DIABETES MELLTIUS

People who have diabetes mellitus are more likely to develop certain medical problems than are people who do not have diabetes. These problems include an abnormal sensation in the feet, kidney problems, heart attacks, eye problems and foot sores. Good medical care can help prevent these complications.

Diabetes and the Nervous System
Occasionally, diabetes can cause problems with the way your nerves work. When this happens, it can cause a numbness, tingling or discomfort in your feet and is called "diabetic neuropathy." Usually, it is not a severe problem and it may resolve without any treatment. If the symptoms become troublesome, diabetic neuropathy can be treated with medicines.

Diabetes and the Kidneys
Diabetes can damage your kidneys. This is referred to as "diabetic nephropathy." If this complication is not treated, the disease can become so severe that you may develop kidney failure and require either kidney dialysis or a kidney transplant. Diabetic kidney disease is more likely to occur if you have high blood sugars, untreated high blood pressure and if you smoke.From time to time, I will check for evidence of diabetic kidney disease by ordering some blood and urine tests. If I find that you have diabetic kidney disease, I will monitor your kidneys more frequently and I may recommend a special diet; I may also elect to treat your kidneys with a blood pressure medicine.

Diabetes, Heart Attacks and Strokes
Patients with diabetes are more likely to develop "hardening of the arteries," which can cause a heart attack or stroke. In order to minimize this possibility, it is essential that you do not smoke cigarettes. It is also important that your blood pressure, cholesterol level and weight are all normal. If I find that your blood pressure or cholesterol level is too high, you will be treated either with a special diet or medicines. Obviously, you should also not allow yourself to be overweight.

Diabetes and the Eyes
Diabetes can damage the blood vessels in your eyes, this is called "diabetic retinopathy." If not properly treated, diabetic retinopathy may lead to blindness. For this reason, it is essential that you see an ophthalmologist (eye doctor) about once a year. Patients who have diabetic retinopathy are sometimes treated with "laser eye surgery" to prevent the disease from getting worse. It has also been demonstrated that the likelyhood of developing diabetic retinopathy is markedly reduced if your blood sugars are very well controlled (this is called "tight control.") In order to achieve tight control, you may need to measure your blood sugars at home several times a day.

Diabetes and the Feet
Diabetics can develop sores on the bottom of their feet. If these sores are not treated immediately, they may result in a bone infection. This is a serious complication which may require 6 weeks of intravenous antibiotic therapy. In some cases, the antibiotics do not work and the foot or leg must be amputated. In order to prevent this from happening, it is essential that you examine the bottoms of your feet every day. If you see an area of redness or a sore, do not walk on the sore and call me within 24-48 hours. All people who have diabetes should wear good quality shoes or running shoes and should change their shoes at least once a day. People who have had problems with diabetic foot sores should change their shoes twice a day. It is also important that you do not smoke because diabetics who smoke are more likely to have diabetic foot ulcers.

Clean Feet - The First Step

• Clean your feet every day with a soft brush, lukewarm water, and mild soap.
• Pay special attention to the areas between your toes.
• Dry by blotting or patting—instead of rubbing.
• Powder your feet lightly after washing, using powder that is mild and unscented.
• Use a moisturizer for dry skin, but don't put any between your toes.
• Never go barefoot. Always wear some type of footwear–slippers, shoes, sneakers.
  

The Right Way to Trim Your Toenails

• Always trim your toenails straight across.
• Use an emery board to file any sharp edges.
• Don't ever cut the nail so short that the toe will bleed or become raw.
• Be careful not to disturb your cuticles because they are there for your protection.
• Keep your toenails trimmed properly; never let them become too long.
  

Keep Your Eyes On Your Feet

• Look your feet over every day for cuts, blisters, or sores.
• If your feet are cold at night, wear loose-fitting socks to bed.
• Avoid very hot or very cold water.
• Never use Epsom salts, heating lamps, hot water bottles, heating pads, or compresses near your feet.
• Never treat corns, bunions, calluses, blisters, or ingrown toenails yourself—you could cause a very serious problem. Contact your podiatrist or physician to treat these conditions or any foot problem that does not improve.
  

For Fit Feet, Wear Shoes That Fit

• Wear only cotton or wool socks when you wear any type of footwear.
• Avoid elastic socks, garters, and socks that have holes or mends.
• Before putting on your shoes, check inside for any foreign objects or tears in the lining.
• Shoes should fit well—with plenty of room for your toes.
• Avoid pointed or open-toed shoes.
• Sandals or thongs may cause problems.
• New shoes should always be broken in slowly. Start by wearing them for 1 hour on the first day. Increase the time by 1 hour each day, gradually building up to a full day.
• Plan ahead. Purchase new shoes before your old ones wear out.
• Consider changing your shoes at least once a day.
  

Hayward Zwerling, M.D. is a Fellow of the American College of Physicians and of the American Association of Clinical Endocrinologists. He is board certified by the American Board of Internal Medicine in Internal Medicine and Endocrinology.