Diabetic foot


Diabetes mellitus (DM) is a metabolic disorder in which the body can not produce or effectively use the hormone insulin. Insulin is a hormone that is responsible for enabling the conversion of sugar into energy in the cells of the body, and if this function is impaired, blood sugar (glucose) levels can become abnormally high.

A prolonged period of time with high glucose levels in the blood can lead to damage of various body parts, including the feet. Besides diabetic neuropathy, diabetic foot is one of the major complications of diabetes. Moreover, the abnormally high glucose level in blood can cause some changes in blood vessels, including arteries.

So, in peripheral vascular disease, fat deposits are leading to an obstruction of blood vessels that supply the brain and heart, while diabetes tends to affect the blood vessels going to and from the extremities also, reducing the blood flow to the arms and feet.

Reduced blood flow can cause pain, slow wound healing, and infections that may progress to a state where amputation is needed.

Risk factors for diabetic foot

There are various risk factors that increase the chance for the development of diabetic foot and leg infections in people with diabetes. Some of the most important ones are:



Unsuitable shoes are a common cause of problems with feet in people with diabetes. If a patient has dry and red skin, rash or constant pain associated with footwear, it is necessary to get appropriate shoes as soon as possible.

If a patient has common abnormalities in the legs, such as flat feet, bunions or clinodactyly, special shoes or appropriate inserts may be necessary.


People with long-term or poorly controlled diabetes are at risk of nerve damage in legs, and this phenomenon is known as peripheral neuropathy.

Due to damage to the nerves, the patient may have a reduced ability to feel the pain in legs. Moreover, they may not be able to feel the position of their feet and fingers while walking and balancing. With fully functional nerves, a person can usually feel that their shoes are rubbing with their feet or if one part of the foot is pushed to the ground while walking.

People with diabetes may not be able to properly experience minor injuries such as cuts, scratches or calluses. Usually, people can feel the presence of stones in shoes, and then they can immediately remove them. A person with diabetes may not be able to spot a stone, and this constant rubbing can easily create an injury.

Poor circulation

Diabetes can lead to hardening of arterial walls or atherosclerosis, especially if it‘s not under control. When blood flow to damaged tissue is inadequate, the healing process can not be done properly.

diabetic foot infection


Athlete‘s foot, fungal skin or nail infection, can lead to more serious bacterial infections that need to be treated immediately. If a toenail gets ingrown, it should be immediately reported to a doctor.


Smoking of any form of tobacco causes damage in small blood vessels of the feet and legs. These damages can disrupt the healing process and they represent the main risk factor for infections and amputations. The importance of quitting smoking can never be overemphasized.

Treatment of diabetic feet

You need to avoid walking to prevent pain and ulcers. This is recommended for all forms of diabetic foot problems because the pressure done by walking can aggravate the infection and the spread of the ulcer.

A doctor may sometimes recommend you some orthopedic appliances such as diabetic shoes, a compression bandage or footwear inserts or they can treat diabetic foot by debridement, removal of the dead skin, foreign objects, or infected tissue that are possible causative agents of the ulcer.

Pharmaceutical treatment

A doctor may prescribe you some antibiotics, antiplatelet or anticoagulant drug to treat ulcer if the infection progresses. The most common bacteria that cause infections of diabetic foot are Gram-positive bacteria, such as Staphylococcus aureus or beta-hemolytic streptococci. Severe conditions are usually infected with different types of bacteria.

Chronic kidney disease

Chronic kidney disease

Chronic kidney disease (chronic kidney insufficiency / chronic renal failure) is a disorder in which kidneys are losing their function gradually over time. That process usually takes months or years. It can not be reversed, but with early diagnosis, appropriate treatment and some changes in lifestyle, it can slow down or in some cases even stop.


This disease represents a huge health problem and it is often associated with cardiovascular diseases. Millions of people die every year due to this problem, and around 10% percent of the human population is affected by it. People with hypertension or diabetes have a greater chance of developing chronic kidney disease. Chronic kidney disease is also a major financial problem, as many people can’t afford to treat it effectively.

Classification of chronic kidney disease

Chronic kidney disease can be classified due to the severity of condition on 5 stages, from very mild stage 1 to end-stage 5.

Glomerular filtration is the ability of kidneys to filtrate waste products and excess fluids into urine collecting tubules allowing their elimination. Stages of renal failure are divided by the glomerular filtration rate.

