Diabetes And Feet: Why A Podiatrist Is A Vital Part Of A Diabetic’s Care

Diabetes is a serious disease that affects millions of Americans, and that number is going to astronomically grow as the baby boomer generation ages further. Complications associated with diabetes can be devastating, and can lead to organ failure and even death. Foot-related complications in particular are very common in diabetes, and unfortunately cause the majority of leg amputations performed by surgeons. Comprehensive care by a podiatrist can identify foot problems early before they lead to leg loss, and in many cases can prevent those problems in the first place. This article will discuss the ways a podiatrist can protect diabetic feet, and ultimately save a diabetic’s limb and life.

Diabetes is a disease in which glucose, the body’s main source of ‘fuel’, is not properly absorbed into the body’s tissues and remains stuck in the bloodstream. Glucose is a type of ‘sugar’ derived from the body’s digestion of carbohydrates (grains, breads, pastas, sugary food, fruits, starches, and dairy) The body needs a hormone called insulin, which is produced in the pancreas, to coax the glucose into body tissue to fuel it. Some diabetics are born with or develop at a young age an inability to produce insulin, resulting in type 1 diabetes. The majority of diabetics develop their disease as they become much older, and the ability of insulin to coax glucose into tissue wanes due to a sort of resistance to or an ineffectiveness of the action of insulin. This is called type 2 diabetes. Diabetes can also develop from high dose steroid use, during pregnancy (where it is temporary), or after pancreas disease or certain infections. The high concentration of glucose in the blood that remains out of the body tissue in diabetes can cause damage to parts all over the body. Organs and tissue that slowly are damaged by high concentrations of glucose stuck in the blood include the heart, the kidneys, blood vessels, the brain, the nerve tissue, skin, and the immune and injury repair cells. The higher the concentration of glucose in the blood, and the longer this glucose is present in the blood in an elevated state, the more damage will occur. Death can occur with severe levels of glucose in the blood stream, although this is not the case in most diabetics. Most diabetics who do not control their blood glucose well develop tissue damage over a long period of time, and serious disease, organ failure, and the potential for leg loss does eventually arrive, although not right away.

Foot disease in diabetes is common, and one of the more devastating and taxing complications associated directly and indirectly with high blood sugar. Foot disease takes the form of decreased sensation, poor circulation, a higher likelihood of developing skin wounds and infections, and a decreased ability to heal those skin wounds and infections. Key to this entire spectrum of foot complications is the presence of poor sensation. Most diabetics have less feeling in their feet than non-diabetics, due to the indirect action increased glucose has on nerve tissue. This decreased sensation can be a significant numbness, or it can be a mere subtle numbness that makes sharp objects seem smooth, or erases the irritation of a tight shoe. Advanced cases can actually have phantom pains of burning or tingling in addition to the numbness. With decreased sensation comes a much greater risk for skin wounds, mostly due to the inability to feel pain from thick calluses, sharp objects on the ground, and poorly fitting shoes. When a wound has formed as a result of skin dying under the strain of a thick corn or callus, from a needle or splinter driven into the foot, or from a tight shoe rubbing a friction burn on the skin, the diabetic foot has great difficulty starting and completing the healing process. Untreated skin wounds will break down further, and the wound can extend to deeper tissue, including muscle and bone. Bacteria will enter the body through these wounds, and can potentially cause an infection that can spread beyond the foot itself. A diabetic’s body has a particularly difficult time defending itself from bacteria due to the way high glucose affects the very cells that eat bacteria, and diabetics tend to get infected by multiple species of bacteria as well. Combine all this with decreased circulation (and therefore decreased distribution of nutrients and chemicals to preserve foot tissue and help it thrive), and one has all the components in place for a potential amputation. Amputations are performed when bacteria spreads along the body and threatens death, when wounds and foot tissue will not heal as a result of gangrene from advancing tissue death and infection, and when poor circulation will not allow the tissue to thrive ever again. The statistics following a leg amputation are grim: about half of diabetics who undergo one amputation will require an amputation of the other foot or leg, and about that same number in five years will be dead from the heart strain endured when one’s body has to expend energy to use a prosthetic limb.

