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By Paul M. Dake, M.D.

Q:  I’ve just been diagnosed with type 2 diabetes.  Several of my close relatives have also been diagnosed with this in the last decade or so.  What concerns me most is that two of them have had to have foot or lower leg amputations in the last few years, something I would very much like to avoid.  Is there anything I can do to either delay or prevent such a thing in my own case?

A:  There are several important aspects of diabetes care that are directed at preventing such complications.  It helps to understand the pathology behind the “diabetic foot.”

The root causes are a decrease in both circulation and nerve function in the lower legs and feet.  The circulation problems are most often caused by cholesterol deposits in the arteries in and leading into the legs, something that is dramatically worsened by having diabetes.

The loss of sensation in the lower legs and feet is caused by damage to the nerves in the legs from being exposed to excessive levels of glucose in the blood supplying those nerves.

It is well-accepted treatment of diabetics that lowering the LDL portion of one’s total cholesterol to about 100, by whatever means necessary, and by aggressively controlling blood pressure, many times with several different medications at once as suggested in this content, are the best ways to minimize these vascular and neurological complications of diabetes.

Aside from religiously taking medications prescribed by your physician, you can take particular care of your feet by:

1) thoroughly drying your feet with a small towel (reserved for only your feet), following bathing, especially between the toes, to help prevent skin breakdown, the first event in the chain leading to amputation;

2) inspecting your feet once weekly to look for unusual redness or calluses, especially in the absence of any discomfort in those areas, often the first indication of a developing foot ulcer (for those of us who aren’t as limber as we used to be, place a small mirror on the floor under the foot and lean  the knee to one side and then the other so that you can see the entire sole);

3) testing sensation to light touch in your feet every 2-3 weeks, by having another person hold a 2-inch piece of medium fishing line by one end and poking the other end into the skin of the bottom of each foot in 10-12 spots;

4) when you see your doctor for diabetes care, make sure to remove your shoes and socks so your feet can be carefully examined as described above.   Certainly if you detect any abnormalities in your own monitoring of your feet, they should be reported to your physician ASAP.

To learn more about this and many other health topics, visit the American Academy of Family Physicians’ website familydoctor.org, where you can click on the Search box in the upper right corner of the website, and enter your topic of interest.

I want to thank Norman L. for suggesting this topic; if you have a topic you would like to hear more about, please message me at paulmdake@gmail.com.