Diabetes Mellitus

Since 1996, the number of people diagnosed with diabetes in the UK has risen from 1.4 million to 3.5 million.

So, what is it?
Diabetes is a condition that results from low/no insulin that leads to high blood sugar in the body, whether this be because of the body’s inability to produce effective insulin (Type I) or that the body can’t produce enough insulin or can’t use the insulin that it has produced due to insulin-resistant tissues in the body (Type II). Those are the two main types of Diabetes.

Type I generally has a juvenile onset (diagnosed usually before the age of 15) and the management usually requires lifelong insulin injections, which is why it is also known as insulin-dependent diabetes.
Type II is generally a condition that develops later in life (around the age of 40). It can have a number of different causes and can usually be managed through diet adjustments to control blood glucose levels, although sometimes medications are also used. I will be focusing on Type II diabetes in this article but if you have any questions about either type, feel free to get in touch.

What is insulin?
To put it simply, insulin is a hormone produced in the pancreas that works to break down sugar in the blood. Without insulin, the sugar can’t enter the cells and be used up as energy, it just sits in the blood vessels wreaking havoc.

Why does this matter?
Because of the build-up of sugar in your blood vessels, other organs which rely on nutrients delivered by the blood vessels are suddenly getting clogged up with sugar and damaged. Structures commonly affected include your eyes, kidneys, and nerves. That is why you may frequently hear of people with diabetes having retinopathy (eyesight problems), nephropathy (kidney problems) and neuropathy (nerve problems) as a result of their diabetes. And of course, problems with their now-filled-with-sugar blood supply.

How does this affect your feet?
You may be wondering why I’m going on about diabetes, when I am a podiatrist. It may surprise you to know that I would estimate that approximately 70% of my caseload are diabetic patients. The foot can be quite seriously affected by the neuropathy and vascular changes associated with Type II diabetes.

The neuropathy most commonly seen in diabetics (about 10-50%) is progressive peripheral neuropathy. This starts with small nerve fibres such as pain and temperature but can progress to include all kinds of nerve fibres. While there are many symptoms of peripheral neuropathy, the one that I would most commonly see is when people lose some of the feeling in their feet and walk on something and cut themselves without knowing. One of my patients walked around with a nail in their foot for an entire week (don’t worry they made a full recovery, and a lesson was definitely learnt – check your feet).
The sugar build-up narrows the blood vessel diameter, which leads to decreased blood supply to the feet. Decreased blood supply leads to impaired wound healing as all those important things needed for wound healing such as platelets, white blood cells and oxygen are carried by the blood. Also, if you think of antibiotics and how they travel on board the blood supply train too – they could be rendered ineffective on a foot wound if the blood supply can’t reach the wound. This is why there is a rise in the incidence of diabetic foot ulcers and sadly, lower limb amputations.
But don’t fret, it isn’t all doom and gloom as ALL of the above is fully preventable and can be managed with good blood sugar control, diet, good foot care and awareness.

So, what can you do?
You can keep a regular eye on your feet for cuts and skin breakdown and you can educate yourself on the signs and symptoms of diabetes.
The classic signs of diabetes are excessive thirst, needing to urinate frequently, weight-loss and extreme hunger. In severe diabetic shock, something called ketoacidosis – more frequently seen in Type I diabetes – the symptoms include drowsiness, major dehydration and your breath will also smell sweet due to acetone (a ketone formed by fat breakdown). It is important for us all to be aware of these symptoms and to spot them in ourselves and others should we need to.

Takeaway points:
Diabetes is a condition caused by lack of or reduced insulin that results in high levels of sugar in the blood.
There are two main types.
Type I is generally managed through life-long insulin injections and diagnosis usually occurs before the age of 15 years.
Type II has a later onset usually and can lead to secondary complications involving your eyes, kidneys, nerves and blood supply.
All of these side effects are preventable.

Please don’t fret, as lots and lots of people suffer from Diabetes and there are groups out there to help people affected with diabetes in the UK. A list of which I’ve included below.

This article was intended as an information piece and should not be taken as medical advice. If you or someone you know suspects that they have diabetes, you should consult your doctor or nurse as soon as possible.

Diabetes Information UK:

Diabetic Support Groups Local to Huddersfield:
7 Mary Seacole Close
Park Lane, Bradford BD5 0JQ
Tel: /Helpline: 01274 729 687 Text 07486 605 651
Email: bradfordduk@gmail.com

Wakefield Group
Barbara Smith – Group Secretary, Tel: 01924 252958

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