Since November is American Diabetes Month, I thought it fitting that my first article be about Diabetes in general, as well as give some insight on the effects of Diabetes on the lower extremities, the feet in particular. What, might you be thinking, do feet have to do with Diabetes? Well, in a word, EVERYTHING.

First, a little about Diabetes. Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone (produced by the pancreas) that is needed to convert sugar, starches and other food into energy needed for daily activities. Without insulin, the cells of the body are not able to properly utilize glucose (sugar/ carbohydrates).

For the past ten years that I have been in practice in Dutchess County, there has been an increase in not only the number of Diabetic patients that make up most podiatric practices, but an increase in the frequency of overall complications that patients suffer from.

A modification of the old Midas commercial for the Diabetics- “You can pay me now. Or you can pay me later” translates into if you don’t pay attention to it (diabetes) now, you will pay attention to it later. Patient’s who have poor control of their sugar levels will have problems! If you ignore the warnings that your doctor’s have been giving you over the years, you will end up with foot complications and in need of a Podiatrist.

For those of you who are Diabetic, you have most likely been made aware of the fact that you are at a high risk for severe foot disorders. Two of the most devastating complications are:
1.Neuropathy (a loss of, or increased sensation) of the feet
2.Peripheral Vascular Disease (poor circulation of the extremities)
Together, these increase the risk for skin breakdown, foot infections, ulcerations and even amputations.

Along with taking proper care of yourself and your body as a Diabetic, studies show that proper footwear, consisting of well-fitting shoes with sufficient width and depth, along with protective molded insoles, can dramatically reduce the risk of ulceration and amputation.

A Podiatrist can evaluate, fit and order the correct shoe for you, specific to your podiatric concerns or problems, such as bunions, hammertoes, corns, callouses or poor arches.

Furthermore, if you have Medicare and are Diabetic, whether insulin-dependent, taking pills, or are diet-controlled, you may be eligible for a pair of “Diabetic” shoes through a federally-sponsored program. It is called the Medicare Therapeutic Shoe Program.

For all you Diabetics that have been in good control, keeping an eye on what you put on your plate and in your mouth, I applaud you loudly and at the top of my lungs. It is not easy, to say the least, that when faced with another helping of your Aunt Rose’s pasta, apple pie from the CIA, or holiday goodies, you put your fork down, push away from the table or just politely decline. Even though it is killing you inside. If you actually think about it, if you do indulge in tasting all the pies on the Thanksgiving table, it literally would be killing you, slowly and from the in and outside. For those of you who thought your gym membership ended with high school Phys Ed class and now find yourself walking on the treadmill or enrolled in cycling or swimming classes, I have great respect for you, especially if it is at 6:30 in the morning. In February. Dr. James J. DeLorenzo is located at 21 Old Main Street Suite 107 in Fishkill, next to Allsport Gym. For questions or to schedule an appoint call 897.FEET (3338) or email dr.delorenzo@yahoo.com.

Table 1:

MAIN TYPES OF DIABETES

Type 1 (formerly Insulin Dependent) results from the body’s failure to produce sufficient insulin. Some type of insult usually occurs to the pancreas (i.e. an infection, trauma) which causes it to stop producing insulin. Only about 5-10% of Diabetics are type 1.

Type 2 (Formerly Non-Insulin Dependent) Diabetes results from insulin resistance, a condition in which the body’s organs (i.e. muscle, liver) fail to properly take in insulin. The pancreas can still produce insulin it’s just that the muscles, etc are not able to utilize it. Most Americans who are diagnosed with diabetes are typically type 2 diabetics.

Gestational Diabetes: can affect some mothers during pregnancy

“Pre”-Diabetes: occurs in persons whose sugar levels are above the norm but are not high enough to be considered Diabetic

Table 2:

WHAT IS A PODIATRIST?
A medical doctor that specializes in the treatment of disorders of the foot and ankle.

Table 3:

Eligibility for the Medicare Therapeutic Shoe Program
Peripheral Neuropathy
Poor circulation (PVD or PAD)
A history of ulcerations
Painful corns/ callouses (pre-ulcerative)
Foot deformities
A history of toe or foot amputations

Table 4:

Complications of Diabetes in The United States
Heart disease
Stroke
High blood pressure
Blindness
Kidney disease
Nervous system disease
Circulatory disease/ Peripheral Vascular Disease
Amputations