A podiatrist can ensure that all the above complications are significantly limited, and in some cases prevented all together. Podiatrists are physicians who specialize solely in the care of foot and ankle disease, through medicine and surgery. The attend a four year podiatric medical school following college, and enter into a two or three year of hospital-based residency program after that to hone their advanced reconstructive surgical skills, and to study advanced medical. Podiatrists are generally considered the experts on all things involving the foot and ankle, and their unique understanding amongst other medical specialties of how the foot functions in relationship to the leg and ground (biomechanics) allows them to target therapy towards controlling or changing that function in addition to treating tissue disease. A great majority of the problems that lead to diabetic amputations start off as problems related to the structure of the foot and how it relates to the ground and to the shoe worn above. Controlling or repairing these structural problems will often result in prevention of wounds, which in turn will prevent infection, gangrene, and amputation.

To start with, a podiatrist will provide a diabetic patient with a complete foot exam that takes into account circulation, sensation, bone deformities, and skin issues, and pressures generated by walking and standing. From this initial assessment, a protection and treatment course can be created specific to the individual needs of the diabetic for maintenance, protection, and active treatment of problems that do develop. Commonly performed maintenance services include regular examinations several times a year to identify developing problems, care of toe nails to prevent a diabetic with poor sensation from accidentally cutting themselves when attempting to trim their nails, regular thinning of calluses to prevent wounds from developing, and repetitive education on diabetic foot problems to ensure proper habits are followed. Preventative services include using special deep shoes with protective inserts in diabetics at-risk for developing wounds from regular shoes, assessment of potential circulation problems with prompt referral to vascular specialists if needed, and possible surgery to reduce the potential of wounds to develop over areas of bony prominences. Active treatment of foot problems performed by a podiatrist involves the care and healing of wounds, the treatment of diabetic infections, and surgery to address serious foot injury, deep infections, gangrene, and other urgent problems. Because of a podiatrist’s unique understanding of the way the foot structure affects disease and injury, all treatment will be centered around the principles of how the foot realistically functions in conjunction with the leg and the ground. This becomes invaluable in the struggle to prevent diabetic wounds and infections, while allowing one to remain mobile and active at the same time.

The essential goal of a podiatrist in caring for a diabetic patient is to prevent wounds, infections, and the amputations that result. This philosophy is called limb salvage, and it is accomplished through the above listed methods. Because of the severity of foot disease as a complication of diabetes, a podiatrist is an integral part of a diabetic’s care, and sometimes can even be the physician that diagnoses diabetes in the first place if foot disease appears as an early symptom of undiagnosed diabetes. For these reasons, all diabetics should be assessed by a podiatrist for potential problems, and those at-risk for foot wounds and infections should have regular foot examinations and preventative treatment. As a final note, online resources by podiatrists discussing diabetic foot issues abound, including a regular blog by this author ( thediabeticfoot.blogspot.com ). While these resources do not replace a diabetic foot exam, they do help educate diabetics on how best to care for their feet, and what to do if problems develop. This can lead to better knowledge and understanding of foot issues when diabetics begin to see a podiatrist regularly, and can help prevent early foot complications from developing.

Medifast and Diabetes – How Does Medifast Help Diabetics?

Are you a diabetic considering the Medifast plan? For many diabetics, weight loss is an important part of the treatment program. If that is the case for you, then you probably want to know exactly how Medifast can help diabetics. I’ve done a little research on that very question so I hope I can provide a few answers to your questions.

One thing to keep in mind is that Medifast’s diabetic plan is designed for people with Type 2 diabetes. Losing weight with Medifast is not recommended for you if you have Type 1 diabetes.

The main benefit of Medifast, not only for diabetics, but for anyone who need to lose weight, is the significant weight loss results that can be achieved. Because it is a low calorie diet combined with a reduced carbohydrate intake, results can often be dramatic, as much as 2 to 5 lbs per week.

Some common benefits for diabetics who lose weight are lower levels of fasting glucose, lowered blood pressure and better insulin levels. Some type 2 diabetics may also be able to reduce or stop taking their diabetes medication as well. Just make sure that you don’t make a decision like this without consulting with your doctor. You’ll want to discuss your changing medication needs before you start using Medifast, and then keep checking in with your Doctor to make adjustments as you continue with the plan.

