Foot Problems

Proper foot care should be an important part of a diabetics daily routine. High blood glucose levels can damage the blood vessels that carry oxygen and nutrients to the legs and feet. This can lead to nerve damage, poor circulation, infections and foot deformities.

Diabetes is often associated with foot problems and amputation. Not including those caused by accidents or trauma, more than 60% of lower-limb amputations performed each year are on people with diabetes.¹

What to Look For

Diabetes Australia recommends that your feet be examined at least once a year—more often if you have foot problems.² If you experience any of the following symptoms, see your healthcare professional:³

• Pain or less sensitivity in the leg or foot
• Cuts or breaks in the skin
• Ingrown nails
• Changes in the shape of your foot
• Corns or calluses

Healthy Diabetic Foot-Care Habits

By keeping your blood glucose level within the range recommended by your healthcare professional and paying special attention to your feet every day, you may be able to prevent long-term complications. For healthy toes and feet, follow these simple steps:²

• Check your feet regularly – look for redness, sores, swelling etc.
• Wear comfortable shoes that fit
• Wash your feet daily with soap and lukewarm water
• Moisturise your feet daily to avoid dry skin
• Trim your toenails straight across and not too short
• Get medical advice early if you notice any change or problem

Eye Disease

People with diabetes are at elevated risk for several types of eye disease, including retinopathy, cataracts and glaucoma. Any of these diseases can lead to blindness over time. Early detection is the key to avoiding or lessening the risk of these diseases.

Retinopathy, the most common eye disease in people with diabetes, is caused by damage to the blood vessels of the retina. In some cases, these vessels may swell and leak fluid. This is called non-proliferative, or background, retinopathy.

As these areas heal, scarring occurs and abnormal new blood vessels may grow on the retina's surface, causing vision loss or blindness. This is called proliferative retinopathy and has consequences that are more serious. Unfortunately, some level of retinopathy is common, especially in people who have had diabetes for many years. But with good control of your blood glucose levels, it does not have to affect your vision.

Cataracts cloud the lens of the eye. They are often an early complication of diabetes. An annual eye exam can help detect cataracts before they become severe.

Glaucoma is an increased pressure in the fluid inside the eye. This can damage the optic nerve and lead to vision loss. Glaucoma is more common in people with type 2 diabetes.

Reducing Your Risk for Eye Disease

Taking a few important steps may greatly reduce your risk of diabetes-related eye disease.

• Control your blood glucose. As average blood glucose levels rise, so does the risk of retinopathy. Typically, the better a person's blood glucose control, the slower the onset and progression of retinopathy. Proper control may also decrease your chance of getting cataracts.
• Reduce your blood pressure. High blood pressure may increase the risk of retinopathy.
• Stop smoking. Smoking raises your risk of cataracts and many other diabetes-related complications.
• Get an annual dilated-eye exam. People with diabetic eye disease often have no symptoms or pain until a disease becomes advanced. Your Optometrist can detect retinopathy before you have any vision problems. A dilated-eye exam lets your Optometrist examine the blood vessels in the back of the eye. The earlier retinopathy is diagnosed, the better your chances for preventing further damage to your eyes.

High Blood Pressure

High blood pressure, or hypertension, occurs when the force of blood flow inside blood vessels is too high. The heart has to work harder to pump blood through the body, which can contribute to serious health problems.

People with diabetes and high blood pressure have nearly twice the risk of heart disease as people who have only high blood pressure. Studies also show an increased risk of kidney damage, diabetic eye disease and stroke when hypertension is a factor.¹

Causes of High Blood Pressure

According to the American Diabetes Association, about 73% of adults with diabetes also have high blood pressure or use prescription medications to treat high blood pressure.² The causes of hypertension are unknown, but several factors may play a role in its development:

• Heredity
• Race
• Age
• Inactive lifestyle
• Heavy alcohol consumption
• Salt sensitivity
• Being overweight
• Stress

Identifying High Blood Pressure

High blood pressure has no signs or symptoms. The only way to identify it is by having your blood pressure checked at every visit to your doctor. This is a quick and easy procedure and is something you have probably done many times before.

If you have a high blood pressure reading, your healthcare professional may recommend a series of additional blood pressure tests.

