Leg care rules for diabetes
Sugar diabetes is a disease associated with insulin disadvantage or a decrease in its action, as a result of which the metabolism is violated, the excessive amount of glucose in the blood is accumulated, which has a direct toxic effect on small and large vessels, as well as at nerve endings, which causes one Of the most terrible complications of diabetes. This complication is called diabetic polyneuropathy, as well as the diabetic foot syndrome, as a result of which the lower limbs are affected.
Mechanisms for occurrence:
- Defeating the nerves of the lower limb (neuropathy), as a result of which a person can feel the feeling of numbness, burning, pain in the foot, decrease in the sensitivity of the skin of the foot. Another mechanism is the defeat of the arteries of the lower limb (angiopathy). In this case, there is a trophic violation (i.e., the supply of nutrients and tissue oxygen, as well as a slow output from the tissues of decay products), the result of the trophic violations can be slow healing of wounds;
- Due to the reduction of sensitivity, a person may simply not notice how he came on something sharp, something hot or cold. He may also not feel that the shoes are close and rubbed to him, while in the places of the greatest pressure, can be formed to be formed (ulcers);
- Due to trophic violations, the healing of microtrams is very long, infection can join. Therefore, it is much easier to prevent the development of the diabetic feet than then it is treated.
Prevention This dangerous complication of diabetes should be reduced to constant control of blood glucose levels, as well as compliance with some uncomplicated rules, allowing long years to maintain the health of the stop in patients with diabetes.
So, go directly to Leg care rules:
- Daily inspect the legs, interfallated intervals, soles stop to detect blisters, cuts, scratches and other damage, they can become an entrance gate to penetrate the infection. Stop soles can be easily viewed using a mirror. Even a slight scratch with diabetes mellitus can grow into a big problem !!!
- Make your feet daily and carefully (not rubbing) wipe them. Do not forget about the interfallated intervals. After the shower, swimming needs to thoroughly dry the legs.
- Do not expose the legs of very low and very high temperatures. Water in the bathroom check first by hand to make sure that it is not very hot. If the legs are freezing at night, wear warm (woolen) socks. Do not use the heating, steam heating batteries, electric heaters, hot foot baths and other hot objects.
- Daily inspect your shoes - whether sharp items did not get into it, whether the lining was not broken, did not come down the insole. Since all this can damage your skin.
- Daily change socks and stockings. We carry only suitable stockings or socks, with free rubber band. You can not size less than you need and \ or with a tight rubber band.
- Buy only that shoes, which from the very beginning comfortably sits on the leg, the occurrence of corns and scuffs contributes both narrow and too spacious shoes. Shoes should be soft, narrow gouring and rigid shoes are prohibited. The heel should be stable, maximum 4-5 cm, you can not choose shoes on the heel. Never put on the barefoot leg sandals, sandals with a strap that runs between your fingers. Walking on the beach or on the grass only in closed slippers. Never go barefoot, especially on a hot surface!
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In this article you will learn:
Currently, diabetes (SD) and its complications are a serious cause of mortality and disability of people around the world. According to the World Health Organization today, 422 million people in the world suffer from diabetes, and by 2030 diabetes will be the 7th prevalence cause of people's mortality.
One of the complications of diabetes mellitus is diabetic neuropathy, which in the early stages is manifested by pains in the limbs, and in the later stages it may threaten the development of gangrenes, requiring amputation, sepsis and even the death of a person. If you or your loved ones with diabetes are sick, this article will help you to know what to do to prevent the development of complications and avoid amputation.
Neuropathy - the cause of pain in the legs in diabetes
Sometimes patients even have a long-suffering diabetes mellitus do not know that there is a connection between their illness and why their legs hurt. Diabetic neuropathy is the most common complication of diabetes mellitus, with the same frequency developing in diabetes both the first and second types, in which the nerve fibers are affected.
In the risk group for the development of this complication there are people who are long-suffering sugar diabetes, as well as patients who do not receive adequate treatment and poorly controlling blood sugar indicators.
Also, the development of neuropathy is promoted by concomitant obesity, diseases of the cardiovascular system, elderly age, smoking and alcohol abuse. The longer the patient lives with diabetes, the higher the risk of developing diabetic neuropathy, on average, this pathology develops in 50% of people with SD.
The main reason for the occurrence of complications in diabetes is a constantly elevated blood sugar level.
This leads to damage to the wall of blood vessels (angiopathy) and nerve fibers, the consequence of which is the lack of oxygen in the tissues and organs and the death of the cells. From the fact that the body suffered from this defeat, the clinical manifestations of the disease and the patient's complaint depends.
"Diabetic Stop" - the cause of disability of patients with diabetes
With damage to vessels and nerve fibers of the feet there is a condition called in medicine "Diabetic Stop". In the early stages of the development of the diabetic foot syndrome, patients complain about soreness in the legs, feet, numbness in the footsteps and fingers of the legs, while often they already have diabetes mellitus of the first or second type and it is very important to obtain timely help and prevent the development of complications.
