INTRODUCING DIABETES

Diabetes is one of the oldest known diseases: an ancient Egyptian medical text, the Ebers Papyrus, written in 1500 BC, mentions diabetes symptoms and suggest treatments. However, it was not until just over a century ago that a British surgeon named Pryce made the statement that “diabetes itself plays an active part in the cause of a perforating ulcer.” It is not within the scope of this book to go deeply into the nature of diabetes but it is worth just explaining the link between diabetes and the diabetic foot ulcer.




Put simply, diabetes is a condition in which the body cannot use foods properly. In this condition, glucose (the simplest form of sugar in our blood that gives us energy) simply rises in concentration until it has reached unacceptable levels.

HOW DO PEOPLE BECOME DIABETIC?

Normal levels of glucose in the blood, before eating, are in the range 4.0 – 7.0 mmol per 1 litre of blood. Anything higher than this is classified as hyperglycemia. When the glucose or sugar reaches 12.0 mmol per 1 litre of blood, the body tries to eliminate the excess sugar or glucose by drawing water from the body tissues, which causes the person to need to visit the bathroom more frequently.

The key reason for the body not being able to get the sugar out of the blood is due to a chemical called insulin, which is produced by the body in an organ called the pancreas. Insulin helps the sugar move out of the blood into the body cells in the leg, arm, head and so on, thereby providing the energy a person needs in order to run, walk, think and carry out the activities of everyday living.

In the case of some people who have diabetes, injections of insulin can be instrumental in controlling the condition. For others, insulin is not needed; instead, a careful diet, exercise and oral medications will control the situation.

This defensive reaction on the part of the body to get its blood sugar or glucose levels back to normal can create one or more of the following symptoms: (Note any that you experience)

❑ Excessive thirst
❑ Weight loss
❑ Infections
❑ Itching
❑ Numbness, pain or tingling in the hands or feet
❑ Fatigue, Weakness
❑ Increased Appetite
❑ Slow Healing Of Wounds
❑ Changes In Vision

You now know that the effect of diabetes is to increase the levels of blood sugar (glucose). This increased blood sugar level contributes in the following two ways to the development of foot ulcers:

1. NERVE DAMAGE

Known medically as peripheral neuropathy (PN for short). This is a breakdown or disorder of your nerves near the surface of your feet. (“Peripheral” means near the surface and “neuropathy” means disorder of the nerves.) The exact incidence of PN is difficult to assess. However it is estimated that 10% to 20% of people with diabetes have PN; as the years pass, this figure can increase to over 50%.

2. BLOOD CIRCULATION PROBLEMS

Known medically as peripheral arterial disease (PAD for short), this simply means problems with your blood circulation system near the surface of your feet. Another word your medical team may use for this problem is ischemia, which means poor blood supply. Keeping in mind that “peripheral” means near the surface while arterial relates to the arteries, you can see that PAD is a disease near the surface, related to the arteries. Sometimes your medical team may say peripheral vascular disease, and in this case “vascular” means all blood vessels (including veins) instead of just arterial.

There can be many causes of blood circulation problems; certainly diabetes can cause blood vessels to age and harden faster than normal. However, poor circulation can also be caused by arteriosclerosis, where the arteries become rigid and hard. Also, veins can become blocked or narrowed so fluid and waste materials spill out into the surrounding foot.

These two factors are the primary reasons for foot ulcers associated with diabetes. One of these problems may dominate but the cause of a foot ulcer is always a combination of both nerve damage and blood circulatory problems. By understanding how these two conditions – PN and PAD – contribute to foot ulcers, you will have a greater understanding of your treatment and be more receptive to what you need to do to help yourself.

Imagine that during the night while you are sleeping, your heel is pressing against a wooden part of your bed. If no nerve impulses are sent to your brain, you may remain in that position for a considerable length of time. This can cut off the blood supply to that skin area and an ulcer may start to develop. It has been shown that a mere five to seven pounds of pressure on a bony prominence can cause damage and destruction to the surface blood vessels in just seven hours.

The diagram shows where you can develop foot ulcers most easily.