The American Diabetes Association reports that 25% of Americans over the age of 60 now have diabetes, but a leading local physician still believes the disease is preventable.
Diabetes is a well-documented disease. Type 2 is the most common; it is tied to family history, being overweight, and an inactive lifestyle. Type 2 has its onset later in adulthood.
Most people, even those with no vested interest, know there is also Type 1 diabetes, usually diagnosed in children and young adults, In Type 1, the body makes little or no insulin. In Type 2, the body makes insulin, but doesn’t use it the right way.
Dr. Deepti Sadhwani, a physician of internal and bariatric medicine who established Quality Health Care in Sebastian 15 years ago where she treats many diabetic patients, believes that diabetes can be prevented with diet and exercise.
“Carbohydrates are the biggest culprit,” Sadhwani says, “Our bodies don’t know what to do with them, so they are stored ‘for later’. Unless we are going to run a marathon, later never comes, carbohydrates become fat, and carrying that extra weight increases the risk for Type 2 diabetes.”
Dr. Sadhwani is also concerned about popular misconceptions that people have about different kinds of foods and their ties to diabetes. For example, there is a popular misconception that all fruits and vegetables are good for you and can’t do any harm. The truth is that all fruits and vegetables are not created equal, as some are high in carbohydrates and should be avoided, such as grapes, bananas, pears, apples, corn, potatoes and carrots.
If Type 2 diabetes is diagnosed, treatment involves medication (insulin injections in severe cases), avoidance of fatty and sugary foods, and consistent exercise – five days a week, at least 30 minutes each time.
Diabetes affects many body systems and parts and can contribute to many other related conditions, all of them potentially serious and warranting close and constant examinations by medical professionals, but one body part that is at particular risk from diabetes is the foot.
Many bad things can happen to the feet because of diabetes for various reasons, but there are measures people can take that can help prevent problems.
Diabetes doubles the risk of foot conditions, as it causes damage to blood vessels and peripheral nerves. Alarmingly, 60% of all lower limb amputations are a result of diabetes. Two of the most serious conditions are Peripheral Artery Disease (PAD) and Peripheral Neuropathy, and both are diabetes-related.
PAD is the narrowing of arteries outside of the brain and heart, resulting in decreased oxygen flow to hands and feet. Severe cases can result in ulcers and tissue death (gangrene). In Peripheral Neuropathy, damage to the peripheral nerves decreases sensation in legs and feet, making it more difficult to feel injuries – the feet can’t effectively send information to the brain.
Other common foot-related problems include:
• Dryness, due to dysfunction of the nerves that control oil and moisture, which can cause skin to peel and crack.
• Calluses, which are potentially dangerous for diabetics because they can hide a developing ulcer.
• Ulcers, most commonly on the ball of the foot or on the bottom of the toe, which can lead to infection.
• Poor circulation, which can make feet less able to fight infection.
Dr. Sadhwani says that preventative foot care is a critical component of all treatment plans, and that annual foot exams are essential. “Physicians should look for signs of neuropathy,” she says, “ as well as checking the skin for corns, blisters, and calluses, all of which can lead to infection.”
Some specific guidance on at-home care, courtesy of the American Diabetes Association:
• Check feet regularly for red spots, swelling, and blisters. Don’t forget to check between the toes (blisters and infections can start there) and the soles – if necessary, use a mirror or ask someone to help.
• Wash your feet every day, and dry carefully, especially between the toes.
• Keep your skin soft and smooth by rubbing a thin coat of lotion on the tops and bottom; diabetics often have dry skin, which can crack and peel, allowing germs to enter.
• Trim toenails straight across and use an emery board to smooth the edges.
• Always wear shoes and socks; shoes should be comfortable, with a smooth lining.
• Protect feet from hot and cold; don’t put your feet in hot water, and never use hot water bottles, heating pads, or electric blankets – you can burn your feet without realizing it.
• Keep blood flowing to your feet – put your feet up when you can, wiggle your toes often, don’t cross your legs for long periods of time.
• Don’t smoke, as smoking decreases blood flow and negatively affects circulation.
In addition, Dr. Sadhwani emphasizes the importance of exfoliation (removal of dead skin) as a way to prevent the growth of bacteria and possible infection; it can be done with a washcloth, pumice stone, or loofah.
Diabetes is a serious disease, which can affect many other parts of the body as well. While foot problems may be more evident, diabetes also affects other parts of the body, including eyes and kidneys.
That’s why annual exams are critical for diabetics. Patients should also be diligent about getting flu and pneumonia shots to prevent infections, and keep close tabs on their blood pressure.
Dr. Sadhwani is passionate about education to both prevent diabetes – and treat it properly if it manifests itself; she says it’s the most important prevention tool we have.
Anyone with diabetes, or concerned about developing it, should seek guidance and information from his or her physician, and talk specifically about diet. While diet advice for diabetics is widely available on the internet, it is often contradictory and therefore can be confusing.
Your physician is still your best bet!