Microcirculation violation ( microangiopathy ) and damage to nerve endings lead to a violation of metabolism in tissues and as a result of their damage. As a result of cracks, micro-gras are formed ulcers that are poorly healing. Wearing close and uncomfortable shoes, improper hygiene aggravate the development of ulcers. In the absence of treatment of ulcers on the skin progress, and there is damage to muscle and bone tissues.
The causes of the development of diabetic ulcers in 33% of cases are wearing inappropriate shoes, in 16% - foot injuries, 13% thickening of the epidermis of the foot of the foot.
Vascular damage plays a large role in the development of pain in the legs in diabetes - Diabetic microangiopathy which develops due to the blockage of the glorification of the artery by plaques. Violation of blood supply leads to insufficient delivery of oxygen to the tissues, their hypoxia and dying.
Symptoms of diabetic foot
If you periodically experience pain in your feet and found the following symptoms, immediately refer to your doctor to get the necessary surveys and treatment:
- Pain in the legs;
- Distinguishing sensitivity in the form of numbness, tingling, disorders of temperature sensitivity, pain sensitivity, as a result of which the patient may not notice small injuries, blows and cracks, which additionally carries the risk of infection;
- Changes from the skin: dry, cracks, corns, ulcers;
- Poor healing and infection of the wounds.
In large cities and regional centers, specialized centers for the treatment and prevention of the diabetic foot are organized, where patients can fully obtain qualified assistance. You should not resort to folk remedies, if you have a feet with diabetes me, what to do - only a doctor will tell you, and delaying with treatment can contribute to the progression of disease and complications.
Surveys and consultations
When handling complaints of pain in the patient's legs, the doctors of the following specialties advise:
- ophthalmologist (the state of the eye dna),
List of necessary laboratory surveys
- glycemic profile, level of glycosylated hemoglobin;
- Lipid blood plasma profile.
Instrumental research methods
- ultrasound study of the arteries of the lower limbs with dopplerography;
- X-ray Stop study.
If you have a leg sick with diabetes, you must take the following measures to prevent diabetic foot syndrome:
- regularly monitor the level of sugar using a glucometer, to directly access the doctor and follow the appointment;
- Refusal of smoking, it increases the risk of amputation by 2.5 times;
- treat accompanying pathology - arterial hypertension, obesity, etc.;
- Do not wear close and uncomfortable shoes, wearing leather free shoes and socks made of natural fabrics, for part of patients, we need to carry orthopedic shoes;
- prevent the development of corns and hopes;
- Avoid traumatization and carefully care for the nails, it should be coated straight, not spinning corners;
- perform exercises for legs walking on short distances, ride a bike;
- Every day to observe feet hygiene, inspection of the foot for the presence of a wound and cracks, regularly cut the nails, lubricate the skin with emollient creams, when the fungal lesion occurs, contact the dermatologist.
If you have diabetes, you must carefully monitor blood sugar and maintain it within normal values. Treatment and adherence to the diet to normalize the level of glycemia can help improve the condition in the legs in the legs associated with diabetes mellitus. If the level of glycemia is not controlled adequately with the current treatment regimen, another mode can be assigned.
Patients with diabetes mellitus of the first type can be assigned additional insulin injections or the use of insulin pumps. For patients with second-type diabetes, additional oral sapperizing drugs can be appointed or insulin injections are assigned.
The normalization of the level of cholesterol, causing the blockage of the arteries, is needed to control the level of cholesterol in the biochemical analysis of blood and the reception of cholesterol-reduction drugs.
Pain in the legs in diabetes can very seriously affect the quality of life, so an important part of treatment is to control pain with the help of drugs. There are several drugs that are effective in the treatment of pain associated with diabetic neuropathy are dulssetin and pregabalin. Tricyclical antidepressants, gabapentine, tramadol are also used.
In the presence of peripheral diabetic neuropathy, vitamins of group B, vitamin D, antioxidants - alpha-lipoic acid are prescribed.
In the presence of a concomitant disease, their treatment is necessary - control over the arterial hypertension, the reception of hypotensive and antiarrhythmic drugs, a strict refusal of smoking and alcohol, normalization of body weight, neurological pathology therapy.
If there are microcracks in the field of foot, RAS and ulcers need to use local anesthetic and antibiotics.
If infectious complications occur, it is necessary to appoint adequate antibiotic therapy of a wide spectrum.
In severe course and progression of the disease, there is sometimes a need for surgical treatment - in the form of an operation on excresses, phlegmon, the removal of necrotic tissues, as well as limb amputation.
New and experimental treatment methods
In view of the relevance of the problem around the world, the search for new methods of helping patients with pains in the legs and manifestations of neuropathy caused by diabetes are underway.
The main directions are methods allowing to prevent the progression of the disease and facilitate wound healing. This helps to reduce the frequency of limb amputation, which, unfortunately, is common to patients with sugar diabetes complications.
In developed countries, national programs and centers for the prevention of development of diabetic neuropathy and diabetic foot are being created, allowing new technologies.
