Diabetes - Preventing damage to the feet and legs

Preventing Damage to the Feet and Legs

Diabetes is responsible for more than 60% of lower limb amputations not caused by trauma. Over all, people with diabetes are 10 times as likely to have an amputation as those without the disease.

The underlying problem is a combination of peripheral and autonomic nerve damage (neuropathy) and diminished blood flow from the buildup of plaques that block the large and medium-size arteries feeding the legs. When these conditions coincide and are compounded by changes in small blood vessels, a simple cut on the bottom of the foot or even an ingrown nail can become so severely infected that a toe or foot must be amputated.

How does this happen?
Because peripheral neuropathy impairs pain sensation, a foot injury can go unnoticed, worsen, and become a feeding ground for invasive bacteria. Altered sweating patterns with autonomic neuropathy can also affect the skin’s ability to fight infections. Poor circulation exacerbates the problem by impeding the body’s infection fighters. White blood cells, antibodies, and other defenders can’t easily reach the infected area, and ulcers develop. Foot ulcers are dangerous and require immediate attention. If not treated, they can penetrate deep below the skin and spread infection into bone.

Toes are most vulnerable to infection. People with severe peripheral neuropathy are also more prone to Charcot’s foot, a condition in which joint destruction and deformity interfere with walking. Charcot’s foot develops when minor trauma to a joint or bone due to daily wear and tear goes unnoticed. Because no changes are made in the individual’s stride, footwear, or exercise program, the foot joints are destroyed.

Putting your best foot forward

The adage “An ounce of prevention is worth a pound of cure” applies to many diabetes complications, and foot and leg damage is no exception. The best way to avoid these problems is to keep circulation health and your blood sugar levels tightly controlled and to practice good foot care:

    * Examine your feet every day for any sores, cuts, scratches, breaks in the skin,
       or swollen areas. Don’t forget to check between your toes.
    * Massage feet with a moisturizing cream to prevent dryness and reduce the
       chance of cracking, which can lead to skin infection.
    * Wash your feet with warm water and soap every day, and dry them carefully.
       Never soak feet because this can dry and crack skin.
    * Keep toenails well cared for to avoid ingrown nails, but if this problem
       develops, don’t try to remove the nail yourself.
    * Have all calluses, corns, warts, and other common foot ailments treated by a
       podiatrist.
    * Don’t use anything that’s too hot or too cold on your feet.
    * Put on clean socks or stockings each day.
    * Wear well-fitting, comfortable shoes. If neuropathy makes it hard to tell how a
       shoe feels, consult an expert in fitting footwear for people with diabetes.
    * To minimize the chances of injuring your feet, avoid going barefoot.
    * Treat any foot injury immediately, and seek professional help for any wound
       that seems unusual or doesn’t heal.

Detection and treatment

Because people with peripheral neuropathy can’t rely on symptoms to tell them something is wrong, they must carefully check their feet and toes every day for a possible injury. Footwear must be carefully fitted.

Natural remedies include aloe vera (internally and topically) speeds up healing and soothing, shea butter (topically) soothing and moisturising, ginger root capsules 1500mg, apple cider vinegar (internally - assists mucus removal), ginger root &/or niacin (circulation), milk thistle to assist, cleanse kidneys and liver, Vitamins E, A & C (cell protection), B complex (support the nervous system),

1) Ginseng

Although there are several different types of ginseng, most of the promising studies on ginseng and diabetes have used North American ginseng (Panax quinquefolius). Those studies have shown that North American ginseng may improve blood sugar control and glycosylated hemogobin (a form of hemoglobin in the blood used to monitor blood glucose levels over time) levels.

• Ginseng Fact Sheet
  
• Ginseng and Blood Sugar

2) Chromium

Chromium is an essential trace mineral that plays an important role in carbohydrate and fat metabolism and helps body cells properly respond to insulin. In fact, studies have found low levels of chromium in people with diabetes.
There are many promising studies suggesting chromium supplementation may be effective, but they are far from conclusive. For example, a small study published in the journal Diabetes Care compared the diabetes medication sulfonylurea taken with 1,000 mcg of chromium to sulfonylurea taken with a placebo. After 6 months, people who did not take chromium had a significant increase in body weight, body fat, and abdominal fat, whereas people taking the chromium had significant improvements in insulin sensitivity.

