If you have diabetes and are thinking about hitting the beach or pool without shoes, think twice about it. Diabetics need to constantly wear shoes due to nerve changes in the feet and legs called neuropathy. Most individuals experience some nerve damage or neuropathy through normal aging, but diabetics are at an increased risk because elevated glucose or sugar levels along with high blood pressure, high cholesterol and/or high triglycerides impair circulation.
The condition can cause the loss of one’s ability to feel pain, heat and cold, and sufferers can develop minor cuts, blisters or pressure sores that they may not be aware of due to the lack of feeling. If these injuries are left untreated, complications can occur and lead to amputation. Neuropathy also can cause deformities in the feet such as bunions, hammertoes and charcot foot.
Two types of neuropathy exist. Peripheral neuropathy is the most common type, and symptoms include pain, numbness and tingling in the legs, feet, arms and hands. Additionally, autonomic neuropathy causes digestive problems such as feeling full, nausea, vomiting, diarrhea, constipation, impotence in men, an inability to recognize symptoms of low blood sugar and loss of the typical warning signs of a heart attack.
Half of diabetics have some form of neuropathy, but not all people with neuropathy experience symptoms. Diabetic neuropathy is more common among people with problems controlling their blood sugar levels, high levels of cholesterol and/or triglycerides, those who are overweight, and individuals older than age 40. The highest rates of neuropathy are typically found among individuals who have had diabetes for 25 years or more.
There are several ways patients with diabetes can prevent or delay neuropathy. One of the most important ways is maintaining a normal blood sugar range. The goal for diabetics is to maintain a fasting blood sugar between 80 and 120 and a postprandial on two hours after a meal blood sugar of 140 and lower. Other ways to decrease the risk for neuropathy include getting a hemoglobin A1C test at least twice a year, exercising on a regular basis, quitting smoking and wearing footwear designed for diabetics. Diabetics need to specifically look for shoes with high, wide toe boxes and removable insoles for proper fitting with custom orthotics.
It’s also imperative that diabetics inspect their feet and legs daily. The best time of day to get in the habit of doing this is after a bath or shower. When drying off, look at your legs and the top and bottom of your feet. A mirror may be needed to see the bottom of your feet. If you notice any sores or cuts that are not healing, or experience pain, numbness, tingling in the feet and legs, or any unusual swelling, call your doctor.
Some patients find that walking or regular physical activity helps alleviate neuropathy. Taking warm baths or using elastic stockings also may help with pain. If the pain continues to persist, neuropathy can be treated with medications including low doses of antidepressants and some anticonvulsant medications.
Dawn Hollaway is a registered nurse and certified diabetes educator at the Blount Memorial Diabetes Management Center, where she also serves as program coordinator. She also holds a master’s degree in public health.