How a Podiatrist can help if you have diabetes

The human body is the perfectly designed machine. Like a car needs petrol, so too does the human body need energy in order to work properly. When we eat food, this travels into the small intestine where it is broken down and the sugars are transported into the blood stream ready to be transported to all of the cells of the body to be used as energy.

Insulin which is released from the pancreas is like a key that opens the door of the cells (such as muscle, liver and fat cells) in the body allowing the glucose to enter and be used as energy for metabolism, repair and defence. Other cells that do not not need insulin to get the glucose they need are those in the brain, the meet pis system, the heart, blood vessels and kidneys.

If you have diabetes this means you have too much sugar circulating in your blood which are not being taken up by the cells that need it. This can be because of a lack of insulin production, or faulty insulin.

If the insulin is faulty then the glucose cannot enter the cells; it accumulates in the blood stream. The brain detects that your cells are not receiving their glucose needed for fuel, and so stimulates the pancreas to produce more insulin, which only adds to excess glucose in your blood.

The other type of diabetes is when the pancreas does not produce any insulin at all, which means there is no key available to open the cells up to receive glucose.

The muscle, fat and liver cells that need insulin to receive glucose are starved; while the nerves, kidney cells and small blood vessels have a too much glucose which damages them and makes it impossible to perform their normal function. They fail to produce key enzymes, fail to repair themselves, and fail to transport nutrients needed in the cell.

Your body will try to eliminate this excess glucose, making your kidneys work overtime. They excess sugar will exit your body through your urine, your breath, and your sweat. Did you know that when your sweat has more sugar you are more attractive to fungus and bacteria; this means you more susceptible to fungal infections making it more difficult to eliminate).

12 monthly Neurovascular assessment:
You should visit your Podiatrist every 12 months to assess for risk of foot complications related to diabetes such as ulceration and or amputation. Your podiatrist will assess the circulation in your feet, and your ability to detect sensation in your feet.

1. Vascular - blood flow in the feet, which indicates the ability to repair after injury
2. Neurological - sensation/feeling in the feet and detect injuries
3. Dermatological - skin condition (defence barrier to the outside world against pressure, friction, germs, etc.)
4. Musculoskeletal - deformities, prominent lumps and bumps which may receive too much pressure. Too much pressure and can lead to ulceration and eventually amputation.

Circulation assessment:
1. Questioning of symptoms subjectively experienced by the patient (e.g. Pain or cramping in the legs)
2. visual inspection (skin colour, temperature, texture);
3. palpate pulses;
4. Doppler ultrasound which can provide an audible sound and visual printout of the waveforms showing regularity, strength and volume of blood flow in the feet.

Neurological assessment:
1. Questioning of subjective symptoms (e.g. Pins & needles, numbness, tingling)
2. Visual inspection (standing and walking assessment
3. Response to stimuli (10g monofilament, 128Hz tuning fork). Inability to feel these sensations means you cannot protect yourself from injury as you cannot detect it, such as wearing shoes that rub and cause blisters, or standing on glass.
4. Muscle atrophy and strength testing: damaged blood vessels cannot supply enough oxygen to nerves that innervate muscles. Your podiatrist can assess the strength of your muscles in your feet.

Assessment of foot deformities, lumps and bumps that stick out and may become areas of that receive too much pressure. E.g. Claw toes or bunions, or collapsed arches that rub in your shoes or against the neighbouring toes. These high pressure areas can form corns and callous, and if ignored may turn into ulcers.

Neurovascular assessments performed by your podiatrist are basic, non-invasive tests that are then forwarded onto your GP who may decide to refer you on for further assessment and or intervention with a vascular specialist, neurologist etc.

If you think you could benefit from a diabetes assessment conducted by one of our Podiatrists, give us a call on 9894 2463 or book online to make an appointment.

As a person with diabetes, you may be eligible for a Chronic Disease Management plan which would entitle you to up to five bulk-billed podiatry appointments in a calendar year at our clinic.  If this is the case, your GP will arrange the paperwork to be sent to our clinic, usually via fax at 9894 0242.