Stage 1 – There is mild kidney damage with normal glomerular filtration rate ≥ 90 ml / min / 1.73 m2

Stage 2 – There is mild kidney damage with lowered glomerular filtration rate between 60 and 90 0 ml / min / 1.73 m2

Stage 3 – There is a moderate kidney damage with glomerular filtration rate between 30 and 60 ml / min / 1.73 m2

Stage 4 – There is moderate or severe kidney damage with glomerular filtration rate between 15 and 30 ml / min / 1.73 m2

Stage 5 – There is severe kidney damage where they are about to or at complete failure with glomerular filtration < 15 ml / min / 1.73 m2

chronic kidney disease

Signs and symptoms

Signs and symptoms of chronic kidney disease often nonspecific showing up only after kidney suffer irreversible damage. One of the most characteristic signs of chronic kidney disease is swelling around eyes, ankles or other body parts due to the inability of kidneys to remove excess water or because of increased protein loss. Also, changes in urination may occur. As most of the signs and symptoms are nonspecific they include various organs and systems of organs, and some of them are:

Cardiovascular disorders which include hypertension, heart failure, arrhythmia, and pericarditis.

Manifestations of the central nervous system which include fatigue, sleepiness, hallucinations, loss of concentration, different consciousness problems including coma. While peripheral nervous system manifestations show up as muscle pain, cramps, tingling, or restless leg syndrome.

Hematological disorders like anemia, bleeding or infections.

Metabolic disorders including acidosis, electrolyte imbalance, and azotemia.

Gastrointestinal disorders, including loss of appetite, nausea, vomiting, burping, diarrhea, or esophagitis.


The goal of chronic kidney disease treatment is to slow down or stop the disease progression. Treatment of the cause of kidney disease and hypertension is needed in a state of decreased kidney function. When the levels of nitrogen-containing compounds such as urea and creatinine get increased causing condition known as azotemia, it is needed to limit the intake of proteins, salt, and potassium, while also limiting physical activity. Acidosis is treated with bicarbonate, and anemia with iron.

When chronic kidney disease progresses into end stage, dialysis or kidney transplantation is needed.

Black pepper

Black Pepper (Piper nigrum) is a perennial, flowering plant whose fruit has been used for centuries for human consumption as a spice and because of its medicinal properties. Black pepper has been the most traded product on the world market of spices throughout history, and today it is one of the most commercial tropical cultures. It was used for tax payment, even wars were fought for this spice as its value was higher than the value of gold. The characteristic smell and taste of pepper come from the piperine compound found in the fruits.

Although there are over 100 types of peppers in nature, the most famous classification of this spice on the market is on: black, white, green and red pepper. This division is based on the method of preparing pepper fruits rather than on the basis of the plant species.

Black pepper is unavoidable in the preparation of dishes, but it is especially important that since ancient times, it has been used in traditional medicine as a herbal remedy. Black pepper exhibits antibacterial and mild anti-inflammatory effects, it stimulates the movement of food through the digestive tract and facilitates digestion, stimulating metabolism and eliminating excess fluids from the body. Some studies have shown that pepper contains phytochemicals with strong antioxidant action that prevent the occurrence of damage caused by the action of free radicals.

Nutrition facts of Black pepper

Black Pepper is a very good source of fibers, iron, manganese, potassium, and vitamin K. Black pepper contains carbohydrates, proteins, fats, and phytosterols. Other micronutrients are copper, calcium, magnesium, phosphorus, potassium, zinc, selenium, folic acid, vitamin B2, vitamin B3, vitamin B6, vitamin A, vitamin C, choline and betaine. In one spoon, that contains about six grams of ground black pepper we can find 4.1 g of carbohydrates (1% of daily needs), 1.7 g of fibers (7%), 0.7 g proteins (1%), 0.2 g of total 0.7 mg of copper (4%), 27.3 mg of calcium (3%), 12.1 mg of magnesium (3%), 0.4 mg of manganese (18%), 0.1 mg of copper ), 10.8 mg sodium (1%), 78.7 mg potassium (2%), 0.2 mcg selenium, 0.1 mg zinc (1%), 0.6 mcg folic acid, 0.001 mg vitamin B2 (1% ), 0.1 mg Vitamin B3, 0.001 mg Vitamin B6 (1%), 18.7 IU Vitamin A, 1.3 mg Vitamin C (2%), 10.2 μg Vitamin K (13%), 0.7 mg choline, 0.6 mg betaine 5.7 mg phytosterols.

black pepper

The influence of black pepper on health

Black pepper contains a number of compounds with antibacterial, antimicrobial, anti-inflammatory and antioxidant agents that enable the preservation of health and the treatment of diseases. Thanks to phytochemicals with a medicinal effect, it can improve digestion, cognitive function, ease weight loss, reduce the risk of malignant changes, lower high blood pressure, affect blood sugar level regulation, relieve respiratory problems, prevent caries and fight its bacteria.

Improves digestion

Black pepper increases the production and secretion of hydrochloric acid in the stomach, which improves digestion and facilitates the digestion of food. Hydrochloric acid is an important component of gastric juice that prepares food for the passage through the intestines and allows the absorption of nutrients. It is thought that piperine in black pepper is the one that affects the increase in the release of hydrochloric acid. Pepper also strengthens the digestive tract, which reduces the time it takes to process and transport food.

