The three main types of diabetes —type 1 diabetes mellitus, type 2 diabetes mellitus, and gestational diabetes— occur when the body cannot produce enough amount of insulin hormone or it cannot effectively use insulin.
Insulin acts as a key that allows body cells for absorbing glucose and using it as energy. When we eat, our body processes all starch and sugars turning them into glucose, a basic fuel for body cells. Insulin carries glucose to the cells. When glucose accumulates in the blood instead of entering the cells, it may cause diabetes complications.
People with diabetes are more likely to develop different problems in their feet. Even the simplest problems such as a blow, a blister, etc. may worsen leading to severe complications. They usually occur when the diabetic person suffers from a condition called neuropathy, bad circulation, and changes in feet or toes shape.
Diabetic foot, according to the International Consensus on Diabetic Foot, is an infection, ulceration, or disruption of deep tissues related to neurological disorders and different degrees of peripheral vascular disease in lower limbs that affects patients with diabetes mellitus.
It is important to prevent wounds and ulcers in foot, as they are the main causes of amputations. Seven out of every ten amputations occur in diabetic people. An ulcer is a sore on the skin that can even reach bone (depending on its degree). Due to a bad circulation in feet, wounds and blisters may easily become ulcers that get infected and do not cure. This is a common and very severe complication of diabetes. The lack of blood flow together with toxins derived from infection metabolism cause tissue death in certain areas. If this dead tissue is not properly removed, toxin release to the blood eventually causes limb gangrene and leads to foot, leg or life loss.
Vascular problems. Arterial peripheral vascular disease
In diabetes, the leg blood vessels that reach feet often become narrow and hard, diminishing their blood flow as a result of the damage caused by the disease. Arteries function is to provide cells with nutrients and oxygen for them to work properly. The foot is an area of compromised flow due to its distance to the heart. This added to the damage suffered by blood vessels significantly reduces foot arterial supply, leading to important trophic disorders, that is, “tissue nourishment” disorders, including skin fragility, dry skin, and other nail and body hair abnormalities. In addition, arterial insufficiency not only causes cell and tissue distress, but also implies a reduction in the inflammatory response, which is also blood flow-dependent. Arteries are responsible for carrying the necessary materials for a tissue to regenerate, so that if a wound is formed, it will hardly heal.
Changes in the skin
Neuropathy and bad circulation may dry up the skin because the nerves controlling fat and humidity in feet do not work properly. Dry skin eventually peels or is chapped and may result in sores. Additional humidity in feet, which may for example appear in hotter seasons, may cause infections by allowing microbial and fungal growth. It is important to keep the skin dry and at its optimal temperature conditions.
Corn formation in people with diabetes who suffer from neuropathy can be a severe problem. Feet corns are formed when a point on the skin is submitted to continuous pressure. Corns should be properly treated to prevent wounds and ulcers that may be infected.
Blisters and sores
Blisters are usually round-shaped fluid-containing lesions, so that they are at risk of opening with any touch, leaving the skin unprotected. The lack of sensibility caused by neuropathy may make noticing blisters difficult, so that patients cannot prevent them. They usually occur in areas where friction is higher, such as feet sides, heel and metatarsal bones.
Ingrown toenails (which grow curved into the skin along the lateral edges of nail) and mycosis may be unperceived due to the lack of sensibility. If not treated, they can cause infections.
Neuropathy can cause pain and numbness, as well as sensibility loss on the most external areas of the body, such as feet or toes. This sensibility loss implies that patients cannot feel a blow, a wound, an excessive rubbing, a hyperpressure on a definite point or an overexposure to heat or cold, and lesions appear without realizing it. As pain is a defensive mechanism of body that urges to take protective measures against aggressive factors, people with diabetes may suffer a wound and do not realize until their skin is infected.