Remember - it is important to handle any form of pain in the legs to the doctor, even if the symptoms do not interfere with everyday activity. Frequent cramps or pain when walking may indicate the deterioration in the flow of diabetic neuropathy. Immediately inform your symptoms to your doctor.
Medical treatment can help relieve pain and prevent complications. But still there are several measures that patients can follow at home. As practice shows, they turn out to be no less effective.
Regular physical exertion
Active lifestyle and regular physical exertion have a lot of health benefits, and most importantly - to normalize blood circulation. Physical exertion helps to deliver oxygen and nutrients to limb tissues, which significantly reduces the likelihood of complications.
It is known that patients with a diagnosis of diabetic neuropathy note a significant improvement in the condition and a decrease in symptoms with an increase in the level of physical activity. But before taking measures and increase activity, it is necessary to talk to the doctor, because there may be contraindications.
Power control, calorie and sugars consumed - one of the main rules for controlling diabetes and maintain a stable blood sugar level. Following the principles of proper nutrition will help to cope with pain in diabetic neuropathy.
The diet is recommended to include basic food groups:
- Sources of protein: legumes, low-fat varieties of meat;
- Some types of fats, such as vegetable oils, seafood;
- Non-historical vegetables;
- some fruits;
- complex carbohydrates.
Nutrition is the main source of the necessary vitamins, minerals and other substances. But still it is not always possible to get all the nutrients from their diet. And it's not just in the wrong or defective diet, but also in some diseases of the internal organs.
Recommend the reception of food additives, in particular, polyvitamins can only a doctor after the necessary surveys. An additional intake of vitamins is prescribed: D, B12, as well as alpha lipoic acid and acetyl-L-carnitine.
Patients should remember that the reception of additional doses of vitamins, minerals and other substances may affect the assimilation of other drugs taken.
Rejection of bad habits
Refusal of bad habits has a positive impact on the overall health condition, especially in patients with such severe chronic disease as diabetes. In the course of many studies, patients noted that after the refusal of bad habits (smoking, alcohol abuse) managed to significantly improve well-being.
The doctor can recommend other actions that will help relieve pain in the legs and prevent complications in diabetes. These include:
Diabetic stop (Diabetic foot syndrome, SDS) is a difficult complication of diabetes in the form of infection, ulcers or deepening deep tissues, which occurs due to violation of the macrostructure of the foot and microcirculation of blood, due to the destruction of nerve endings and nerve fibers. [one]
The main cause of DS is diabetes (SD). And although the diabetic foot syndrome does not develop from the first day of increasing blood glucose levels of more than 7.0-8.0 mmol / l, each patient with a diagnosis of "diabetes" should be remembered about such a formidable possible complication.
SDS develops to varying degrees and different forms:
- after 5-7 years in 60% of patients with type 1 (glucose level of more than 8 mmol / l);
- After 15-20 years, 10% of patients with non-associated-dependent type 2 (glucose level 8-9 mmol / l) - often occurs during osteopathology, injury and dermatitis of the foot of various etiology.
- After 10-15 years with 90% of patients with insulin-dependent LD 2 types.
The main "starting mechanisms" of the development of ulcers at the SDS:
1. Wearing uncomfortable shoes . To change the load on the joints of the foot, squeezing or curl of the skin, local microchemistry, infiltrate, or necrosis, I can bring any defects of the shoes:
- inappropriate shoe size (less or more than necessary);
- Stopping and / or high heels;
- scar on the insole;
- sole defect;
- wet shoes;
- Non-compliance of the shoes of the year.
2. Increased body weight . Considering the stop area, with an increase in body weight (even 1 kg), the load on each foot joint increases. The most vulnerable area is a sole surface.
3. Expanding the epidermis (surfaces) of the skin . This process occurs due to the disturbed metabolic processes in the skin on the background of the SD (under the thickened epidermis-"corn" in the skin layers, microcirculation is broken, which leads to micro-semia and necrosis).
4. Microtrauma :
- animal bites;
- injections of spikes of plants;
- Cuts for pedicure, etc.
5. Stenosis (narrowing) and occlusion (blockage) of the main arteries . As a result of the lack of blood supply in the footsteps and heads to microcemia, macrocemia is joined and the development of the limb gangrenes.
6. Conditionally pathogenic or pathogenic microflora . The activation of the flora (microbes and other microorganisms) on the surface of the skin in the conditions of the SD leads to inflammation of the skin, and the development of gangrenes is significantly accelerated into conditions of ischemia or microtrauma.
Often there is a combination of several reasons for the occurrence of ulcers when SDS.
The starting point of the development of the SDS is not the date of the diagnosis of diabetes diabetes, and the time when the first SD symptoms were identified (single blood glucose lifts, dry mouth and others).