Eases the loss of excess weight

Black pepper has thermogenic properties that can stimulate basal metabolism and influence the increase in heat production, which together can lead to the elimination of excess fat. Piperine in black pepper also improves metabolism and induces the differentiation of fat cells resulting in weight loss.

Improves cognitive function

According to a study published in Food and Chemical Toxicology 2010, in which it has been shown that piperine in black pepper can improve cognitive function, protect the brain against neurodegeneration and reduce memory damage in rats with Alzheimer’s disease. It is thought that it can prevent the development of Alzheimer’s disease by curing damaged neurons and hippocampus in the brain.

black pepper

Relieves breathing problems

Anti-inflammatory, antibacterial, and expectorant effects of black pepper can help in the treatment of respiratory diseases such as asthma, difficulty breathing, sinusitis, nasal congestion, coughing and colds. Piperine in black pepper can also inhibit the development of bacteria that cause respiratory infections.

Regulating blood sugar levels

Antioxidant properties of black pepper can help in treating diabetes and stabilizing blood sugar levels. Namely, a study published in the Proceedings of the National Academy of Sciences in the US in 2016 found that piperine helps regulate muscular tissue metabolism in a state of rest, which can help diabetics and ease the loss of body weight. A study published in the West Indian Medical Journal of 2015 found that black pepper inhibits two enzymes that break down starch into glucose, which can have a positive effect on blood glucose regulation and reduce glucose uptake. A second study, published in the Advances in Pharmacological Sciences, 2013, found that anti-oxidants in black pepper essential oil can help in fight type 2 diabetes.



Thrombocytopenia represents a decrease in the number of blood cells called blood platelets, which may cause bleeding in the skin and internal organs. This is a lack of blood platelets, small blood cells that play a key role in the closure of damaged blood vessels may cause excessive bleeding. Normal blood platelet count in blood is 150 – 450 x 109/L.

Signs and symptoms

An enlarged spleen that can be determined by clinical examination – palpation or ultrasound is one of the possible signs and symptoms. Detection of an enlarged liver can also point out to possible chronic liver disease, which may be another cause of thrombocytopenia.

Skin bleeding appears most often in the form of small red spots that do not vanish after exposed to pressure – petechiae when the platelet count gets significantly reduced. They are most often located in the area of the ankles and feet. Furthermore, bleeding in the gums and in the oral cavity may occur.

The skin bleeding, larger of petechiae. called purpura, or ecchymosis, a skin bleeding similar to a hematoma, which is most often located on the feet, but also in other parts of the body may occur. Ultimately, stool bleeding, urinary tract infections or prolonged menstrual bleeding can lead to a significantly lower number of platelets.


Thrombocytopenia may be hereditary or caused by various different reasons. Some of the important ones include:

Decreased production of platelets – Thrombocytopenia due to decreased production of platelets is most commonly occurring with the decreased production of other blood cells, such as in leukemia or myelodysplastic syndrome. Another possible cause may be the absence of vitamin B12 or folic acid, viral and bacterial infections, sepsis, and liver failure.

breaking down

Increased breakdown of platelets – A number of various conditions such as pregnancy, hemolytic uremic syndrome, autoimmune diseases, certain medications, thrombotic thrombocytopenic purpura may cause an increased breakdown of platelets, so when platelets are getting destroyed faster than they are produced that results in reduced blood platelet count.

Platelets trapped in the spleen – A disorder of redistribution of platelets in circulation occurs when the spleen is enlarged. Normally, there are about 30% platelets in the spleen and an enlarged spleen stores up to 90%, while there are few in the circulation. The platelet life is normal and there is no increased risk of bleeding. If the enlarged spleen is associated with liver cirrhosis, blood coagulation is disturbed and there is a risk of bleeding.


Thrombocytopenia treatment depends on the cause and severity of the condition. The main goal of the treatment is to achieve a sufficient number of platelets, preventing serious bleeding.

Mild thrombocytopenia sometimes does not need to be treated because bleeding can stop normally. In severe thrombocytopenia, on the other hand, the doctor will prescribe medication to you or change the drugs you are currently taking to stop their side effects.

transfusion in Thrombocytopenia treatment

Treatment of the underlying cause of thrombocytopenia when your doctor identifies a condition that is causing thrombocytopenia will improve the signs and symptoms.

Drugs and therapeutic procedures used to stabilize serious conditions caused by thrombocytopenia may include blood or platelet transfusion, splenectomy (surgical removal of the spleen), plasma exchange, or use of corticosteroids or immunoglobulins, which block the effects of the immune system.