Reducing and Treating High Blood Pressure

High blood pressure cannot be cured, but it can usually be controlled. Here are some positive steps you can take to reduce blood pressure:³

• Maintaining a healthy weight
• Staying physically active
• Eating a healthy diet that includes daily servings of fruits, vegetables and whole-grain foods
• Choosing foods lower in salt and fat
• Choosing lean meats
• Drinking alcohol in moderation
• Quitting smoking

Your healthcare professional may also prescribe medication to control high blood pressure. The type and amount of medication will depend on your specific situation.

Heart Disease

Diabetes increases the risk of heart disease and stroke. Heart or blood-vessel disease accounts for about 75% of all deaths for people with diabetes.¹

High blood glucose levels can damage blood vessels, leading to cardiovascular complications, such as high blood pressure, high cholesterol and hardening of the arteries. In addition to risk factors you cannot control—such as heredity, age and gender—you can be at greater risk of heart problems from the following:¹

• High levels of blood fats, such as cholesterol and triglycerides
• High blood pressure
• Lack of physical activity
• Being overweight
• Stress
• Too much alcohol
• Smoking

Heart Disease Symptoms

Any one of the following symptoms could be a sign of heart disease, stroke or other heart problems. If you experience any of these symptoms, talk to your healthcare professional:

• Chest pain or discomfort
• Dizzy spells
• Jaw, back, arm, neck or stomach pain
• Slow-healing cuts and sores
• Numbness or weakness on one side of the body
• Leg pain, which may go away with rest
• Shortness of breath
• Sweating or light-headedness

Reducing the Risks of Heart Disease

One of the most important things to do to reduce the risk of heart disease is to meet with your doctor and/or credentialed Diabetes Educator to discuss your individual risk factors and how to reduce them. In general terms you can reduce the risk by:²

• Managing blood glucose levels in the range recommended by your healthcare professional
• Keeping your blood pressure within a healthy range
• Control cholesterol and triglycerides through a healthy meal plan
• Stop smoking
• Get physical activity every day
• Lose weight, if you are above a recommended range
• Talk to your healthcare professional about any concerns

If lifestyle changes are not enough, your healthcare team may recommend medication or surgery. The most common form of treatment is aspirin therapy, which helps reduce your risk of blood clots. Other options include:

• Beta-blockers to decrease heart rate and blood pressure
• ACE inhibitors to enlarge blood vessels
• Statins to help reduce cholesterol levels

Kidney Disease

Kidneys filter your blood through millions of blood vessels and then dispose of body waste in your urine. Diabetes can damage these small blood vessels, making it hard for the kidneys to filter your waste.

As a result, diabetes is the leading cause of kidney failure. About 30% of people with type 1 diabetes and 10%–40% of those with type 2 diabetes will eventually have kidney disease, or nephropathy.¹

Smoking, uncontrolled blood glucose, or high blood pressure, may increase the risk of kidney disease. Having a family member with kidney disease also increases the risk of developing kidney disease.

Detecting Diabetic Nephropathy

While there are no early symptoms of kidney damage, your healthcare professional can test for it.

Your healthcare professional will check your urine for a protein called albumin. This screening can detect nephropathy in its early stages, when treatment can slow or even prevent progression of the disease. If you have diabetes and are between the ages of 12 and 70, you should have a urine protein test at least once a year.²

Prevention and Care

• Keep your blood glucose levels close to normal range. Discuss your target range with your healthcare professional.
• Lower your blood pressure, if it is high. Discuss your normal range and how to treat high blood pressure with your healthcare professional. Medications such as ACE inhibitors may both effectively lower blood pressure and protect the kidneys.
• Reduce the protein in your urine. If you have protein in your urine, discuss how to treat it—whether through medication or by limiting protein in your meals—with your healthcare professional.
• Stop smoking. Smoking increases your risk of kidney damage.

Diabetes and Sexual Health

Diabetes can lead to difficulty with sexual performance for men and women.

Issues Affecting Men

Diabetes may cause nerve and artery damage, disrupting the blood flow needed for an erection. Men who have diabetes are 3 times more likely to experience this issue, known as erectile dysfunction or impotence.¹ Experiencing erectile dysfunction is common and can be treated.

A few factors that may increase the possibility of experiencing impotence:

• Poorly controlled blood glucose
• High cholesterol
• High blood pressure
• Smoking
• Drinking too much alcohol

In addition, some medications—such as blood-pressure drugs, anti-depressants and stomach-ulcer medications—may have side effects that contribute to sexual dysfunction. Stress can have an impact as well.