- numbness, zyabacity, burning, eccs and other discomfort;
- Hair loss on foot and legs, steep sweating;
- change of skin coloring (hyperemia, hyperpigmentation, cyanosis);
- thickening, stratification, change in shape and color of nail plates;
- hemorrhage under the nail plate in the form of "bruises" under the nails;
- Stop deformation;
- reduction of the sensitivity of stop - vibratory, temperature, pain and tactile perception;
- pain in the field of foot and ulcers arising both alone or at night and when walking at certain distances;
- thinning of the skin, peeling;
- lowering or increasing the temperature of the stop and the heads;
- Long epithelialization (healing) microtrams - up to two months, while brown scars remain;
- Trophic ulcers that do not heal long in the footsteps.
Most often, distal limbs are subject to trophic changes: the fingers and the sole surface of the foot in the projection of the pink bone heads. The zone of formation of trophic ulcers depends on the cause of its occurrence.
The SDS development mechanism is the following pathological sequence:
- The production of insulin hormone in insufficient quantity;
- hyperglycemia (increasing blood glucose);
- blockade of blood microcirculation, oxygen and other trace elements through the vascular wall;
- the destruction of nerve fibers and receptors;
- micro and macrocemia of foot tissues;
- The occurrence of trophic ulcers.
So, with VDS, there are damage to all tissues of the lower limb.
As a result of insulin deficiency in the diabetic body, the amount of glucose in the blood increases. This in turn negatively affects the state of both small and large vessels:
- Immunological substances accumulate on the walls of the vessels;
- Membranes become wound;
- Vessel clearance narrows.
As a result of these changes, blood circulation is broken and small clomes are formed. These changes in the body prevent the admission of sufficient number of trace elements and oxygen into the cells and thereby lead to violations of the exchange process. Oxygen fasting fabrics slows down the process of cell division and provokes them to decay.
Increasing blood glucose levels also cause damage to nerve fibers - sensitivity decreases.
All destructive processes occurring in foot tissues lead to the fact that any damage to the skin becomes a light process, and the healing is long. To aggravate the state of the foot can affect infections that are able to lead to the formation of gangrenes - tissue necrosis. [nine]
Classification of I International Symposium for Diabetic Stop
In 1991, in the Netherlands at the I international symposium, the classification of the SDS was adopted, which is the most common. [one] It involves the division of the disease into three types, depending on the prevailing pathological process:
- Neuropathic Infected Stop:
- long flow of diabetes;
- Later, the emergence of complications;
- lack of pain;
- The color and temperature of the skin are not changed;
- reduction of all types of peripheral sensitivity;
- The presence of peripheral pulse.
- Ischemic Stop's gangrenose:
- significantly expressed pain syndrome;
- skin pallor and reduce its temperature;
- preservation of peripheral sensitivity;
- Related pathological conditions - hypertension and dlypidemia.
According to the degree of severity of lesions of the foot tissues, the following SDS stages are distinguished:  
- Stage 0 - a change in the bone structure of the foot - arthropathy;
- Stage 1 - ulceration (ulcers) of the skin;
- Stage 2 - the ulceration of all soft tissues, the bottom of the ulcers are bones and tendons;
- Stage 3 - abscess and osteomyelitis (bone inflammation);
- Stage 4 - the formation of gangrenes of distal fees (fingers);
- Stage 5 - The formation of gangrene feet and shin departments. Classification of Texas University
This classification was developed in 1996-1998.
[eight] It is based on an assessment of ulcers in depth, the presence of infection and ischemia - the risk of limb amputation. Degree
|Stage 0.||Stage 1.||Stage 2.||Stage 3.||Predasy|
|A||Skin ulcer Summer bone dryer||ulcer with the bottom of the drying capsule||ulcer with the bottom of the Kostiyi joint||+ Infectedness|
|C||+ infection and ischemia|
Diabetic stop What bodies amazing:
Blood vessels, joints, bones and nerves The reasons:
Sugar diabetes, infection Symptoms:
Dry cracked skin on the legs, tingling, burning, pain, loss of sensitivity, gradual change in shape Complications:
Gangrene, amputation Doctor:
Endocrinologist, orthopedist traumatologist, vascular surgeon Treatment:
Diet, Healing Physical Culture, Medical Treatment, Surgical Treatment Prevention:
Timely Check-AP, Correct Stop Care, Sugar Compliant, InsulinTherapy Why does diabetes affect legs?
The elevated blood glucose level characteristic of diabetes can cause circulatory disorders, affect the nerve fibers and reduce their sensitivity. The result can be a serious lesion of tissues. At the same time, the feet turn out to be the most vulnerable, as they experience the pressure of the entire body and are often susceptible to trauma (Fig. 1).
Figure 1. Development of diabetic foot syndrome. Source: CCH0 Public Domain
At the same time, the insufficient inflow of blood to the legs and feet caused by diabetes is aggravated by the situation, making it difficult to heal in the resulting wound or ulcers. Infection, hitting such a wound, is able to quickly develop and lead to gangrene.
The main danger of SDS
The most dangerous complication of the diabetic foot is the limb and amputation gangrene. In order to keep the feet, patients with diabetes in no case should you ignore the recommendations of the doctor for nutrition and treatment, leather care of the foot and the choice of shoes. Careful attitude to their own health can lead to loss of legs and even to death.
