Diabetes is a chronic disease that causes a lack of insulin production in the pancreas or reduced sensitivity to its effects in the cells. Cells need insulin to take up glucose. If left untreated, long-term high blood glucose levels can damage organs and nerves, especially the small peripheral nerves that extend to the eyes, arms, and legs. According to the United States Department of Health and Human Services, 60-70 percent of people with diabetes also have nerve damage (neuropathy). Usually, the first symptoms of diabetes occur in the feet. So, learn about the symptoms of diabetes that appear in your feet and have regular checkups to prevent permanent damage and paralysis of your feet.
Step
Part 1 of 3: Looking for Changes in Sensation in the Feet
Step 1. Watch out for numbness in the feet
One of the earliest and most common symptoms of peripheral neuropathy is loss of sensation and numbness in the feet. Numbness can start at the toes, then progress to the foot like a sock being put on. Usually, these symptoms occur in both legs, although the sensation may be more pronounced in one leg first.
- Associated with numbness, feet also feel less pain due to temperature extremes (both hot and cold). Therefore, diabetics are prone to blisters from hot baths or frostbite during winter.
- Chronic numbness will keep a diabetic person unconscious when their leg is cut, blistered, or injured. This phenomenon is common in people with diabetes, and can lead to foot infections. Sometimes, the neuropathy in patients is so severe that the infection in the foot has been around for a long time before the patient is aware, and has spread deeply into the tissues and even affects the bones. This condition requires long-term treatment with IV antibiotics and is potentially life-threatening.
- Symptoms of peripheral neuropathy, such as numbness, usually get worse at night while sleeping.
Step 2. Watch out for itching and burning sensations
Other common symptoms are uncomfortable sensations, such as itching, pinching, pins and/or burning sensations. These sensations may feel similar to the sensation of the return of blood flow to the legs after previously "falling asleep". The level of this unpleasant sensation (also known as paresthesias), ranges from mild to severe, and usually the sensation in both feet is not the same.
- The itching and burning sensation usually starts at the bottom of the foot (the sole), although sometimes it radiates to the feet.
- This strange sensation is sometimes similar to a fungal infection (athlete's foot) or insect bites, although the itching in people with diabetes is usually not very intense.
- Peripheral neutopathy in the legs usually develops as a result of excessive levels of sugar (glucose) in the blood, causing poisoning and damage to small nerve fibers.
Step 3. Watch for increased sensitivity to touch, also known as hyperesthesia
Another symptom that develops in a small number of people with diabetes is increased sensitivity to touch in the feet. Instead of decreasing or experiencing numbness, the sensitivity of the feet of diabetics can actually increase or even be too sensitive (hypersensitive) to touch. For example, in this condition, even the weight of a light blanket can be painful for a diabetic.
- This complication of diabetes can resemble or be misdiagnosed as gout or severe inflammatory arthritis.
- The pain from this increased sensitivity is usually described as an electric shock or burning pain.
Step 4. Watch for cramping or sharp pains
As it progresses, peripheral neuropathy begins to affect the muscles in the legs. One of the symptoms of the development of diabetes has reached the muscles is leg cramps and / or sharp pain, especially at the bottom of the foot. The cramping and pain can be severe enough that diabetics can't walk and suffer when they sleep at night.
- In a typical muscle cramp, you can see the muscle twitch or contract. Cramps experienced by diabetics are usually quite difficult to see.
- In addition, cramps and pain experienced by diabetics also do not recover or disappear with walking.
- The cramping and pain associated with diabetes are usually similar and are misdiagnosed as a stress fracture or Restless Leg Syndrome.
Part 2 of 3: Looking For Another Leg Change
Step 1. Monitor for muscle weakness
When high glucose levels reach the nerves, water also follows the glucose to the nerves by osmosis. The nerves will swell and lose their blood supply so they become slightly dead. If the nerves that supply the muscles are dead, it means that the muscles are no longer receiving stimulation from the nerves. As a result, your legs may appear to be shrinking (shrink) and their weakness may affect your gait, causing them to become wobbly or limp. This is why patients who have had diabetes for a long time usually use a cane or wheelchair.
- With regard to leg and ankle weakness, the nerves that provide feedback for coordination and balance to the brain are also damaged. Therefore, diabetics find it very difficult to walk fast.
- Nerve damage and weakness of the ankle muscles/tendons also cause reduced reflexes. Therefore, plastering the Achilles tendon in diabetics will not have much effect.
Step 2. Check for deformities in the toes
If your leg muscles feel weak and your gait has changed, your walking posture is no longer correct and it puts added pressure on your toes. Both of these can cause toe deformities, such as hammertoes. Hammertoe occurs when one of the three toes in the middle of the foot is deformed at the joint so that it bends like a hammer. In addition to symptoms of deformities such as hammertoe, this uneven gait and balance can cause increased pressure in certain areas of the foot. This can lead to pressure ulcers, which can then become infected and cause additional problems.
