The incidence of pre-diabetes and diabetes appears to be rising in the U.S. population and almost one-third of those with diabetes do not know that they have it. The likelihood of American Indian and Alaska Native adults to have diagnosed diabetes is 2.3 times the rate of non-Hispanic whites. In American Indian and Alaska Native youth between the ages of 10 and 19 to have diagnosed diabetes is nine times the rate of non-Hispanic whites.
The cost of treatment of diabetes and its complications is extremely high. At least 33% of these costs are tied to the treatment of diabetic foot ulcers, and that doesn’t even begin to measure the cost in suffering from an amputation. Diabetes is the number one reason other than trauma for amputations. So, how does diabetes lead to foot ulcers?
People with diabetes often have circulation problems that can lead to neuropathy in the feet and lower legs. Neuropathy means that there is no feeling in that part of the body. Because we need to feel pain to know when something is wrong, doctors call this neuropathy a “Loss of Protective Sensation” or LOPS. LOPS is the first step to developing a foot ulcer.
Pain will tell the person with diabetes if they have stepped on something and injured their foot. Pain will send a message that shoes are too tight and a callous is forming. Pain will let someone know when the bones in the foot have broken. People with LOPS might go months with an injury and not know it.
The American Diabetes Association and Indian Health Services recommend that every year a person with diabetes have a diabetic foot exam from your doctor or other health professional. At that exam, your feet should be tested for Loss of Protective Sensation. Your health professional should also do a second test such as an Arterial-Brachial Index to check for causes of LOPS. Your doctor will look for wounds, callouses or other signs that you are at risk for developing an ulcer. If everything is fine, you will not need to have another complete diabetic foot exam for a year. If there is something wrong, your health professional should refer you to a specialist to prevent and treat any problems.
You can help prevent foot ulcers by making some smart choices. First, if you smoke, stop. Smoking constricts the blood vessels and speeds up the development of LOPS. Second, eat healthy. Healthy eating supplies the body with the nutrients to prevent and to heal wounds. Third, control your blood sugar. Fourth, move. Moving will help your circulation and help to control your blood sugar. Finally, every time you visit your doctor, take off your shoes before the provider comes into the room. Ask your provider to look at your feet. This does not take the place of yearly diabetic foot exams, but it may help prevent a small problem from becoming a bigger problem.
For more information, talk to your healthcare professional or call the Certified Diabetes Educator working for the Salt River Pima-Maricopa Indian Community Department of Health and Human Services: Maggie Fisher (480) 362-6640