Medifast actually has a specific weight loss program for diabetics that is different than their regular program. The special product line, known as Medifast Plus for Diabetics, is designed with the specific nutritional needs of diabetics in mind. But that isn’t the only difference, so you’ll want to look at the program material as well. Medifast publishes a 34 page “Medifast and Diabetes” program guide which you can read to figure out how the plan will work for you. You can even give a copy of it to your doctor.

The Medifast plan for diabetics is a bit different than the standard 5 & 1 plan other users follow, so you’ll want to look over all the options and have your doctor help you figure out the best choices for you. After that, sticking to the Medifast program is pretty easy with the large variety of shakes and other products for you to choose from, according to your taste.

Diabetics – Are You a Heart Attack Waiting to Happen?

Diabetes is sneaky. Most patients feel fine, even with their blood sugar 50-100 points too high.

But behind the scenes, much is happening. By the time a person is diagnosed with diabetes, the risk of having a heart attack has already soared as high as that of a person who has already suffered one. And sometimes a diabetic has already had a heart attack without even knowing.

How is this possible? Doesn’t everyone with a heart attack clutch his chest in agony and fall to the ground? No! Especially in diabetics, heart attacks may be brushed off as something else: heartburn, indigestion, fatigue, hypoglycemia.

Diabetes damages blood vessels, particularly coronary arteries – the arteries that carry blood and oxygen to the heart muscle itself. Diabetes also damages nerves – including the nerves that alert a person to cardiac ischemia (lack of oxygen-carrying blood to the heart).

Do you remember what it feels like to run so hard that your leg muscles cramp and become weak? That’s what happens to the heart when it can’t get enough oxygen. But if you can’t feel the damage occurring, how will you know?

Leprosy and diabetes have this in common: nerve damage may occur to the degree that a person is unaware they are hurting themselves. Both lepers and diabetics may lose toes or even feet due to untreated injuries. I’ve had diabetics step on a tack and not even feel it.

The heart can be damaged on this basis as well. Classic symptoms of heart disease may be minimal or absent. As a diabetic, you may have no chest pain, no arm pain, no shortness of breath. Or you may experience something as mild as the heartburn you had after eating spaghetti last weekend. Possibly, you may have sweating and nausea that you attribute to a low blood sugar.

Knowing all this, what should you do?

Hopefully you have a doctor who you have partnered with in your care. If not, find one right away. If your doctor has not suggested an annual EKG, request one yourself. If you experience chest pain, heartburn, shortness of breath, nausea, sweating, fatigue, or other symptoms, see your doctor to make sure they are not coming from your heart.

Diabetes often coexists with other risk factors for heart disease. If you smoke, you assuredly are a heart attack waiting to happen. Make sure your blood pressure is under control. Know what your cholesterol level is and ask your doctor how to lower it. If you’re overweight, aim to lose at least 5% of your body weight.

Being aware of the risk is the first step. Now do yourself a favor, and take good care of yourself.

Copyright 2010 Cynthia J. Koelker, M.D.

The Benefits of Fava or Broad Beans for Diabetics

Fava beans, as they are called in the Americas, or broad beans, as they are more commonly called in Europe, Australia and New Zealand, have been a part of diet in the eastern Mediterranean since about 6,000 BCE.

They grow in broad, leathery pods, like much enlarged pea pods. Each pod contains three to eight oval beans.

The term broad bean refers to the larger-seeded cultivars that are grown for human food, while horse bean or field bean refers to cultivars with smaller, harder seeds mainly (but not exclusively) used for animal feed.

The fava bean is a hardy plant. It can withstand harsh and cold climates.

Preparing fava beans

Preparing fresh fava beans can be a bit of a pain.

When buying the beans, choose green pods that are firm and don’t bulge. The bulging pods may be old and often have a bitter taste.

To remove the beans from the pods, just run a thumb nail along the seam of the pod to split it open. Take out the beans. They are wrapped in a thick white skin that needs to be removed.