Another study published in the same journal, however, examined the effect of chromium on glycemic control in insulin-dependent people with type 2 diabetes. People were given either 500 or 1,000 mcg a day of chromium or a placebo for six months. There was no significant difference in glycosylated hemoglobin, body mass index, blood pressure, or insulin requirements across the three groups.
One form of chromium not recommended is chromium picolinate. For more information, read Chromium Picolinate Side Effects.

3) Magnesium

Magnesium is a mineral found naturally in foods such as green leafy vegetables, nuts, seeds, and whole grains and in nutritional supplements.
Magnesium is needed for more than 300 biochemical reactions. It helps regulate blood sugar levels and is needed for normal muscle and nerve function, heart rhythm, immune function, blood pressure, and for bone health.
Some studies suggest that low magnesium levels may worsen blood glucose control in type 2 diabetes. There is also some evidence that magnesium supplementation may help with insulin resistance.
For example, a study examined the effect of magnesium or placebo in 63 people with type 2 diabetes and low magnesium levels who were taking the medication glibenclamide. After 16 weeks, people who took magnesium had improved insulin sensitivity and lower fasting glucose levels.
High doses of magnesium may cause diarrhea, nausea, loss of appetite, muscle weakness, difficulty breathing, low blood pressure, irregular heart rate, and confusion. It can interact with certain medications, such as those for osteoporosis, high blood pressure (calcium channel blockers), as well as some antibiotics, muscle relaxants, and diuretics.

4) Cinnamon

A couple of studies have found that cinnamon improves blood glucose control in people with type 2 diabetes. In the first study, 60 people with type 2 diabetes were divided into six groups. Three groups took 1, 3 or 6 g of cinnamon a day and the remaining three groups consumed 1, 3 or 6 g of placebo capsules. After 40 days, all three doses of cinnamon significantly reduced fasting blood glucose, triglycerides, LDL cholesterol, and total cholesterol.
In another study, 79 people with type 2 diabetes (not on insulin therapy but treated with other diabetes medication or diet) took either a cinnamon extract (equivalent to 3 g of cinnamon powder) or a placebo capsule three times a day.
After four months, there was a slight but statistically significant reduction in fasting blood glucose levels in people who took the cinnamon (10.3%) compared with the placebo group (3.4%), however, there was no significant difference in glycosylated hemoglobin or lipid profiles. For more about cinnamon, read Cinnamon and Blood Sugar and Is Cinnamon a Proven Diabetes Remedy?

5) Zinc

The mineral zinc plays an important role in the production and storage of insulin. There is some research showing that people with type 2 diabetes have suboptimal zinc status due to decreased absorption and increased excretion of zinc.
Food sources of zinc include fresh oysters, ginger root, lamb, pecans, split peas, egg yolk, rye, beef liver, lima beans, almonds, walnuts, sardines, chicken, and buckwheat.

6) Aloe Vera Gel

Although aloe vera gel is better known as a home remedy for minor burns and other skin conditions, recent animal studies suggest that aloe vera gel may help people with many common conditions and illnesses including diabetes.
A Japanese study evaluated the effect of aloe vera gel on blood sugar. Researchers isolated a number of active phytosterol compounds from the gel that were found to reduce blood glucose and glycosylated hemoglobin levels. For more information about aloe vera, read the Aloe Vera Fact Sheet

7)  Bromelain - Benefits, Uses & Precautions

8)  Water - H2O - The Main Source Of Life - Seriously!

9)  DHEA - The Mother Of Hormones

10) Proteolytic Enzymes

11) Gymnema

Several preliminary studies suggest that the herb gymnema can lower blood sugar levels in people with type 2 diabetes.

Because gymnema may lower blood sugar levels, people taking medications for diabetes or using insulin shouldn't take gymnema unless they are closely monitored by their health care provider.

8) Vanadium

Vanadium is a trace mineral found naturally in soil and many foods. It is also produced during the burning of petroleum. Vanadium has been found to improve insulin sensitivity and reduce blood sugar in people with type 2 diabetes. It appears to mimic many of the actions of insulin in the body.
The use of vanadium for diabetes, particularly without the supervision of a qualified health care practitioner, is not recommended, because the dose needed to affect blood glucose levels can be potentially toxic. The typical amount of vanadium found in the average diet (less than 30 micrograms per day) appears to have little toxicity.

Other Herbal Remedies

• Momordica charantia
  
• Nopal
  
• Fenugreek

Circulation
Your doctor may prescribe oral or intravenous antibiotics for a foot ulcer or sore that’s infected, but healing can take anywhere from weeks to months and may require bed rest and elevation of the affected limb.

When circulatory problems inhibit healing, procedures of the sort often used to treat cardiovascular problems may be necessary. If all treatment options are exhausted, or if an infection penetrates to the bone or gangrene sets in, part of the foot or leg may need to be amputated. Usually a prosthesis can be fitted afterward to make walking possible.

A healthy lifestyle all round including nutrition, personal care, light exercise, care to avoid injury (knocks, cuts or abrasions), hydration and quality rest should prevent complications. It may sound complicated but making them a regular routine with a little patience will work wonders in sustaining a good quality of life.

Gentle Massage/Reflexology can be useful for enhancing circulation, reducing odema and general refreshing of the legs or hands to obtain general well relaxation and being.


More about Diabetes
Diabetes
Definition

Diabetes is a life-long disease marked by high levels of sugar in the blood. It can be caused by too little insulin (a hormone produced by the pancreas to regulate blood sugar), resistance to insulin, or both.

Diabetes mellitus
Causes, incidence, and risk factors

To understand diabetes, it is important to first understand the normal process of food metabolism. Several things happen when food is digested, below is a simple outline:

• A sugar called glucose enters the bloodstream.
• Glucose is a source of fuel for the body.
• An organ called the pancreas makes insulin.
• The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.

Type 2 diabetes is a chronic, life-long disease that results when the body's insulin does not work well. Insulin is a hormone released by the pancreas in response to increased levels of blood sugar (glucose) in the blood.

 What is Type 2 Diabetes?

According to the American Diabetes Association, nearly 21 million people in the United States have diabetes, with about 90 to 95% having type 2 diabetes. Unfortunately, this could probably be the standard in the western world.
Sugar, in the form of glucose, is the main source of fuel for body cells. The hormone insulin allows glucose in blood to enter cells. In type 2 diabetes, either the body doesn't produce enough insulin or cells are resistant to effects of insulin.As a result, glucose builds up in the blood instead of entering cells, which causes cells to be deprived of energy. If high glucose levels in the blood persist, it may damage the eyes, heart, kidneys, or nerves.

Natural Remedies for Type 2 Diabetes

There are some natural treatments that are being explored for type 2 diabetes. If you are interested in trying a natural treatment in addition to standard treatment, be sure do so only under the close supervision of a qualified health professional. If diabetes is not properly controlled, the consequences can be life-threatening.
Also inform your physician about any herbs, supplements, or natural treatments you are using, because some may interact with the medications you are taking and result in hypoglycemia unless properly coordinated. Consider keeping track of your herbs, vitamins, and supplements with the Supplement Diary and giving your doctor a copy. See natural remedies above.

See also type 1 diabetes.
Reviewer: Nikheel S. Kolatkar, MD, Clinical and Research Fellow, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Date: 8/1/2005

Type 1 diabetes is a chronic (lifelong) disease that occurs when the pancreas produces too little insulin to regulate blood sugar levels appropriately.
Reviewer: Kevin Pho, M.D., Attending, Internal Medicine, Boston VA Medical Center, Boston, MA. Date: 2/9/2005


Gestational diabetes is a carbohydrate intolerance of variable severity that starts or is first recognized during pregnancy.
Reviewer: Sharon Roseanne Thompson, M.D., M.P.H., Clinical Fellow, Department of Obstetrics & Gynecology, Brigham and Women's Hospital, Boston, MA. Date: 8/8/2005

