People with diabetes should examine their feet daily and have them inspected regularly by their physician because of a condition known as diabetic neuropathy, according to a physician at New York University Medical Center.
"Diabetic peripheral neuropathy is a form of nerve damage that can cause a loss of sensation in the feet," said Dr. Andrew Drexler, assistant professor of clinical medicine and a specialist in diabetes. "It can occur in people with either insulin-dependent or non-insulin-dependent diabetes."An article in an upcoming issue of the center's Health Letter explains that if, because of this lack of feeling, a foot injury does not receive attention, aperson may develop a foot ulcer or infection.
People with diabetes are also at risk for developing peripheral vascular disease, which often coexists with neuropathy. "The two conditions aggravate each other and may increase the tendency for gangrene to develop in an infected foot," Drexler observed. "If untreated, amputation may eventually be necessary."
Neuropathy tends to develop slowly, and its early symptoms may escape a person's notice. Since it is important to recognize the condition early, all people who have diabetes should examine their feet daily - not just the tops of their feet but the soles and between the toes as well. They should also show their feet to the physician at each office visit. Any sign of injury calls for immediate attention. "Many over-the-counter remedies for corns, calluses and bunions, which are safe for the general public, should not be used by people with diabetes," Drexler added. "The person with diabetes should not attempt to self-treat feet. Regular visits to a podiatrist may be useful."
A number of factors may contribute to the development of neuropathy in people with diabetes. "High levels of glucose in the blood may produce a substance called sorbitol, and may also lead to a chemical reaction called glycosylation," he stated. "Both processes can disrupt the protective myelin sheath that surrounds nerve fibers."
In addition, the level of a sugar alcohol, myo-inositol, is decreased in the nerves of people with diabetes and this, too, may be responsible for disrupted nerve function.
"Some medications are available to treat diabetic neuropathy, but none is entirely effective," he asserted. "It is generally held that control of blood glucose levels may help prevent diabetic neuropathy."
The condition can occur in two forms: either lack of sensation or painful, burning or tingling sensations in the feet. "There is a distinction between pain and sensation," Drexler noted. "In people who have had a loss of feeling in their feet, a tingling sensation may be a sign that nerve function is improving," he maintained.
"Loss of sensation in the foot need not result in injury if people with diabetes are watchful," he concluded.