- Hammertoe can heal on its own. However, to fix it, the patient usually requires surgery.
- A common deformity of the thumb in diabetics is a bunion (swelling of the first joint of the thumb), which causes the thumb to be pushed against the other toes.
- Diabetics should wear shoes that have plenty of space in the toes to reduce the risk of toe deformities. Women should not wear high heels if they have diabetes.
Step 3. Watch carefully for signs of injury or infection
Apart from falls and fractures while walking, the most serious complication that diabetics face is foot injury. Due to reduced foot sensitivity, diabetics often do not feel minor injuries such as abrasions, minor cuts, blisters, and insect bites. As a result, these minor injuries can become infected. If not treated before it's too late, a finger or toe may have to be amputated.
- Symptoms of infection that can be seen are usually large swelling, discoloration (red or bluish), and discharge of white pus or other fluid from the wound.
- The infection usually starts to smell bad when it oozes pus and blood.
- The ability of people with chronic diabetes to heal themselves also decreases due to a weakened immune system. Therefore, minor injuries can last a long time and increase the risk of infection.
- If a minor injury turns into a serious open ulcer (such as a large canker sore), it's best to visit emergency services immediately.
- We advise diabetics to check the bottom of their feet once a week and make sure the doctor examines your feet carefully at all examinations.
Part 3 of 3: Looking for Other Symptoms of Neuropathy
Step 1. Look for similar symptoms on your hand
Although peripheral neuropathy usually starts in the lower body, especially in the legs, it eventually affects the small peripheral nerves that go to the fingers, forearms, hands, and arms. Therefore, check your hands carefully for the presence of the above symptoms and complications of diabetes.
- Similar to the feet, the spread of symptoms of complications of diabetes in the hands also starts from the fingers and towards the arms (such as wearing gloves).
- Symptoms of complications of diabetes in the hands can be similar to or misdiagnosed as carpal tunnel syndrome (CTS) or Raynaud's disease (arteries narrow more than normal when exposed to cold temperatures).
- It's easier to check your hands regularly than your feet. In daily activities, usually both your feet are covered by socks or shoes.
Step 2. Check for symptoms of autonomic neuropathy
Your body's autonomic system includes the nerves that control your heart rate, bladder, lungs, stomach, intestines, genitals, and eyes. Diabetes (hyperglycemia) can affect these nerves and cause various complications, such as increased heart rate, hypotension, bladder retention or incontinence, constipation, bloating, loss of appetite, difficulty swallowing, erectile dysfunction, and vaginal dryness.
- Feet or other body parts sweating uncontrollably (or not being able to sweat at all) is a symptom of autonomic neuropathy.
- Widespread autonomic neuropathy will eventually lead to organ dysfunction, such as heart or kidney disease.
Step 3. Watch out for visual disturbances
Peripheral and autonomic neuropathy can affect the eye through damage to small blood vessels from glucose poisoning. In addition to the risk of infection and possible leg amputation, blindness is one of the things that people with diabetes worry the most. Eye complications related to diabetes include difficulty adapting to dim light, blurred vision, watery eyes, and a gradual decrease in visual acuity, which eventually leads to blindness.
- Diabetic retinopathy affects the blood vessels in the retina of the eye and is the most common cause of visual impairment in people with diabetes.
- In fact, adult diabetics are 2-5 times more prone to cataracts.
- Eye disease in people with diabetes also increases the risk of cataracts (clouding of the lens) or glaucoma (increased pressure and damage to the optic nerve).
Tips
- If you have diabetes, even if you are on medication, you should check your feet for symptoms of complications every day.
- If you experience any of the symptoms discussed above, see your family doctor or a diabetes specialist for evaluation.
- Trim your toenails regularly (1-2 times a week), or see a podiatrist if you're afraid of injuring your toes.
- Always wear shoes and socks, or slippers at home. Do not go barefoot or wear shoes that are too tight as this increases the risk of blisters.
- If you have diabetes, you may notice that your feet sweat more and look shiny. If so, change your socks regularly and often.
- Wash your feet daily with warm (not hot) soapy water. Rinse well and pat with a towel (don't rub) until dry. Make sure you dry between your toes too.
- Try salt bathing your feet as often as possible. This treatment sanitizes the skin and reduces the risk of bacterial infection.
- Dry feet can move and cause permanent sores. So, make sure your feet are always moist. Use petrolatum lotion or jelly as a lubricant, but don't apply it between your toes.
Warning
- If you have black or green areas on your feet, see a doctor immediately because you may have gangrene (dead tissue).
- Applying lotion to your toes can stimulate fungal growth.
- If you have a sore on your leg, or one that doesn't heal, see a doctor immediately.
