Painful Diabetic Neuropathy

What symptoms do people get?

Bamila S & Seena Rajsekhar

M.V. Centre for Diabetic Foot Care, Podiatry, Research & Management

Commonly reported symptoms include...


Burning sensation as if feet are on fire


Freezing sensation as if feet are on ice although they feel warm to touch.


Stabbing sensation, as if from sharp knives.


Lancinating sensation like electric shocks.

Abnormalities of the foot which worsen the effects of neuropathy or vascular disease...


High Instep


Bunions


Clawed Toes


Abnormal Toe nails


Rocker bottom deformity with neuropathic ulcer



Maceration


Very dry skin


Deformed toes which cause excessive pressure at the tip and at the top.


Take Care of Your Feet

Daily foot care should include the following:

Look at your feet - every day. Look at the top and bottom of your foot. Check between your toes and around the heel area.


What to look for:
• Bruises
• Cracks/breaks in skin
• Soggy skin
• Dry skin
• Swellings/swelling in only one foot or leg
• Corns and calluses
• Ingrown toenails
• Blisters
• Sharp toe nails
• Hot/cold spots
• Discolouration
• Anything that is not normal or that was not there yesterday


If you are unable to see your foot, use a mirror or ask someone to help you.


Check for Corns and Calluses (hardened skin).

Corns and calluses can be a problem. They cause pressure and can lead to ulceration. Never trim or cut a corn yourself. The only safe way to treat a corn or callus is to see a podiatrist.


Wash your feet every day using plain water and mild soap. Dry your feet well using a light coloured towel, especially between the toes. Look at the towel to make sure there is no blood or pus on it. If you can see any blood or pus tell your doctor immediately.


Rub cream into your feet to stop them getting dry and cracked. Do not put cream between the toes. Use the cream twice a day if your feet are very dry.

A properly cut toe nail


A poorly cut toe nail


Do not cut your nails too short. Cut your nails straight across. Always check your nails for sharp edges. To smooth sharp edges use a nail file. If you are unable to cut your nails, see a podiatrist.

Consult with your Podiatrist regularly.

You can get routine integrated examination for your feet at the M.V. Centre for Diabetic Foot Care, Podiatry, Research and Management, Royapuram. The clinic provides education on practical aspects of foot care, early recognition of the foot at risk, advice on the selection of special footwear and comprehensive care for all diabetic foot complications.

At the M.V. Hospital for Diabetes, Royapuram, you will find a wide range of foot wear to suit your requirement including custom- built foot wear with moulded insole made at our in-house facility.
The DiaStep is a specially designed shoe made in collaboration with The Central Leather Research Institute, Chennai supported by Novo Nordisk Educational Foundation. It is suitable for diabetic patients with neuropathy, minor foot deformities and for those who have had minor foot complications.
It distributes pressure effectively, has better grip and traction, is comfortable, ensures limited joint movement and prevents foot ulcers and foot infections.

Constipation

Aruna.V, Dietician

Constipation happens to everyone occasionally, but some people suffer from chronic constipation which makes their lives a misery and each bowel movement a huge relief! Constipation is a symptom, not a disease. Understanding its causes, prevention, and treatment will help most people find relief.

About one in every four diabetics experience frequent bouts of constipation, making it by far the most common gastrointestinal issue for people with diabetes. The problem afflicts both, type 1 and type 2 diabetes sufferers, and is known to be significantly more prevalent among those diabetics who also suffer from nerve damage.

Definition: Constipation is defined as having a bowel movement fewer than three times per week. With constipation, stools are usually hard, dry, small in size, and difficult to eliminate. Some people who are constipated find it painful to have a bowel movement and often experience straining, bloating, and the sensation of a full bowel.

Some people think they are constipated if they do not have a bowel movement every day. Bowel habits vary from person to person. However, normal stool elimination may be three times a day or three times a week, depending on the person.

What causes constipation?

Know how the colon or large intestine works to understand constipation. As the food moves through the colon, water is absorbed during the process of forming waste products or stool. Muscle contractions in the colon then push the stool toward the rectum. By the time the stool reaches the rectum, it is solid because most of the water has been absorbed.

Constipation occurs when the colon absorbs too much water or if the colon's muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly. As a result, stools can become hard and dry.

Causes:

1. Occasional constipation is usually caused by the diet, the lack of exercise, stress, or drinking insufficient liquids.

2. Chronic constipation can be caused by a variety of factors, including digestive disorders such as Irritable Bowel Syndrome (IBS), the lack of fiber and fluids in the diet, depression, the lack of exercise and some medical conditions such as diabetes, colon cancer and hypothyroidism.

3. Constipation may also be a side effect of some prescription drugs, high blood pressure and pain relief. Many people also lose the natural bowel movements due to the overuse and abuse of OTC and prescription laxatives.

