NOVEMBER is the month where we nationally recognise the condition diabetes mellitus (DM), so it is only fitting that I dedicate this article to the diabetic foot.

Diabetes has reached epidemic proportions in Jamaica. Sixty-five per cent of the patients who attend my office are diabetic, many having been diagnosed several years ago. In 1960, the prevalence of DM in adult Jamaicans stood at 1.3 per cent. By 1995 it had jumped alarmingly to 17.9 per cent. The reasoning behind this jump is thought to be due to poor diet obesity and an increase in sedentary lifestyle. Studies have shown that of those people who have DM in Jamaica, less than 50 per cent are well controlled. Diabetes is the second leading cause of death in Jamaicans under 70.

These are very worrying and shocking statistics. The United Nation Secretary-General Ban

Ki-moon spoke just last week regarding the impact of diabetes in the Caribbean and its devastating effects. The World Health Organization has also recognised this. It is only through lifestyle changes (beginning in childhood), education, and

first-class multi-disciplinary treatments that we will be able

to reduce these figures.

We know that people with diabetes have a much greater risk of developing problems with their feet due to the damage raised blood sugars can cause to the peripheral circulation and sensation. If you are diabetic, you are 15 times more likely to have a limb amputated due to gangrene. As the old saying goes, “prevention is better than cure”, so follow these tips.

CARING FOR DIABETIC FEET

1. Have your feet checked by a podiatrist at least twice a year, even if you don’t think you have any problems.

2. Check your feet every day for signs of redness, pain, hard skin, and swelling. Be aware of any loss of feeling in your feet, because you may not feel if your feet hurt anymore.

3. Look after your nails. File them rather than cutting or clipping, and don’t go too low. If you have poor circulation or numbness in your feet, your nails should be cut by a podiatrist or medical professional.

4. Do not use corn removing plasters, solutions or blades, as these can damage healthy skin. Also, avoid nail softeners as these can damage the nail bed and surrounding tissues.

5. Use moisturising lotions and creams daily, but avoid between the toes.

6. If you have a cut on your foot that is not showing significant signs of healing within 48 hours, seek medical help.

7. Examine the insides of your shoes before you put them on. You never know if a stone or sharp object may have entered. Sometimes the lining of a shoe may have ruffled up and can cause abrasions. The shoes you wear should be roomy enough for you to wriggle your toes. They should also be supportive with a lace or strap to hold them securely onto your foot. Avoid flip-flops, as these offer no support at all and often cause trips and falls.

8. Never wear socks that have holes or have been darned. The top of the sock should never be too tight as this may restrict circulation.

9. If you smoke, stop. Get support from your general practitioner. Smoking affects the blood circulation and increases your risk of developing serious foot problems.

10. Maintain good control of your blood glucose levels, blood pressure, and cholesterol. Seek help from your doctor if you are struggling with this. Eat a healthy diet that is low in saturated fat, sugar and salt, and high in fruit (not sweet ones like mangoes), and vegetables.

11. Exercise regularly. Obesity is a huge predisposing cause of diabetes. Many of my obese patients say that they have tried, but can’t lose the weight. I met a gentleman recently who was 300 pounds, and his fiancée was 250 pounds a year ago. They made a conscious decision to lose weight steadily through diet and a complete lifestyle change.

They cut out all alcohol, red meat, salt, and sugar. They started power-walking and jogging. A year on and they are half the size they used to be. They were both at high risk of developing diabetes and cardiovascular disease. It can be done! It just takes discipline and determination.

12. Give your diabetes the respect it deserves. You only have one pair of feet, so look after them. Don’t ignore the symptoms or there may be a very high price to pay.

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293-7119), Mandeville

(962-2100), Ocho Rios

(974-6339), and Savanna-la-Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.