I've been managing and treating diabetic patients for my entire professional career frequently involving patients with diabetic neuropathies. Uncontrolled diabetes can damage nerves that result in a lack of sensation in the legs and feet. If you do not feel a cut or sore on your foot because of neuropathy, the cut could get worse and become infected. The muscles of your foot may not work properly because nerves to the muscles are damaged. This could cause your foot to not align properly predisposing patients to severe functional limitations through symptoms of incessant pain and unsteadiness. The circumstances of diabetic peripheral neuropathies can also create too much pressure on one part of the foot creating non-healing wounds and ulcerations with severe complications including sepsis, which occurs when an infection spreads into the bloodstream that can be life-threatening and amputation.
Neuropathy is the most commonly encountered complication in patients with both type 1 and type 2 diabetes and affects up to 50% of diabetic patients. A position statement released by The American Diabetic Association (ADA) states that "early diagnosis of diabetic neuropathy with appropriate education, indicated podiatric medical management and regular review may help to reduce the incidence of foot ulcerations, and ultimately amputations.” This recommendation was intended as an update for a complication of diabetes that is both highly prevalent and often overlooked by clinicians.
Diabetic neuropathy and peripheral artery diseases (poor blood flow to the extremities)
share a common denominator, diabetes. Diabetes affects the flow of blood. Without good blood flow, it takes longer for a sore or cut to heal. If you have an infection that will not heal because of poor blood flow, you are at risk for developing ulcers or gangrene (the death of tissue due to a lack of blood). The two combined can result in a perfect metabolic storm.
Over the years the number of diabetic patients seen in my practice has steadily increased often not in a positive way. As a surgeon I have seen more diabetic ulcers, untreated or poorly managed resulting in hospitalization or amputation. Even under the best of circumstances, the progression of diabetic sensorimotor peripheral neuropathy (DSPN) can lead to foot ulceration, Charcot neuroarthropathy, an increased risk of falls and fractures, lower-limb amputations and distressing painful neuropathic symptoms while being a known risk factor for both cardiovascular and other systematic problems with increased mortality. With nearly 246 million people across the globe battling diabetes and its complications, staying one step ahead of the disease has never been more important. Greater attention and an understanding that manageable foot problems, injuries and deformities in general patient populations can have more serious complications for diabetics.
Research in responsive footwear technology that relieves pressure on areas of the feet that experience high stress during walking and other activities may help prevent foot ulcers in diabetic patients that can lead to amputation of a toe, foot or leg. More drugs are in development for the treatment of diabetes and its complications with a better understanding of the pathogenesis of the disease.
Science-based nutrition for adults living with diabetes who experience diabetic foot ulcers (DFU) has often been an overlooked part of wound care. More nutrition-focused therapies that can help provide patients with early and aggressive intervention and more non-pharmacologic options to improve disease progression and patient quality of life are now accepted and available. A study posted in the 9 June 2022 journal Nutrients cites that certain antioxidant vitamins and minerals, have the potential to alleviate chronic inflammation associated with DFU and and could play a key role in chronic-wound healing. In particular vitamins C, A, and E, as well as zinc, manganese, and copper, are strong antioxidants and show potent anti-inflammatory effect. Certain drugs such as Metformin cause a drop B12, an essential vitamin for nerve health and healthy blood cells. Researchers found that 40% of type 2 diabetics using Metformin had a vitamin B12 deficiency or were in the low-normal range for the essential vitamin. And 77% of metformin users with vitamin B12 deficiency also had peripheral neuropathy.
It is important to consult with your podiatric physician or other healthcare provider on nutritional intervention to incorporate patient-specific targeted nutritional therapy to support the wound-healing process and associated pathologies.
My hope is that in the next phase of my practice I will see less need for extended antibiotic therapies, surgical intervention, amputation and limb salvage for my diabetic patients. Due to greater awareness about the disease and its complications, screening programs and better treatment options, I look forward to improved response rates in patients. A more proactive attitude encouraging and assisting diabetic family members and friends to manage their illness and have a proactive attitude about their foot care can keep them one step ahead of this disease.