or leg amputation, blindness is often the main fear of the diabetic patient. Ocular complications include decreased ability to adapt to darkness, blurry vision, watery eyes, and gradual reduction in visual acuity leading to blindness.
- Diabetic retinopathy affects the blood vessels of the retina and is the most common cause of vision loss among the diabetic population.
- In fact, an adult with diabetes runs a 2-5 times greater risk of having cataracts than an individual with a normal blood sugar.
- The diabetic eye is more prone to cataracts (clouding of the lens) and glaucoma (ocular hypertension and damage to the optic nerve).
Advice
- If you have diabetes, even if it is under control with medication, you should inspect your feet daily for symptoms of related complications.
- If you notice any signs or discomfort described above, make an appointment with your family doctor or diabetologist and bring the situation to their attention.
- Trim your nails regularly (every week or two) or go to the podiatrist if you are concerned about injuring your feet.
- Always wear socks, shoes, or slippers when you're at home. Do not walk barefoot and do not use shoes that are too tight as they increase the risk of blisters forming.
- If you are diabetic, you may notice that your feet sweat more and have a shiny appearance. if you experience this problem, change your socks often to keep them dry.
- Wash them every day with warm soapy water (but not hot), rinse them thoroughly and pat them dry without rubbing; remember to dry the area between the fingers with particular care.
- Consider taking salt water foot baths often; this simple precaution sanitizes the feet reducing the risk of bacterial infections.
- Dry foot skin can crack and blister, so remember to keep it hydrated. use cream or petroleum jelly to lubricate dry areas, but don't apply it between your fingers.
Warnings
- If you notice black or green areas on your feet, call your doctor right away as it could be gangrene (tissue death).
- Applying the cream between your fingers can cause fungus to develop.
- If you develop a sore in your feet or have a wound that doesn't heal, see your doctor right away.