Who is in the risk group
The main reason for the development of the diabetic foot is diabetes itself, which destroys the nerves and affects the vessels. The external factor in the appearance of the SDS is infection (bacterial and fungal).
Hypertension and atherosclerosis are not simply accompanying diabetes, but are a consequence of metabolic disorders that develop in this disease. The main risk factors:
Duration of diabetes 10 years and more.
- Diabetic polyneuropathy is the defeat of peripheral nerves with diabetes mellitus.
- Macro- and micrigiopathy - the pathology of the vessels of large and small diameters cause, and stagnation of venous blood in varicose diseases of the legs and lymphostasis further enhance the circulatory disorder. Hypertensive disease with arterial pressure of more than 140/90 mm Hg. Art., like atherosclerosis, aggravate the defeat of the vessels during diabetes.
- The deformations of the foot of various origins that provoke increased pressure on certain zones of the soles and fingers. In the zones of increased pressure, corns and thickening of the skin (hyperkeratosis) are formed with a risk of subsequent injury and infection.
- Fungal infections that are accompanied by cracks and thickens of the skin, contribute to the rotation of the nails with the subsequent development of purulent inflammation.
- Injuries, rubbing, burns on the background of reduced sensitivity and improper leg care.
- Violation of visual acuity in a patient at which a full-fledged daily skin care and nails have difficulty.
- "The earliest and therefore the most common complication of SD is diabetic neuropathy (nerve atrophy). It is precisely she often launches the further cascade of pathological changes and serves soil for the development of such heavy complications as a diabetic stop, "the Candidate of Medical Sciences, Endocrinologist Larisa Alexandrovna Marchenkova warns.
The development of SDS also contributes to:
wearing uncomfortable, close or too big shoes,
- alcohol consumption,
- Heart and kidney diseases,
- What is the diabetic stop
Depending on the main cause of the disease (damage to nerves or vessels), three forms of the diabetic foot (Table 1) are isolated: neuropathic (predominantly damage to nerves), ischemic (predominant vessel damage) and mixed - neuroecehemic (combined damage to vessels and nerves).
Table 1. Diabetic foot syndrome forms
|Ischemic||Neuriecemic||Appearance of Yazv|
|Dry, warm, pink, eating corns||Blue, cold||Pale, thin, cool||Deformations|
|Specific specific||May exist, but not to wear a specific character||Pulsation|
|Saved||Absent||Reduced or absent||Location of Yazv|
|In overpressure||Top surface of fingers, heel area||Red, granulating, surrounded by necrosis|
|Prevalence||Strong covered, total necrosis||Vygloganorying, covered with necrosis and lap||Jazd pain|
|No pain||Pronounced||Moderate pain||Degree of lesion|
When SDU, the defeat begins with the skin, gradually spreading to the subcutaneous tissue, muscles, a tendon apparatus of the foot, joints and bones. Depending on the depth of the lesion, 6 degrees of ulcerative defects are isolated (Table 2).
Table 2. Degree of development of diabetic foot syndrome
|Manifestations||The wound defect is missing, but there is dry skin, the beak deformity of the fingers, protruding the heads of metatar bones, other bone and articular changes|
|0||Surface ulcerative defect without signs of infection|
|1||Deep ulcer (penetrates the tendon or joint capsule), usually infected, but without the involvement of bone tissue|
|2||Deep ulcer with inflammation of bones (osteomyelitis) and joints (purulent arthritis)|
|3||Limited gangrene (within one finger of foot or heel region), requiring small amputation - at the level of fingers|
|4||Gangrene of the whole foot when you need a big amputation (above the ankle joint)|
|5||There are other classifications that reflect not only the depth of the defect, but also the presence of infection and the degree of reduction of blood flow in the leg. These classifications are needed to determine the optimal tactics for the treatment of patients with SDS.|
Symptoms: When you need to consult a doctor
When you are sick diabetes, it is important to inspect your feet every day and regularly attend your doctor to suspect the symptoms of the SDS on time.
Immediately sign up for the reception to the doctor follows, if you notice:
Tingling, burning and pain in the legs,
- Pain or spasms in buttocks, hips or caviar during physical activity,
- Loss of touch or ability to feel warm or cold
- Gradual change in shape of the feet,
- Hair loss on the fingers, feet and legs,
- Dry cracked skin on the legs,
- Changing the color and temperature of your feet,
- Thickened yellow nails on the legs,
- Signs of fungal infection, for example, between fingers,
- Blister, wound, ulcer, infected corn or ingrown nail on foot.
- Most people with diabetes can prevent serious complications, starting treatment in time.
There are also a number of features with which you can define not only the presence of a SDS, but also its form.
The neuropathic form is usually developing with a long flow of diabetes, it is accompanied by the deformation of the stop and fingers. The sore feet of eutile, the skin on the touch is warm and dry, there are areas of hyperkeratose and dry corn. Ulcerative defects are often formed in the places of overpressure - the zones of the projection of hanging bones, distal (end) phalanges of the fingers. Temperature and tactile sensitivity reduced, pulsation on the county arteries is saved. Ulcers are painless, the skin thickening is often present around the defect. Pains in the legs with neuropathic form arise at night, accompanied by numbness, impaired sensitivity, convulsions in the ion muscles.