* The Diet


People who eat a high-fiber diet are less likely to become constipated. The most common causes of constipation are a diet low in fiber or a diet high in fats, such as cheese, eggs, and meats. Both children and adults, often eat too many refined and processed foods from which the natural fiber has been removed.

A low-fiber diet also plays an important role in constipation among older adults, who may lose interest in eating and choose foods that are quick to make or buy, such as fast foods, or prepared foods, both of which are usually low in fiber. Also, difficulties with chewing or swallowing may cause older people to eat soft foods that are processed and low in fiber.

* Liquid Intake

Liquids add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. People who have problems with constipation should try to drink liquids every day. However, liquids that contain caffeine, such as coffee and cola drinks will worsen one's symptoms by causing dehydration. Alcohol is another beverage that causes dehydration. It is important to drink fluids that hydrate the body, especially when consuming caffeine containing drinks or alcoholic beverages.

* Changes in Life or Routine

During pregnancy, women may be constipated because of hormonal changes or because the uterus compresses the intestine. Aging may also affect bowel regularity, because a slower metabolism results in less intestinal activity and muscle tone. In addition, people often become constipated when traveling, because their normal diet and daily routine are disrupted.

* Specific Diseases

Diseases that cause constipation include neurological disorders, metabolic and endocrine disorders (Diabetes, Uremia, Hypocalcaemia, poor glycemic control, Hypothyroidism), and systemic conditions that affect organ systems. These disorders can slow the movement of stool through the colon, rectum, or anus.

* Physical Activity

Constipation often occurs after an accident or during an illness when one must stay in bed and cannot exercise. Lack of physical activity is thought to be one of the reasons constipation is common in older people.

Can constipation be serious?

Sometimes constipation can lead to complications. These complications include hemorrhoids, caused by straining to have a bowel movement, or anal fissures—tears in the skin around the anus—caused when hard stool stretches the sphincter muscle. As a result, rectal bleeding may occur, appearing as bright red streaks on the surface of the stool.

Health problems caused by constipation:

* Bad Breath * Headaches * Body Odor * Hemorrhoids * Anal fissures

* Rectal bleeding * Rectal prolapse (rare) * Fecal impaction * Varicose Veins

* Septicemia* Colon and colorectal cancer

* DEATH = There's an old saying "Death begins in the colon." That's right. Constipation can even cause death if it is not treated properly. When constipated, bacteria and toxins are stored in the body and they get reabsorbed into the bloodstream. At first, this might not cause big problems. But the bacteria levels will increase as time passes and eventually, bacteria and toxins will spread all over your body and this is when serious problems, like colon cancer and death, can happen.

How is constipation treated?

Although treatment depends on the cause, severity, and duration of the constipation, in most cases dietary and lifestyle changes will help relieve symptoms and help prevent them from recurring.

Diet

A diet with enough fiber (20 to 35 grams each day) helps the body form soft, bulky stool. High-fiber foods include beans, whole grains and whole cereals, fresh fruits, and vegetables such as asparagus, sprouts, cabbage, and carrots. For people prone to constipation, limiting foods that have little or no fiber, such as cheese, meat, and processed foods, is also important.




Drink plenty of water and fluids


Drinking plenty of water and other liquids including clear soups and fruit and vegetable juices will help prevent constipation. Liquids add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass.


Get enough exercise

Regular exercise helps your digestive system stay active and healthy. You don't need to become a great athlete. Simply taking a 20/30-minute walk everyday will help a lot.

Give yourself time

Our hectic schedules keep us feeling in a hurry all the time that we don't pay attention to our body's needs, especially to the urge to have a bowel movement. Allowing yourself enough time in the toilet will ensure that you ease your constipation troubles too.

Tips and Natural remedies


1. Drinking a glass of warm milk at the time of going to bed helps in evacuation, the next morning.

2. Do not stay up late in the night. Regulate your sleeping hours.

3. After you wake-up, drink 2 or 3 cups of water. This will help to push the faeces out of the gut.

4. Apple, papaya, banana and guava help prevent constipation and can be eaten anytime of the day. These provide roughage and clear the bowel.

5. All Greens can be eaten raw or cooked to clear the bowel system and digestive trackt. Deficiency of the mineral magnesium may contribute to constipation. Magnesium is found in natural foods such as green leafy vegetables, nuts, seeds and whole grains and in supplements and can be consumed suitably.







Reference:

1. National Digestive Diseases Information Clearinghouse (NDDIC). NIH Publication No. 07–2754, July 2007. www.digestive.niddk.nih.gov.

2. Diabetes Information Library. Diabetes And Constipation: An Awkward But Real Issue. Author: Michele Carlese, Naturopath, Herbalist. Source: Healthy Living, July 2, 2007

3. Constipation and Herbal management, Monday, October 4, 2010. http://www.siddhapedia.com/2010/10/constipation-and-herbal-management.html

4. Srilakshmi, B. Dietetics, 5th edition, 2005, 221-223.