Diabetes is a systemic disease in which the body is unable to produce or properly utilize insulin. Insulin is a hormone that converts sugar, starches and other foods into energy. There are genetic, as well as environmental factors which play a role in the development of diabetes. Diabetes may be managed with diet control, exercise programs, oral medications and/or insulin.
There are over 20 million diabetics in the United States. Many of these people (about 1/3) have not yet been diagnosed, and they are unaware that they have diabetes. A simple blood test may evaluate for diabetes by checking the level of glucose in a persons blood after a short period of no food intake. Thos test is called a Fasting Plasma Glucose Test (FPG). FPG test values between 100 and 125mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126mg/dl or higher has diabetes.
Because every cell in the body uses glucose, every cell in the body has the potential to be effected by diabetes. Specifically, blood vessels and nerves can be affected by diabetes, and when this happens the diabetic may be at risk for infection and amputation. Neuropathy can be painful; it may be described as burning, tingling, sharp, shooting or stabbing. Often times however, there are no warning signs and there is an absence of feeling to the bottom of the feet. This combination of poor sensation and injury can cause infection and/or ulceration. Ulceration is the major risk factor for many lower extremity amputations. Diabetic with a loss of sensation to their feet must take special precautions, and they should be identified as patients with a risk. Diabetic shoes and orthotics are often used to reduce some of the shear forces on the bottom of the foot. Radiographs, nerve testing, gait analysis and visual inspections and instrumental in monitoring the changes in the diabetic foot. Often times surgical intervention is needed to remove boney prominences, resolve infection, or stabilize the foot.