The ischemic form of the diabetic foot appears on the background of cardiovascular diseases - ischemic heart disease, hypertension, atherosclerosis and obesity. The skin of the affected feet is cold, pale, with a blue tint. Pulsation in the arteries of the stop is reduced or missing, sensitivity is saved. Skin defects are localized more often in the end phalanges of the fingers, in the heel area, the ankle, I and V of the tune-in-standing joints. The ulcers are more often covered with brown or black paper, sharply painful. Pains in the legs in the ischemic form of the CDS occur during exercise, and in the launched cases - and alone.
The neuroecemic form is mixed, combines the symptoms of neuropathic and ischemic forms of the diabetic foot.
Very often, patients with diabetes, especially with sub- or decompensated diabetes, are experiencing serious skin problems. Often the question arises: and how the impaired carbohydrate exchange - diabetes - is associated with dry skin and skin infections with which they are subject to? After all, all this indicates a violation of the barrier, protective function of the skin, or rather, the state of the epidermis and even its upper, horny, layer. And why at a high level of sugar in blood the skin suffers? Read the article
What doctor to go to?
For patients with diabetes mellitus, a precipitated therapist and an endocrinologist are observed. It is necessary to inspect the skin of the skin with each visit to the clinic. When signs of diabetic foot, do not wait for the planned inspection: consult a doctor immediately! In case of suspicion of ischemic form, a consultation of the Vascular Surgeon is required. With an osteoarthropathic version of the neuropathic form, you need to contact an orthopedist-traumatologist. A neurologist, a cardiologist and an ophthalmologist should examine the patient with diabetes at least once a year.
To determine the clinical form of SDS and tactics of patient maintenance:
Careful collection of anamnesis. The doctor clarifies the form and duration of diabetes mellitus, the severity of the violations of carbohydrate metabolism, the nature of pain in the footsteps, the presence of an ulcer in the past, changing the sensitivity of the skin, the presence of impairment of vision.
- Inspection of both legs. Palpation is required to assess the pulsation on the arteries of the stop and skin temperature.
- The identification of diabetic polyneuropathy includes an assessment of the achillov and knee reflexes and various types of sensitivity: pain, temperature, vibration, tactile.
- The instrumental assessment of the condition of the feet of the feet includes ultrasonic scanning of vessels and X-ray study of the main arteries to determine the degree of their narrowing.
- Radiographic assessment of osteoarthropathy, state of the bone-articular apparatus of the foot. Additionally, magnetic resonant tomography of the foot is used, and ultrasonic densitometry (bone density measurement) is used to evaluate the degree of osteoporosis - reducing the density of bone tissue.
- The bacteriological study of the substrate separated from the wound helps to determine the pathogen and its sensitivity to antibiotics.
- Laboratory blood tests on sugar, glycated hemoglobin, lipid profile perform periodically to control the condition of carbohydrate and fat exchanges.
The success of the treatment of diabetic foot syndrome depends on the joint efforts of the patient and continuity in the work of doctors - endocrinologist, cardiologist, neuropathologist, therapist. Important conditions of a good result are compensation for carbohydrate exchange, patient compliance with diet, lifestyle, refusal of smoking and alcohol. Behind sore feet should be carefully looked for, in time to wash and cut your nails. It is also worth thinking about changing the shoes if it causes discomfort. In some forms of illness, wearing orthopedic shoes are shown.
The diabetic foot syndrome occurs against the background of high blood sugar, so the treatment implies compliance with nutrition recommendations. Confectioneries, sweets, white bread, pasta, animal fats, smoked, mayonnaise, sharp, fried and salted dishes. It is possible to use sugar substitutes, but not only fructose, xylitol and sorbitol (very calories, and fructose helps to increase blood sugar levels).
Patients with a diabetic stop are useful to low-fat varieties of meat and fish, vegetables (with potato restriction), low-fat dairy products, some cereals (buckwheat, pearl, oatmeal), berries and fruits (except sweet - watermelons, grapes, bananas).
Hypertension and atherosclerosis are not simply accompanying diabetes, but are a consequence of metabolic disorders that develop in this disease. Medical Physical Culture (LFC)
Sport improves the microcirculation in the stop vessels, strengthens the weak muscles, joint bundles, stimulates lymphatic drainage and prevents the progression of pathological processes in the foot. In addition, physical education classes are able to reduce the increased level of sugar and improve the susceptibility of cells to insulin. It is important not to overdo it with loads, take into account the degree of pressure increase, pulse, sugar level. With a pressure above 140/90, the pulse is more than 80 shots per minute and, blood sugar above 15 mmol / l start the course of therapeutic gymnastics.
