Herald Café: What is Diabetes?
Dr Chitralekha Nayak: Diabetes is characterised by increase in blood sugar levels
resulting from defects in either insulin secretion, action or both.
HC: Can a person in their
20s get diabetes?
Dr CN: Diabetes can happen
to anyone. Risk factors for developing diabetes are excess body weight
(especially around the waist), family history of diabetes, lack of physical
activity, over nutrition and stress.
HC: What is diabetic
neuropathy?
Dr CN: Neuropathy is the
commonest symptomatic complication of diabetes. It is characterised by a
decline and damage of nerve function leading to loss of sensation, ulceration
and subsequent amputation.
HC: Can a person
suffering from diabetes for 2 years with blood sugar levels higher than
250mg/dl develop neuropathy?
Dr CN: Yes. The most
important risk factors for the development of diabetic neuropathy are poor
glycemic control and long duration of diabetes. A combination of lifestyle
factors like alcohol, smoking, increased LDL cholesterol and cardiovascular
diseases have been attributed to cause neural dysfunction.
HC: A diabetic who has
been drinking alcohol daily for 10 years has been complaining of burning feet
since a month. Is it diabetic neuropathy?
Dr: CN: It
can be a sign of diabetic neuropathy. But he also requires evaluation to rule
out alcohol induced- or vitamin B12 deficiency induced-neuropathy.
HC: Is it true that
diabetes damages nerves only of lower limbs?
Dr CN: No. There is a common
misconception that diabetic neuropathy is limited largely to the lower limbs.
This is not really true. About 40% of diabetic neuropathy patients have upper
limb involvement in addition to pain and abnormal sensations.
HC: What type of abnormal
nerve function do diabetic neuropathic patients develop? Dr
CN: Patients commonly
present with decreased sensation over palms and feet. Patients also develop
wasting of muscles and weakness of fingers and palms and slippers falling from
feet. Small nerve fibres can also get involved and they usually present with
burning and stabbing pain, which is more at night. Large fibre nerve damage
leads to electrical tingling sensation or a snug band like sensation around the
ankles or feet. The patient may also have a sense of imbalance with prominent
unsteady gait.
HC: If a person controls
sugar after a long period of neglect and is faced with a burning sensation deep
in the feet at night, is there a need to worry?
Dr CN: Acute painful sensory
neuropathy may occur with poor diabetes control or with rapid control of blood
sugars. If it is due to the latter, it usually improves within few days.
HC: What are
complications of diabetic neuropathy?
Dr CN: A patient of diabetic
neuropathy is at increased risk of development of foot deformity with callus
and fissure formation which can subsequently get infected to form ulcers. This
may be so severe that it may even require amputation.
HC: What tests should be
done by a diabetic to detect neuropathy?
Dr CN: Go to the doctor for
detailed evaluation of bedside nerve function tests like monofilament test,
vibration and pin prick test. In some cases, your doctor may advise you to do
electrophysiological tests like nerve conduction study to evaluate the type of
neuropathy.
HC: Can nerve damage due
to diabetes be reversed?
Dr CN: Diabetic neuropathy
may improve in recently diagnosed diabetes with sensory symptoms. Good glucose
control usually reverses the nerve dysfunction in these patients. But in most
of the cases, especially with long standing and uncontrolled diabetes, it is
irreversible due to small vessel and nerve damage.
HC: Are there any
medications to reduce pain and burning?
Dr CN: There are medications
that can reduce pain and burning feet. They have to be taken only after
doctor’s prescription as these medications can cause some amount of sedation
and giddiness.
HC: How can I prevent
diabetic neuropathy?
Dr CN: Optimal glucose
control with diet, exercise and medications/ insulin is the mainstay in
prevention of the neuropathy in addition to control of blood pressure,
avoidance of alcohol and cigarette smoking.
HC: What should be done
to prevent diabetic foot ulcers?
Dr CN: These are the dos:
Check feet every day
for cuts, cracks, bruises, blisters, sores, infections
Use a mirror to see
the bottom of feet if you cannot lift them up
Check the colour of
your legs and feet – seek help if there is swelling, warmth or redness
Wash and dry feet
every day, especially between the toes
Apply a good skin
lotion every day on your heels and soles. Wipe off excess
Change your socks
every day
Trim your nails
straight across
Wear good supportive
shoes or professionally fitted shoes with low heels (under 5cm)
Buy shoes in the late
afternoon since your feet swell by then
Avoid extreme cold
and heat
See a foot care
specialist if you need advice or treatment
HC: What are the wrong
practices of foot care in diabetes patients?
Dr CN: These are the don’ts:
Don’t cut own corns
or calluses
Don’t treat
in-growing toenails or slivers with a razor or scissors. See doctor or foot
care specialist
Don’t use
over-the-counter medications to treat corns and warts
Don’t apply heat with
a hot water bottle or electric blanket; it may cause burns unknowingly
Don’t soak your feet
or take very hot baths
Don’t use lotion
between your toes
Don’t walk barefoot
inside or outside
Don’t wear tight
socks, garter or elastics or knee highs
Don’t wear
over-the-counter insoles; it may cause blisters if not right for your feet
Don’t sit for long
periods of time
Don’t
smoke
