- Nerve damage : High blood sugar can damage the nerves of the foot, decreasing a person’s ability to notice pain and pressure. If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation.
- Poor blood flow : High blood sugar damages blood vessels which decreases blood flow to the foot. It weakens the skin, contributes to ulcer formation and prevents healing. Deep skin and bone infections can also occur.
- Skin changes : Excessive skin dryness, scaling, and cracking may indicate that circulation to the skin is compromised.
- Deformities : The structure and appearance of the feet and foot joints can indicate diabetic complications. Diabetes can also affect the joints, making them stiffer.
- People suffering with diabetes are more prone to infection.

Because of this, you can face number of problems:
- The foot may get damaged and you are not aware of it.
- Foot ulcers.
- Infections can spread more easily.
- Diabetics is the main cause of amputations.

How to take care of your feet

- Maintain your sugar levels.
- Quit smoking.
- Wash your feet everyday with warm water.
- Moisturize your feet with some lotion. Do not keep them dry.
- Keep feet dry especially between the toes.
- File corns and calluses gently.
- Check your foot daily for cuts, corns, blisters, sores etc.
- Keep your nails cut and filed.
- Avoid going barefoot, even in your own home.
- Exercise daily to promote good circulation. Avoid sitting with legs crossed or standing in one position for prolonged periods of time.
- Get a foot exam by your health care provider at least twice a year and learn whether you have nerve damage.

What should I look for when choosing shoes and socks?

- Don’t wear shoes without socks.
- Don’t wear sandals or other open-toed shoes.
- Wear shoes made out of canvas, leather, or suede.
- Avoid high-heeled shoes and shoes with pointed toes.
- Don’t wear uncomfortable or tight shoes that rub or cut into your feet.
- Talk to your doctor before you buy special shoes or inserts.
- Change socks and shoes every day. Have at least 2 pairs of shoes so you can switch pairs every other day.
- Do not wear stockings with seams that can cause pressure points.
- Wear socks to bed if your feet are cold.

NOTE: Do not use antiseptic solutions, heating pad or hot water bottle to the feet.

- Either the pancreas does not produce enough insulin to break down the sugar in the body. It is also called Type I diabetes whereby the patient has to inject insulin into his body. It is caused by an auto immune reaction where the body’s defense system attacks the insulin producing cells.
- Insulin being produced is insufficient. It is also called Type II diabetes. It is when the body does not or cannot use the insulin effectively. It is often related to lifestyle and eating pattern.

Diabetes is quite capable to affect all the parts of the body and their functions. Diabetes Mellitus is a disease in which abnormally high levels of sugar in the blood are seen. When the amount of glucose in the blood increases, it triggers the release of the hormone insulin from the pancreas. Insulin stimulates muscle and fat cells to remove glucose from the blood and stimulates the liver to metabolize glucose, causing the blood sugar level to decrease to normal range.

As a result of the steady percolation of sugar rich blood the functioning of nearly all the vital organs is impacted and over time, diabetes begins to dramatically impact and invariably damage the heart, blood vessels, kidneys, eyes and the nervous system. Diabetes is not age dependent. It can affect young as well as old.

A healthy lifestyle, moderate but regular exercise and a balanced diet may serve as a key to avoid a disease.
- Indulge in brisk walking for minimum of 30 minutes, 5 times a week.
- Maintain an ideal body weight.

Symptoms vary depending on the nerve(s) affected. They usually develop gradually over years.
- Digestive tract :
* Constipation
* Diarrhea
* Feeling full after only a few bites (early satiety)
* Nausea after eating
* Swollen abdomen
* Unintentional loss of more than 5% of body weight
* Vomiting of undigested food
- Heart :
* Sensation of what is going on in the heart is blunted.
* Blood pressure changes with position.
* Dizziness that occurs when standing up.
* Lacking oxygen, the heart feels pained, a condition called angina. But a diabetic may not feel anything, or realize anything is wrong.
- Urinary tract :
* Difficulty beginning to urinate.
* Feeling of incomplete bladder emptying.
* Urinary incontinence (overflow incontinence).
- Other symptoms :
* Abnormal sweating
* Fainting
* Heat intolerance, induced by exercise
* Male impotence
Occasionally, other symptoms may indicate a problem in the function of the autonomic nervous system, including:
* Difficulty swallowing
* Excessive sweating
* Irregular heart rhythms
* High blood pressure
* Rapid or slow heart rate

Treatment is supportive and may need to be long-term. Several treatments may be attempted before a successful one is found.
* Florinef and salt tablets to increase fluid volume in blood vessels.
* Fludrocortisone or similar medications to reduce postural hypotension.
* Medications to help with salt and fluid retention.
* Proamatine to prevent a drop in blood pressure when standing.
* Sleeping with the head raised.
* Use of elastic stockings.
Treatments for reduced gastric motility include:
* Medications that increase gastric motility (such as Reglan).
* Sleeping with the head raised.
* Small, frequent meals.

SYMPTOMS :
* numbness or insensitivity to pain or temperature.
* a tingling, burning, or prickling sensation.
* sharp pains or cramps.
* extreme sensitivity to touch, even light touch.
* loss of balance and coordination.

TREATMENT :
- Vitamin deficiencies can be corrected.
- Diabetes can be controlled, although control may not reverse the neuropathy.
- Neuropathies that are associated with immune diseases can improve with treatment of the autoimmune disease.
- Neuropathy caused by nerve entrapment can be treated by physical therapy, injections or surgery.
- Prompt treatment with sympathetic injections can minimize the chance of shingles progressing to post herpetic neuralgia.

IMPORTANT :
Another problem with a peripheral neuropathy is pain, which can be severe. It is usually worse in the evening or night, and can be particularly bothersome because it interferes with sleep. Never try narcotics for this pain; many options for pain relief are available, but all are medications that must be prescribed by your doctor. They work by altering the chemistry within the nerve, particularly that which causes pain. These drugs include some of the older anti-depressants (in small doses), anti-seizure medications, and drugs that are sometimes used for rhythm disturbances of the heart. Creams containing capsaicin also help certain individuals. Any of these treatments take weeks to have an initial effect.
Weakness and unsteadiness of the arms or legs can be a problem. When severe, the muscles of the hands waste away and the ability to use the fingers is impaired.

Low Blood Sugar
Insulin or pills help to control diabetes but can sometimes cause low blood sugar, especially during/after exercise if you :
- Skip a meal.
- Eat late meals.
- Do not eat enough.
- Take too much medication.

If you have low blood sugar, you may feel shaky or dizzy, sweaty irritable, hungry or tired. In such conditions, it is important to eat or drink something sweet right away. Consult your doctor immediately.

High Blood Sugar
In general, high blood sugar is defined as plasma glucose above 126 mg/dl fasting and above 200 mg/dl after meals. If your blood sugar remains high for long periods of time, it can cause significant short term and long term complications as mentioned. It is therefore important to keep your blood sugar under control by creating a balance between lifestyle modifications and medications such as pills or insulin.