It is not necessary to make insulin injection before LFK classes. It reduces glucose levels, and it needs muscles as a source of energy. You need to do every day at least 15-20 minutes. The complex is selected individually, taking into account the severity of diabetes and complications. Useful swimming and moderate walking.
Medical treatment will first of all be aimed at compensating for violations of carbohydrate metabolism. Additionally, blood pressure correction, body metabolic disorders, the use of antibacterial drugs in the development of infection, means for improving blood microcirculation, anti-inflammatory and painkillers are required. Uases are resorted to local means.
Among drugs appointed for the treatment of SDS:
Insulin and saccharifying drugs. With the development of VDS in patients with type 2 diabetes, a timely translation with sugar-based drugs, which at some point cease to help, on insulin therapy.
- Antihypertensive preparations are used to maintain blood pressure within the upper limit of the norm - no more than 140/85 mm Hg. It is better if these medicines prescribe a cardiologist after ECG.
- The hypolypidemic drugs (statins, Omega-3, Nicotinic acid, etc.) are needed to correct the violations of fat metment with raising cholesterol, triglycerides, low density lipoproteins.
- For the prevention of thrombosis and improve blood circulation in small vessels, heparin preparations, acetylsalicylic acid, prostaglandin E1, etc. are used.
- Antibacterial therapy is performed taking into account sensitivity to antibiotics of pathogens inhabiting the wound. For their suppression, protected penicillin preparations, cephalosporins 2-4 generations, fluoroquinolones, sulfonamide preparations, carbapenes are used.
- To relieve pain syndrome use non-steroidal anti-inflammatory drugs (NSAIDs), analgesics (including narcotic), anticonvulsants (a number of them have an anesthetic effect).
- An important role in the treatment of defects at SDS plays local treatment with the use of special dressings. This eliminates the use of gauze, alcohol-containing agents, ointments. When choosing a dressing guided by the principle of wet healing of ulcerative defects. Calcium-alginate bandages are used to remove excess fluid from the wound, with the treatment of surface wounds - hydrocellular. For ulcers with necrotic paper and a dense fibrinous, hydrocoleloid bandages help. Ionized silver and povidone-iodine are preferred as antiseptics.
Variants of SDS surgical treatment depend on the form and stage of the disease. Operations are used as:
Opening of abscesses and phlegmon - purulent foci of leakage of the skin, subcutaneous fiber, near-cutting fabrics of the foot.
- Necratetomy - removal of limited areas of necrosis (samples) of foot tissues.
- Skin plastic operations to close wound or ulcerative defects on the foot.
- Operations on foot vessels to restore the deficit of arterial blood flow.
- The latter include:
Balloon angioplasty and stenting - interventions that are conducted on vessels under the control of X-rays. Under local anesthesia, a puncture is made, the conductor is introduced into the artery, through which the vessel clearance is restored using a spray or stent (tube).
- Shunting operations - restoration of blood flow in femoral and popliteal arteries by replacing a part of the affected vessel with a prosthesis in the form of a tube. Such operations are performed under anesthesia using an artificial circulation apparatus.
- The main testimony for angio surgical interventions is the critical level of blood flow in patients with a neuroecemic or ischemic form of the diabetic foot.
Folk remedies, hirudotherapy
The use of only folk remedies (phytetrophy) at SDS is meaningless. As an addition to the complex treatment of type 2 diabetes 2, pods of green beans, blueberries, oats, linen seed, bay leaf, burdock, clover in the form of infusions and decoctions can be used. Useful fresh juices (tomato, cucumber, carrot with adding topinambura, parsley, celery, lettuce leaves, Brussels cabbage, green beans).
When connecting hirudotherapy (treatment with leech), purification and healing of the ulcerative defect occur 2 times faster. This is due to the hit in the blood of a set of enzymes with counter-tomb, antisclerotic, vasodilatory, anesthetic, anti-inflammatory and anti-ethnic effects.
With a diabetic stop, it is better to start fighting before the appearance of it. To do this, do not forget about several simple things.
Each patient with diabetes or violation of glucose tolerance (is determined using the appropriate test) should carefully monitor the skin of the legs, because even minor inflammation can threaten amputation.
Hypertension and atherosclerosis are not simply accompanying diabetes, but are a consequence of metabolic disorders that develop in this disease. Daily inspection stop
Check your feet daily for cuts, redness, edema, ulcers, blisters, hopes, corns, or any other skin changes or nails. If you can not see your feet well, use a mirror or ask someone to help.
"The loss of sensitivity in a patient with a diabetic stop is so strong that he does not feel the relief under his feet. Laming, asphalt, sand - He fits all this as cotton. Footwear presses, the coat of the folds - a person does not feel it. It can put a leg on a hot battery and fall asleep, and wake up with a fourth degree burn, in which the fabrics of the foot are burned to the bone, but with no pain! That is why I recommend to a patient with diabetes mellitus daily inspect the foot with the help of a mirror. This should be included in the same habit as the cleaning of the teeth, "the doctor of medical sciences advises, a professor, head of the endocrinological department of GBUC" GKB named after A.K. Yeramishantseva Department of Health of Moscow "Leonid Yulievich Morgunov.