You can get rid of the skin by using a sharp knife to make a small slit along the edge of the bean. This will allow the raw bean to pop right out. But this is a lot of hard work… bean by bean!

You can get around this by putting the beans into boiling salted water and parboiling them for about a minute-and-a-half. After that put the beans into ice-cold water so they stop cooking. Now you can squeeze the beans right out of their skins.Still… preparing broad beans is hard work. It takes about 3lbs or 1.5kg of fava pods to get one full cup of beans.

Culinary uses

Broad beans are usually eaten while they are young and tender. If they are planted in early winter, they can be harvested in the middle of spring. If they are sown in early spring they will be ready by mid-summer.

Horse beans, on the other hand, are left to mature fully. They are harvested in late autumn and can be eaten by humans as a pulse, though they are most commonly used as animal fodder.

Broad beans were a major foodstuff in the ancient civilizations of the Mediterranean. They were especially popular among the ancient Egyptians, Greeks and Romans. They eventually spread along the Nile Valley to Ethiopia, northern India and China.

Fava beans can be eaten in a variety of ways. For example, you can steam them until they are tender and then toss them in fresh lemon juice. They are lovely in a mixed green salad. Mashed fava beans can be used as a spread on bread or crackers. They are at their best as fúl medammes, which is very popular as a breakfast dish in Arabia. It makes a great lunch.

Making fúl medammes is really easy. Fry finely chopped garlic and onion is a pan using an extremely small amount of virgin olive oil. Once the garlic has been softened, add the fava beans and a little water. Bring to the boil and mash the beans with a wooden spatula. Once the goo is piping hot, pour it into a bowl and service with oat cakes (thin sugar-free biscuits made from oats).

In parts of Latin America, mashed fava beans are used as fillings in corn-based snacks. They are also used whole in vegetable soups.

The beans can also be dry-fried, causing them to split open. You can then spice them to produce a savoury, crunchy snack that is popular in northern Iran, Malaysia, Thailand, China and Latin America.

The immature pods can also be cooked and eaten. In addition, the young leaves of the plant can be eaten, either raw or cooked in the same way as spinach.

How nutritious are fava or broad beans?

The simple answer is… very nutritious.

Here’s what you get in 100 grams of raw mature seeds:

Macro-nutrients

Energy… 1,425 kJ (341 kcal)

Carbohydrates… 58.29 g

Dietary fibre… 25 g

Fat… 1.53 g

Protein… 26.12 g

Vitamins

Thiamine (B1)… 0.555 mg… 48%

Riboflavin (B2)… 0.333 mg… 28%

Niacin (B3)… 2.832 mg… 19%

Vitamin B6… 0 366 mg… 28%

Folate (B9)… 423 μg… 106%

Vitamin C… 1.4 mg… 2%

Vitamin K… 9 μg… 9%

Minerals

Calcium… 103 mg… 10%

Iron… 6.7 mg… 52%

Magnesium… 192 mg… 54%

Manganese… 1.626 mg… 77%

Phosphorus… 421 mg… 60%

Potassium… 1,062 mg… 23%

Sodium… 13 mg… 1%

Zinc… 3.14 mg… 33%

μg = micrograms… mg = milligrams… IU = International units

The percentages refer to the recommended daily amounts for an adult.

As you can see from the above, dietary fibre makes up 25% fava beans. Another 26% consists of protein.

In addition, fava beans are especially rich in micro-nutrients such as the B vitamins, notably folate and thiamine. The broad beans are also full of phosphorus, manganese, magnesium and iron.

Fava beans are one of the top high-folate foods (vitamin B9) around. Folate helps metabolise your energy, supports your nervous system, and keeps red blood cells healthy. It’s also a must for pregnant women.

Benefits of eating fava or broad beans

Fava beans do not directly help diabetics control their blood glucose. But they do help prevent or slow the development of certain adverse medical conditions, many of which arise due to diabetes, such as:

  • hypertension
  • risk of heart disease and stroke
  • weak immune system
  • reduced energy
  • development of osteoporosis
  • poor motor function
  • risk of birth defects

Hypertension… 85% of diabetics suffer from high blood pressure. Studies show that magnesium can lower blood pressure. Broad beans are loaded with magnesium.

