Diabetic foot syndrome - symptoms, treatment and prevention
Diabetes poorly treated or not recognized causes the development of pathological atherosclerotic lesions in the walls of the blood vessels of the calves and feet.
ABC KNOWLEDGE ABOUT DISEASE
Pathological vascular changes in the form of atherosclerosis of large leg arteries are caused by long-term excess blood sugar are known under the names - microangiopathy and macroangiopathy. They cause damage to the arteries and arterioles and vascular pathologies that are complications of diabetes. For this reason, diabetics more often than normal people fall ill with cardiovascular and blood vessel diseases.
Glucose levelin blood
is now recognized
the most common glucometer.Glucose levels are too high (hyperglycemia!)
and denotes diabetes when:
♦ in double fasting, it exceeds 126 mg / dl (7.0 mmol / l)
♦ in random measurement it is greater (or equal to) 200 mg / 100 ml (11.1 mmol / l) and there are typical symptoms of diabetes.
Glucose levels are too low and mean dangerous hypoglycaemia when:
♦ the blood sugar level will drop below 2.8 mmoles / l (50 ml / dl) - this means severe hypoglycaemia.
Definition of the disease
The disease syndrome, called the diabetic foot, is caused by the so-called late vascular complications, mainly atherosclerosis of large leg arteries. The disease is characterized by: insufficient blood circulation of the feet, their deformity, reduced pain and worse healing of wounds. In extreme cases, non-healing ulcers and foot amputations may occur. This disease affects more people with type 2 diabetes, not requiring insulin injections, than type 1 diabetes.
The cause of the disease
The cause of symptoms of the diabetic foot syndrome is inhibition of the blood flow to the feet, which results in hypoxia of the foot and lack of necessary components for tissue nutrition.
If this is accompanied by nerve damage in the lower limb, caused by the earlier diabetic neuropathy - ie damage to the peripheral nerves in the course of long-lasting diabetes - there is a series of secondary changes in the lower limbs, such as: muscular atrophies, disturbances in the shape of the foot (especially the vault) , limitation of joint mobility, incorrect pressure distribution on the foot. The physiological functions of the foot are also changed, such as perspiration, nutrition of foot structures, and normal tissue metabolism.
The above symptoms lead to frequent minor wounds and foot infections.
Inferior blood circulation causes the formation of calluses (corns), deformation and ulceration. An additional threat is ringworm. The neuropathy accompanying the diabetic foot syndrome causes wounds and ulcers to heal much worse than in healthy ones. Inadequately treated long-term ulcers and difficult-to-heal wounds may lead to amputation of the limb in people who have already experienced reduced pain.
Foot ulcers in diabetes are, unfortunately, relatively common.
The US data shows, for example, that they are in all patients with diabetes from 4 to 10%. The so-called. non-traumatic amputations of the limbs (ie not caused by injury) are 85% preceded by ulcers in the feet of diabetic patients. According to US hospital documentation - about 54 000 amputations are carried out annually in diabetic patients - half below the ankle, half above. This is half of all these treatments caused by diseases of the limbs.
Late vascular complications are not only the cause of disability.
They also shorten the lives of people with diabetes. Therefore, efforts to avoid them or reduce the risk of developing the disease are important.Modern achievements in medicine show that due to better treatment of diabetes and prevention of atherosclerosis, the occurrence of diabetic foot syndrome is reduced.
TREATMENT AND PREVENTION
The basic way to prevent complications of the diabetic foot syndrome is to eliminate or reduce the causes of the disease.
Undoubtedly, the most important cause of diabetic foot syndrome is impaired conversion (burning) of sugar, which manifests itself, among others hyperthermia (hyperglycaemia). However, the worst prognostic factor is diabetes-induced neuropathy and ischemia and infection that cause sores that are serious to health. In addition, the formation of this syndrome is supported by hypertension and excess cholesterol and triglycerides (fats) in the blood - factors of atherosclerosis.
It is necessary to achieve the blood glucose value close to the physiological standard in the treatment of diabetes.
The desired level of glucose should be: 70-110 mg% fasting (3.9- 6.1 mmol / l), 1 hour after eating below 160 mg% (8.9 mmol / l), before bedtime 100-140 mg %. (5.6-7.9 mmol / aluminum).
It is advantageous in achieving the above goal to control the glucose level by means of the glycated hemoglobin index - Hb A1c.
It is preferable to control the glycated Hb A1c concentration
The concentration of glycated hemoglobin Hb A1c (long-term diabetes control) should be lower than 6%. As we remember, this indicator is averaged blood glucose measurement from the last few weeks. Maintaining glycemia at this level is a prophylactic protection against the development of diabetic complications.
Glycated hemoglobin - diabetes compensation index
Any treatment that makes it possible to achieve the above-mentioned glycemic values can be considered good.
However, a good condition for good diabetes mellitus is the necessity of regularly taking medicines prescribed by the doctor - also in type II diabetes, where the ailments are minimal and daily glycemic control is not necessary and it is easy to forget about medications. It is also worth paying attention to modern sulfonylurea derivatives (eg glimepiride), which are safer than older medicines and only need to be administered once a day.
RISK FACTORS THAT NEED TO CONTROL
People with diabetes must often control their blood pressure and start treatment immediately when it is too high.
Hypertension is a factor that contributes to the development of lesions, both small and large arteries .. Young people with diabetes should have blood pressure below 120/80 mm Hg, older - below 130/85 mm Hg, after 60. year of life - below 140/90 mm Hg. / 1 / Treatment of hypertension in people with diabetes can be considered effective only when the pressure reaches the values given above. Normalization of arterial pressure very clearly reduces the risk of developing complications, and in people with already existing complications slows their progress.
It is important for SC prevention to normalize cholesterol and lipids in the blood
In people with diabetes, the increased risk of vascular complications of diabetic foot and consequent disability significantly increases high cholesterol and triglycerides in the blood. To prevent the early development of atherosclerosis, which leads to this - it is necessary to maintain the level of cholesterol and triglycerides at the correct level. By. the position of the Polish Diabetes Association from 2009*: total cholesterol should be below 175 mg / dl (<4.5 mmol / l); triglycerides below <150 mg / dl (<1.7 mmol / l). In addition, you should try hard to *:
1. The concentration of LDL cholesterol was below: <70 mg / dl (<1.9 mmol / l);
2. The concentration of "good" HDL cholesterol was above:> 40 mg / dl (> 1.0 mmol / l) [while for women it was higher by 10 mg / dl (by 0.275 mmol / l)];
3. The concentration of "non HDL" cholesterol: <130 mg / dl (<3.4 mmol / l);
The level of blood-borne fatty substances in the arteries is affected not only by the level of glucose in the blood, but also by the amount and quality of fat consumed. The most unfavorable are the so-called "hard" fats (lard, bacon, butter, etc. - i.e. not liquid, e.g. oils), which diabetic patients should avoid.
In the prevention of diabetes complications, it is also important to use a proper diet and a healthy lifestyle.
It is important to have adequate nutrition, which should prefer foods rich in vitamins (A, especially in the form of beta carotene, C, E etc.) and antioxidants, protecting arteries from damage and atherosclerosis.And also taking physical activity (walking, sports) and avoiding overweight, alcohol abuse and smoking.
Self-control of the feet in ill persons and appropriate prophylaxis are extremely important.
Prevention of ulcers in the diabetic foot syndrome