Clean your feet correctly. Make your feet daily with soap, carefully wipe them and dry the interfallated gaps, change socks. This will help avoid the enhancing infection in the arising wounds.
For processing wounds, do not use iodine, green and alcohol, since they doubted the skin. Microtravami can be treated with hydrogen peroxide solutions, chlorhexidine, dioxidine, mormistine.
For softening of corns, do not use acidic and alkaline tools, do not cut them with a razor.
The dry skin stop should be lubricated with nutritional creams, as well as means with urea.
Care of the skin of the feet and nails during diabetes is not only aesthetic, but also the healing procedure. Exercises its special specialist - a subgolator (Fig. 2). It removes a natopath and dry corn, which helps to reduce the load on the sole and prevent the appearance of cracks. At the same time, the regularity of the pedicure is important - every 2-3 weeks.
Basic Pedicure Rules for Diabetes Diabetes:
The water temperature for the bath is 36-37 C0, the duration of its reception is 6-7 minutes. You can add antiseptic and softening oil to water.
- To remove ornaments, you cannot use a razor. You can use fine-grained pums or grinding saws, use disposable fine-grained nozzles at a hardware pedicure.
- Nails cut round, and not straight (if you leave the corners, they will grow into the skin of the fingers, provoking inflammation), to maintain the free edge of the nail from the corner to the center.
- Use antiseptics without alcohol.
- Figure 2. Pedicure from a specialist. Source: CCH0 Public Domain
So that the skin is not damaged, it is important to use comfortable shoes: do not buy a close or narrow, with a thin and soft sole. It should be mild, from natural materials, fit the size of the foot. Choose shoes better in the afternoon when the leg swells. If the sensitivity is reduced, you can use a cardboard insole, repeating the shape of the foot. Inserted insole deformed? Shoes can cause scuffs!
When deforming the foot, transverse or longitudinal flatfoot, it is desirable to use orthopedic shoes or special insoles except magnetic. It is important to examine her daily inside to eliminate seals, folds, deformations.
With the neuropathic ulcer of the front office of the foot, it is necessary to unload using individual orthopedic shoes by the type "Polbashmak". Its design allows you to move on a sore limb. In this case, the load from the front of the foot is transferred to the heel area.
Sick diabetes is contraindicated with barefoot! This can lead to serious damage to the legs.
Hypertension and atherosclerosis are not simply accompanying diabetes, but are a consequence of metabolic disorders that develop in this disease. Protection of legs from cold and heat
If, as a result of diabetes you have developed damage to nerves, you can burn your legs, without even suspecting it. To protect the legs from burns:
Wear shoes on the beach and on the hot asphalt,
- Apply sunscreen on the feet to prevent sunburns,
- Keep your legs away from heaters and open fire,
- Do not put on your feet to your feet.
- Cold can also cause damage to the legs. Wear socks in bed, if your legs freeze. In winter, wear waterproof shoes on the lining so that the legs were warm and dry.
Free influx of blood to the legs
Observe the following recommendations in order to improve blood flow to the legs:
When you sit, lift your legs up (use pouf),
- For the day, move your fingers for a few minutes. Move the ankles up and down, inside and outward to improve the blood flow in the feet and legs,
- Do not wear close socks or elastic stockings,
- Exercise. Select the classes that you like, such as walking, dancing, yoga or stretching, swimming or cycling,
- Do not smoke.
It is extremely important to notice the development of the diabetic foot syndrome. This will help timely start treatment and save legs. At first, the signs of the diabetic foot manifest themselves with a sense of numbness and crawling of goosebumps, unpleasant tingling, feeling of zyabacity in the legs. Then the pain is joined along the nerves - the calf muscles hurt, the legs are reduced to the cramp. Over time, pain may pass, but this is evidence of the deterioration of the state. Too many nerve endings died, followed by a pathological change in bones and joints, intermittent lameness (when after a pair of steps need rest) and the most terrible consequence of diabetes - gangrene. To prevent it will help the correct care behind the foot, saccharifying drugs and insulin therapy.
Bulletin of the International Scientific Surgical Association Vol.3, N. 2-3, 2008 The Fifth International Scientific Distant Congress on Spine and Spinal Cord Surgery "Interspine - 2008", The Sixth International Scientific Teleconference "Cardiovascular Surgery and Angiology - 2008" Saint -Petersburg, Russia, December 2008 - 33 - © Kislyakov VA, 2008.
- Marchenkova L.A. et al. Improving complex approaches to the treatment and medical rehabilitation of patients with diabetic neuropathy. Magazine "Attending Physician" No. 12-2017, https://www.lvrach.ru/2017/12/15436869
- Dedov I.I., Udovichenko O.V., Galstyan G.R. Diabetic stop. M.; 2005.
- International Agreement on Diabetic Stop. Compiled by the International Working Group on Diabetic Stop. M.; 2000.
- Bulletin of new medical technologies - 2007 - T. XIV, № 3 - p. 152
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