According to a meta-analysis of 12 clinical trials covering 545 participants in total, magnesium supplements taken for up to 26 week resulted in a small reduction in diastolic blood pressure. But another study demonstrated that better results are achieved when magnesium supplements are combined with magnesium-rich vegetables and fruit.

Heart disease and stroke… hypertension and diabetes increase the risk of heart disease and stroke at least three times compared to the risk among the general population. Thus improvements in your blood pressure will reduce your risk of suffering a heart attack or stroke.

Weak immune system… is another consequence of diabetes. Healthy white blood cells are necessary to support a strong immune system because without them your body is very susceptible to illnesses and infections. White blood cells destroy pathogens that cause diseases and help eliminate free radicals found in your body.

Copper helps maintain healthy blood cells, and broad beans contain significant amounts of copper thus helping to strengthen your immune system.

Reduced energy… many diabetics experience a feeling of sluggishness. This ongoing tiredness can be due to a lack of iron which is required to produce haemoglobin. Haemoglobin carries oxygen to the cells throughout your body. Fava beans contain significant amounts of iron and their consumption can help put pep back into your step.

Development of osteoporosis… can be prevented to an extent with manganese. Manganese helps increase bone mass and helps reduce calcium deficiency. Fava beans contain significant amounts of manganese. The US National Library of Medicine suggests that consuming forms of manganese along with calcium, zinc and copper may help reduce spinal bone loss in older women.

Risk of birth defects… can be reduced with folate (vitamin B9). Broad beans contain very significant amounts of folate which, as well as being great for providing energy, has long been associated with helping to reduce birth defects.

A meta-analysis of research on folic acid supplementation, published in Scientific Reports by the US National Library of Medicine National Institutes of Health in 2015, found a positive association between folate supplementation and a decreased risk of congenital heart defects.

Birth defects often occur during the first few weeks of pregnancy at a time when many women may not know that they are pregnant.

The Center for Disease Control and Prevention and the US Public Health Service recommend that all women between 15 and 45 years (the child-bearing ages) consume 0.4mg (400μg) of folic acid every day to help reduce the risk of birth defects, spina bifida and anencephaly.

Poor motor function… due to Parkinson’s disease may be helped by eating broad beans regularly, according to some studies. Research published in the Journal of Clinical & Diagnostic Research examined the effects of eating fresh fava beans with their outer shells, fava beans dissolved in alcohol and water, and dried sprouted fava beans.

The researchers discovered that the increase in the levels of the amino-acids L-dopa and C-dopa in the blood stream from the fava beans caused a significant improvement in the motor performance of patients with Parkinson’s, without any side effects.

Side effects of eating fava or broad beans

Fava beans are not the most tasteful food on the planet. But spice them up a bit and they are a pleasure to eat. Most people tolerate them very well.

A few people are allergic to fava beans. However, cooking the beans thoroughly can help reduce the risk of an allergic reaction.

Consuming broad beans can be highly detrimental if you have glucose-6-phosphate dehydrogenase deficiency. G6PDD is an inborn problem with your metabolism that predisposes you to a breakdown of your red blood cells. It is very rare.

This breakdown can be triggered by a variety of infections, medications, stress and a few foods such as fava beans. Thus if you have G6PDD, you must avoid eating broad beans.

Monoamine oxidase inhibitors (MAOIs) are a class of drugs that have a long history of use in the treatment of depression. These drugs interact unfavourably with other medicines and certain foods, so if you are using these drugs you should avoid eating fava beans.

The takeaway

Despite all this, it is a good idea to add broad beans to your diet unless you have a medical condition that can be affected negatively by the beans or you are taking medicines that can cause you to have an adverse reaction to the beans.

But if you can handle them without any health issues, you should avail of their potential to reduce your diabetic’s risk of heart disease and strokes, to boost your energy levels and immune system, to help your motor function and so on, by consuming broad beans on a regular basis.

I enjoy a bowl of fava beans laced with garlic and onion for lunch at least once a week in the form of fúl medammes.