The feet soles are among the most sensitive parts of the body. Most people will laugh when their soles are tickled or yell with pain when sharp object pricks them. But among diabetics, these impulsive responses may diminish with time.
High blood sugar over a long duration often causes the formation and accumulation of fat deposits on the lining of arteries. This consequently leads to narrowing of blood vessels which obstructs normal blood flow in the body. Blood will be pumped from the heart, but obstructions will prevent it from adequately flowing into peripheral or lower parts of the body.
The feet are located furthest from the heart and so they usually suffer most from the impact of insufficient blood supply. They end up becoming malnourished, losing adequate oxygen and nutrients that were integral to their wellbeing.
Ultimately, these aerse changes destroy the disease fighting mechanism of the feet making them vulnerable to attacks.
Therefore, small scratches and cuts that previously healed fast end up taking long and could even become worse. This happens at a time when the diabetic patient is also suffering from neuropathy — loss of sensation due to nerve damage cause by blood flow obstructions.
People are thus unlikely to notice that they have a wound in their foot as they will not be feeling any pain.
“This means that the warning sign of pain is lost. The brain will not be able to alert you when you have an injury. And if you can’t feel then you can’t take any action,” explains Mr Isaac Miruka, Diabetic Foot care specialist Nurse at Kenyatta National Hospital (KNH).
Unknowingly, he adds, those affected will continue to walk normally with the injured foot.
This will put pressure on the wound, increase its size and provide a fertile ground for the multiplication of deadly bacteria on an already “weak” foot that can’t effectively ward off infection. Soon, ulcers will develop and later gangrene (decomposition of tissue) will sets in and destroy the foot completely.
Most patients come to the hospital when the affected foot is already rotten and can only be amputated.
“Yet they will be surprised with this turn of events as all along they hadn’t been feeling pain,” states Mr Miruka who tends to such patients frequently.
Most times, it is the relatives of the affected people or friends who alert them that something is wrong when they perceive the foul smell emanating from the wound. But at this point the damage is often irreparable.
To prevent such painful eventualities, Mr Miruka urges people with diabetes to form a habit of always inspecting their feet for any pricks, cuts and other abnormalities.
“As soon as you spot anything, you should rush to the hospital. Don’t ignore it or self medicate.”
He notes that timely professional care and interventions results in complete healing of wounds thus preventing amputations.
A study published in the Lancet found that in every 20 seconds, a lower limb is lost to diabetes globally. Worse still, risk of death after amputation often rises from a minimum of 15 per cent after a year to between 40 and 80 percent after 5 years. The impact is felt more in developing countries like Kenya where access to diabetic foot Care is insufficient.
“This is a threat to people living with diabetes here and should therefore be addressed to avoid disability,” said Miruka who conducts nationwide trainings on diabetic foot care.
As part of the Africa diabetic Foot Care project, the government has embarked on a nationwide project aimed at establishing special centres across the country to deal with the ailment. It is also training healthcare workers on the management of the disease.
SOURCE: BUSINESS DAILY