Diabetes insipidus is caused by the inability of the kidneys to conserve water, which leads to frequent urination and pronounced thirst.
Reviewer: Irfan A. Agha, M.D., Department of Medicine, Renal Division, St. Louis University, St. Louis, MO. Date: 11/9/2004

A glucose test measures the amount of sugar (glucose) in the blood.
Reviewer: A.D.A.M. editorial. Previously reviewed by Aniket R. Sidhaye, M.D., Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD. Date: 2/2/2005

Renal Diabetes

Hypoglycemia occurs when your blood sugar, called glucose, is abnormally low. The term insulin shock is used to describe severe hypoglycemia that results in unconsciousness.
Reviewer: Nikheel S. Kolatkar, MD, Clinical and Research Fellow, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Date: 8/1/2005

Specific diabetic dietary guidelines have been developed by the American Diabetes Association and the American Dietetic Association to improve the management of diabetes. Key principles are to: Achieve weight control through reducing calories Reduce intake of dietary fat (specifically saturated fat) Individualize guidelines for carbohydrates based on the type of diabetes you have and the control of your blood sugar levels.
Reviewer: Meryl Lindenberg, MS, RD, CDE, LD, Cardiovascular Health Center and Diabetes Management Program, Newton-Wellesley Hospital, Boston, Ma. Date: 10/9/2003

To prevent injury to the feet when you have diabetes, you should adopt a DAILY routine of checking and caring for your feet, especially if you already have known nerve or blood vessel damage or current foot problems.

Foot care for diabetics
If you have diabetes you are more prone to foot problems, because the disease can damage your blood vessels and nerves. TIPS ON SHOES AND SOCKS Wear shoes at all times to protect your feet from injury.
Reviewer: Nikheel S. Kolatkar, MD, Clinical and Research Fellow, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Date: 8/1/2005

Diabetic ketoacidosis is a complication of diabetes mellitus caused by the buildup of by-products of fat metabolism (ketones), which occurs when glucose is not available as a fuel source for the body. Reviewer: Aniket R. Sidhaye, M.D., Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD. Date: 8/6/2004

Risk factors for diabetes
You have a higher risk for diabetes if you have any of the following:
Family history of diabetes
Low activity level
Poor diet Excess body weight (especially around the waist)
Age greater than 45 years
High blood pressure
High blood levels of triglycerides (a type of fat molecule)
HDL cholesterol of less than 35 Impaired glucose tolerance (identified by your doctor)
Diabetes during a previous pregnancy, or a baby weighing more than 9 pounds
Certian ethnicities for example African-Americans, Hispanic-Americans, and Native Americans all have high rates of diabetes
Everyone over 45 should have their blood glucose checked at least every 3 years.

Regular testing of random blood glucose should begin at a younger age, and be performed more often, if you are at higher risk for diabetes.
Reviewer: Nikheel S. Kolatkar, MD, Clinical and Research Fellow, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Date: 8/1/2005

Central diabetes insipidus is a rare condition -- marked by extreme thirst and excessive urine output -- caused by a deficiency of the hormone vasopressin that normally would limit the amount of urine made. See also diabetes insipidus - nephrogenic.
Reviewer: Aniket R. Sidhaye, M.D., Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD. Date: 8/6/2004

Congenital nephrogenic diabetes insipidus is a water losing condition caused by the kidneys that is present from birth. See diabetes insipidus - nephrogenic . Reviewer: Irfan A. Agha, M.D., Department of Medicine, Renal Division, St. Louis University, St. Louis, MO. Date: 10/28/2003

Nephrogenic diabetes insipidus is a disorder characterized by the passage of large volumes of urine due to a defect of the kidney tubules. See also diabetes insipidus-central . Reviewer: Irfan A. Agha, M.D., Department of Medicine, St. Louis University, St. Louis, MO. Date: 1/19/2004




Resources
The following are good resources for information on diabetes:

 www.nhs.uk/Diabetes

 diabetic-forum.net

www.diabetes.org.uk

www.bbc.co.uk/health/conditions/diabetes/

American Diabetes Association 
Juvenile Diabetes Research 
The National Diabetes Information

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