Diabetic foot

Diabetes

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:

shoes

Footwear

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.

Neuropathy

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

Infections

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

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.


Retinopathy

Retinopathy refers to any damage to the retina of the eyes, which may cause vision impairment. Retinopathy often refers to a retinal vascular disease, or the damage to the vessels of the retina caused by abnormal blood flow. Retinopathy can be broadly categorized into proliferative and non-proliferative types. By examining the retina, the light-sensitive layer at the back of the eyes, a doctor can detect early signs of complications of diabetes or high blood pressure, as well as other diseases (such as sickle cell disease, anemia, lupus).

Types of the damage that can occur in the retina are hypertensive retinopathy, a complication of high blood pressure (hypertension), and diabetic retinopathy, a complication of long-term diabetes. Hypertensive retinopathy can lead to blockage of retinal arteries or veins, which in turn may eventually result in the loss of vision. Smoking and diabetes increase the risk of developing hypertensive retinopathy. Diabetic retinopathy is a deterioration of the blood vessels in the retina that usually affects both eyes. Diabetes is the most common cause of retinopathy in the U.S. Diabetic retinopathy is the leading cause of blindness in working-aged people. Almost all people with diabetes show signs of retinal damage after about 20 years of living with the condition. Retinopathy can also be seen in premature newborns.

retinopathy

Causes of retinopathy

Retinopathy is usually a sign of another medical condition. Although several medical conditions (sickle cell disease, lupus) can cause retinopathy, the most common causes are diabetes and hypertension.

Diabetic retinopathy is one of the most common complications of diabetes. Diabetes causes high blood sugar levels, which can damage blood vessels around the retina, that then leak protein and fats, forming deposits. The damaged blood vessels are also not as efficient at carrying oxygen to the retina. Diabetic retinopathy can be proliferative (growing abnormal blood vessels in the retina) or non-proliferative (not growing). Non-proliferative retinopathy is much more common and may not require treatment. In the advanced stage, called proliferative retinopathy, new blood vessels grow, when the existing vessels close off. However, they are weak and often burst, causing bleeding, which can cause scarring and damage vision. Regular eye examinations are important to check for progression of retinopathy from non-proliferative to proliferative stages. Diabetic retinopathy usually affects both eyes.

Hypertensive retinopathy is a complication of high blood pressure that usually takes many years to develop. High blood pressure damages the blood vessel walls, causing them to thicken and narrow, which then reduces the blood supply available to the retina, leading to retinal damage. Visual changes sometimes develop because of advanced retinopathy and may be a sign of undiagnosed or poorly controlled hypertension.

Signs and symptoms

Many people often do not have symptoms until there is irreversible damage. Symptoms are usually not painful and can include:

•    Spots or dark strings floating in your vision (floaters)

•    Blurred vision

•    Fluctuating vision

•    Impaired color vision

•    Eye pain and redness that does not resolve

•    Decreased peripheral vision

•    Changes in color perception

•    Headaches

The earliest sign of diabetic retinopathy that can be detected is the formation of microaneurysms. A more advanced form of diabetic retinopathy, called proliferative diabetic retinopathy, may lead to scars that decrease vision. In proliferative retinopathy, new blood vessels grow over the retina, these blood vessels may swell and burst, causing bleeding and damage to the eye.

Diagnosis and treatment

Retinopathy is diagnosed by an ophthalmologist during a comprehensive dilated eye exam that usually includes: visual acuity testing, tonometry, pupil dilation and optical coherence tomography (OCT). If severe diabetic retinopathy is suspected, a fluorescein angiogram may be used to look for damage or leakage in blood vessels. In the case of hypertensive retinopathy, an ophthalmologist will look for tiny cholesterol plaques as well as narrowing and thickening of the blood vessels.

The key to treating retinopathy is managing the underlying causes behind this condition. Controlling blood sugar levels in diabetes is critical in delaying the progression of diabetic retinopathy. Keeping blood pressure under control will help prevent hypertensive retinopathy. Regular exercise, proper diet, supplements and other lifestyle changes such as quitting smoking will reduce the risk of developing retinopathy. Once retinopathy is detected, early treatment is essential to prevent blindness.

Today, many retinal problems are treated with lasers. Evidence shows that laser therapy is generally safe and improves visual symptoms. If a blood vessel has already leaked and scarring has occurred, your doctor may advise you to have a vitrectomy, which involves removing a part of the vitreous humour along with the scar tissue. Treatment for hypertensive retinopathy includes medications to control blood pressure, laser treatment, and medications injected into the eye (corticosteroids).