[Audio recording] Diabetes is a disease of the nerves and the blood vessels. Poor blood sugar control affects almost all organs of the body, but the worst sufferers are the feet, said Dr KR Suresh, Director, Jain Institute of Vascular Sciences, Bangalore, India, who spoke to CNS at the Amrita Diabetic Foot Conference (ADFC 2011), organized by Amrita Institute of Medical Sciences and Research Centre (AIMS), Kochi, India (6-7 May 2011). The two main components of diabetes are blood vessel damage and nerve damage (neuropathy). Blockage of the blood vessels results in lack of blood supply. In the case of nerve damage, the patient may not know about it in the initial stages, especially in a country like India where people generally do not go for annual medical checkups, said Dr Suresh.
The first symptom of neuropathy is numbness in the feet and sensation block. Loss of protective sensation of pain is a major cause of creating what is called the ‘diabetic foot’. As the disease progresses, the muscles become weak, toes get distorted and curved. This is termed as motor neuropathy. This may be followed by autonomic neuropathy when the blood supply to the sweat glands is hampered. Sweat is needed to lubricate the skin and keep it moist. But with impaired functioning of the seat glands, the skin becomes dry, swollen and cracked. All these three components work in tandem, said Dr Suresh.
Barefoot walking is very common in India, especially in rural areas. Even in the cities, people walk barefoot in their homes, inside temples, and some are too poor to afford to buy shoes. This barefoot walking is likely to injure or hurt the foot. But due to loss of sensation the patient does not come to know about this, till the wound gets swollen and infected. Any wound requires a 30% increased blood supply to heal. This cannot happen in a patient living with diabetes, as the blood supply is already impaired due to blocked arteries. The combined effect of all this is a ‘leg attack’, which is far more dangerous than a heart attack. To add fuel to fire blocked arteries in the leg result in a blockage in the heart or the brain in 70% of the cases. There are other co morbidities associated with diabetes. Nerve damage affects the kidneys and the eyes (retinopathy). In India, diabetes impacts the foot in maximum number of cases, followed by the eyes and then the heart, kidneys and so on, said Dr Suresh.
The only way out to prevent this from happening is to have an annual medical check up, even in the absence of any external symptoms (which unfortunately is not happening in a hospital-shy Indian population), and get the blood sugar checked frequently. If at any stage diabetes is diagnosed then, apart from diet/sugar control, one needs to take extra care of the feet. Any person, who has been living with diabetes for 5 years or more, should go for foot examination once every six months. At this juncture, barefoot walking is to be avoided at all costs and proper foot wear should be worn. Compliance of treatment and care, as advised by the doctor, is essential, said Dr Suresh.
Dr Suresh does not discount Indian traditional medicines which may be good and help in controlling the disease. But he cautions against quacks and faith healers who abound in the field and dupe the gullible public by making false promises
Dr Suresh rightly remarked that either we control diabetes or it would control us. In fact a person living with diabetes can live better than one who does not have the disease. Diabetes compels a person to lead a more disciplined life. This is the only way to beat the disease and lead a quality life.
Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)
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