Prevention and Treatment

Several types of treatment are available for erectile dysfunction, including oral medications, injections, suppositories and vacuum devices. If you notice any erectile dysfunction, talk with your healthcare professional right away.

Issues Affecting Women

Sexual dysfunction from diabetes can affect women as well. High blood glucose levels, nerve damage, depression and yeast infections are all relatively common in women with diabetes and can contribute to sexual problems.²

If you have any of the following symptoms, there is a chance you are suffering from a form of diabetes-related sexual dysfunction:

• Lack of interest in sex
• Vaginal dryness
• Discomfort during intercourse
• More difficulty reaching orgasm

Prevention and Treatment

Start by talking with your healthcare professional, who can help you determine the best course of action. A simple solution, such as using a lubricant during sex, may work. If you are having problems in your sex life, seek help from your healthcare professional.

Nerve Pain and Damage

High blood glucose levels may damage the insulation of nerve cells and nerves may stop sending signals through the body the way they should. This is called neuropathy.

Many people know that nerve damage can affect their hands and feet—that is why your healthcare professional should check the sensation in your feet at every visit. But nerve damage can also affect every organ in the body—from your digestive tract to your bladder and sexual organs. Nerve damage can also affect your ability to feel the symptoms of low blood glucose levels (hypoglycaemia).¹

Who Is at Risk for Diabetic Neuropathy?

About 60%–70% of people with diabetes have some form of nerve damage. The highest rates are among people who have had diabetes for at least 25 years and among those who have high cholesterol, high blood pressure or weight issues. It is also more prevalent among people with problems controlling their blood glucose levels.¹

Neuropathy Symptoms

The symptoms of nerve damage depend on the type of neuropathy and which nerves are affected. In some types of neuropathy, there may be no symptoms at all. Because it develops slowly, mild cases can go unnoticed for a long time. Look for the following symptoms:¹

• Numbness, tingling or pain in the toes, feet, legs, hands, arms and fingers
• Sensitivity to touch
• Indigestion, nausea or vomiting
• Difficulty swallowing
• Diarrhoea or constipation
• Dizziness or faintness when you stand or sit up
• Profuse sweating at night or when eating
• Problems with urination
• Sexual issues, such as erectile dysfunction in men and vaginal dryness in women
• Loss of balance or coordination

Treatment for Diabetic Nerve Damage

Your treatment for diabetic neuropathy is likely to start with tighter blood glucose control. Blood glucose monitoring, meal planning, physical activity and medication may all help as well. Your healthcare professional may also recommend oral medication or a topical cream for pain relief.

If you have any of the symptoms listed above, speak to your healthcare professional to get the help you need.

Dental and Gum Care

People with diabetes are more likely to have gum disease than people without diabetes. Both gum disease and gum infection are common complications of diabetes. In fact, nearly one-third of people with diabetes have severe periodontal disease.¹ Regular dental checkups and good dental care at home can reduce dental problems.

Types of Problems

In addition to tooth decay and gum disease, you may experience these other problems that occur more often in people with diabetes:

Thrush (oral candidiasis) is a fungal infection in the mouth that causes white or red spots on the tongue. It may cause soreness or a burning sensation in the mouth and may be the result of an increase in the amount of glucose in the saliva. Your dentist may prescribe an antifungal medication for treatment.²

Dry mouth (xerostomia) can be uncomfortable and may lead to infection and tooth decay. Your dentist may recommend a saliva substitute, as well as fluoride treatments to help prevent tooth decay.

Preventing Gum Disease

Gum disease is preventable. For healthy teeth and gums, do the following:³

• Tell your dentist you have diabetes
• Brush your teeth twice a day with fluoride toothpaste
• Floss daily
• Have regular dental exams, as often as your dentist recommends
• Eat a well-balanced diet
• Keep your blood glucose levels under control

When to Call Your Dentist

Call your dentist if you notice any of the following:²

• Gums that bleed easily
• Red, swollen or tender gums
• Gums that have pulled away from your teeth
• Persistent bad breath or bad taste in your mouth
• Loose teeth or a change in the way it feels when you bite down
• If you wear dentures and notice a change in the way your dentures fit