02: Overview of diabetic foot problems (NHS Scotland)

Based on United Kingdom population surveys, diabetic foot problems are a common complication of diabetes with prevalences of;

  • 23-42% for neuropathy
  • 9-23% for vascular disease
  • 5-7% for foot ulceration

Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005 Nov 12;366(9498):1719-24.

Amputation rates are higher in individuals with diabetes than individuals without diabetes.

Individuals with diabetes are at increased risk of developing Peripheral Arterial Disease (PAD), especially when other associated risk factors are present, for example smoking, hypertension and hypercholesterolaemia. Diabetic foot ulceration is principally associated with PAD and peripheral neuropathy, often in combination. Other factors associated with increased risk include;

  • Previous amputation
  • Previous ulceration
  • The presence of significant callus
  • The presence of significant structural abnormality
  • Visual/Mobility problems

Complications of diabetes

It is essential that individuals with diabetes are made aware of the complications that can occur as a result of having the condition.

Diabetes complications may occur over many different timescales, from the date of diagnosis, or many years after diabetes has developed.

The majority of diabetes complications occur due to fluctuations in blood glucose levels, particularly elevated blood sugar over a long period of time.

The long term complications of diabetes involve many different systems in the body. These may be found at time of diagnosis of diabetes, or many years after the onset of diabetes. Many of the long term complications of diabetes are thought to be due to persistently elevated levels of blood glucose and it has been shown, that controlling blood glucose levels and blood pressure may minimize or prevent the onset of these complications.

The complications of diabetes may be categorised as;

  • ‘Macro-vascular’ (involving large blood vessels) resulting in increased risk of Strokes, Heart attacks and Peripheral Arterial Disease (PAD)
  • ‘Micro-vascular’ (involving small blood vessels) resulting in increased risk of eye problems (diabetic retinopathy), disruption to nerves (neuropathy) and kidney problems (diabetic nephropathy)

It is difficult to predict who is likely to develop chronic complications of diabetes which may sometimes occur regardless of the level of control. Not everyone who has diabetes will develop complications. There is good evidence that good control of blood sugar, blood pressure, cholesterol lowering, a healthy lifestyle with plenty of exercise and not smoking will prevent complications in a lot of people.

Type 2 diabetes

Type 2 diabetes (formerly referred to as non-insulin-dependent diabetes mellitus, NIDDM for short, and adult-onset diabetes) is a lifelong condition in which the body is unable to regulate the amount of glucose in the blood properly, and is a condition in which tissues in the body fail to use insulin properly, known as insulin resistance. This happens when your body’s tissues don’t respond well to insulin and so can’t make use of the glucose in the blood for energy. An individual with type 2 diabetes can still make some insulin, but not enough to control their blood sugar levels. The individuals pancreas responds by producing more insulin and their liver, where glucose is stored, releases more glucose. Eventually the individuals pancreas becomes less able to produce enough insulin and your tissues become more resistant to insulin. As a result, blood glucose levels slowly start to rise.

In Type 2 diabetes the signs and symptoms may not be so obvious, as the condition develops slowly over a period of years and may only be picked up in a routine medical check up. Symptoms are quickly relieved once diabetes is treated and under control.

Type 2 diabetes is often initially managed by increasing exercise and dietary modifications but as the condition progresses, medications may be required.

It can take several years for blood glucose to reach a level that causes symptoms of type 2 diabetes resulting in many individuals being unaware they have the condition.

Type 2 diabetes usually appears in individuals over the age of 40, though in South Asian and black people, who are at greater risk, it often appears from the age of 25. It is also increasingly becoming more common in children, adolescents and young people of all ethnicities primarily due to obesity.

Type 2 diabetes accounts for between 85 and 95 per cent of all individuals with diabetes and is treated with a healthy diet and increased physical activity. In addition to this, medication and/or insulin is often required.

Type 1 diabetes

Type 1 diabetes (formally referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes) is a lifelong condition that develops when the insulin-producing cells in the body have been destroyed and the body is unable to produce any insulin. In Type 1 diabetes the body is unable to produce any insulin so there is no key to ‘unlock the door’ and the glucose builds up in the blood. Type 1 diabetes is fatal unless treated with insulin.   Nobody knows for sure why these insulin-producing cells have been destroyed but the most likely cause is the body having an abnormal reaction to the cells. This may be triggered by a virus or other infection.

In Type 1 diabetes the signs and symptoms are usually very obvious and develop very quickly, typically over a few weeks. The symptoms are quickly relieved once the diabetes is treated and under control.

Type 1 diabetes can develop at any age but usually appears before the age of 40, and especially in childhood.

Type 1 diabetes accounts for between 5 and 15 per cent of all people with diabetes and individuals require to inject with insulin daily as well as being encouraged to have a healthy diet and undertake regular physical activity.

01: Overview of diabetes (NHS Scotland)

What is diabetes?

Diabetes mellitus, often simply referred to as diabetes, is a common life – long condition where the amount of glucose in somebody’s blood is too high. This is either because their body does not produce enough insulin, or because cells do not respond to the insulin that is produced, known as insulin resistance.

Insulin is the hormone produced by the pancreas that allows glucose to enter the body’s cells, where it is used as fuel for energy so someone can work, play and generally live their lives. It is vital for life. Insulin is the key that unlocks the door to the body’s cells. Once the door is unlocked glucose can enter the cells where it is used as fuel.

Individuals with diabetes cannot make proper use of this glucose so it builds up in the blood and isn’t able to be used as fuel.

Complications may be associated with both low blood sugar and high blood sugar. Low blood sugar may lead to seizures or episodes of unconsciousness ( Hypos) and require emergency treatment. High blood sugar may lead to increased tiredness and can also result in long term damage to organs.

When an individual has high blood glucose it can produce some of the classical symptoms of diabetes:

  • Frequent urination (polyuria)
  • Increased thirst (polydipsia)
  • Dry mouth
  • Loss of weight
  • Weakness or fatigue
  • Blurred vision

There are two main types of diabetes, Type 1 and Type 2: