By Chioma Obinna
EXPERTS say having dia-betes is already a challenge but having to deal with the complications could be even more daunting. The fact is that a person living with diabetes who doesn’t receive correct care will over time come down with serious complications of diabetes and die early. Many countries, including Nigeria, are still unaware of the economic impact of diabetes; consequently stakeholders and policy makers are unable to put effective prevention strategies in place that could reduce the rise in prevalence of this condition.
Statistics from the International Diabetes Federation (IDF) 7th Edition Atlas (2015) predicts that by 2040, worldwide, 642 million people would have diabetes, and the majority of these people will be from developing nations like Nigeria. It is also estimated that in Africa, the number of persons living with diabetes will double to 34.2 million from the current figure of 14.2 million.
Unfortunately, despite these scary revelations, more than two thirds of people with diabetes in Africa are undiagnosed. Currently in the world, 1 in 11 adults has diabetes, and 1 in 2 adults with diabetes is undiagnosed. However, amongst the many complications that may arise from inadequate diabetes care is non-healing foot ulcers which can eventually lead to amputation.
In a person with diabetes, the blood glucose, or blood sugar, levels are too high. Over time, this can damage the nerves or blood vessels. Nerve damage from diabetes can cause loss of feeling in the feet.
You may not feel a cut, a blister or a sore. Foot injuries such as these can cause ulcers and infections and serious cases may even lead to amputation. Damage to the blood vessels can also mean that the feet do not get enough blood and oxygen, hence, it is harder for the foot to heal, if there is a sore or infection.
Proper foot care
In the views of Dr Afokoghene Rita Isiavwe, Project Coordinator, Diabetes Podiatry Initiative Nigeria, proper foot care is an essential in diabetes management. Isiavwe, a foot doctor (podiatrist) is also the Medical Director, Rainbow Specialist Medical centre, said taking care of the foot should be a part of a diabetic’s daily routine. “This is because diabetes is a leading cause of lower limb amputations.”
She said that approximately, one in four persons living with diabetes worldwide will develop sores in their feet at one point in their lives. A condition she said could lead to untimely death of the sufferer. “Majority of diabetes related foot amputations are preceded by foot ulcers. Majority of diabetes foot ulcers are preventable through foot care education and good diabetes management.”
She explained that foot ulcers in diabetics develop because of a combination of many factors, poor diabetes care leading to damaged nerves with deformities of the joints of the toes and poor sensation of the feet, in addition to damaged blood vessels which lead to poor healing. “These combined with inadequate knowledge of basic foot care can endanger your feet if you are living with diabetes, she pointed out.
“If you live with diabetes, form the habit of inspecting your feet regularly, and even more often if you already have reduced sensation or poor blood flow on your feet. Seek medical advice promptly if you notice any change in colour of your feet or blisters or wound. Do not delay.” “The types of shoes you wear are also important. Always get your health practitioner to examine your feet and check for sensation and circulation when you go for your check up.”
Regretting that Nigeria has no structured foot care training programme for healthcare workers, Isiavwe lamented that the situation has made it more difficult for persons living with diabetes who have foot related problems to access preventive foot care.
“With a population of over 170 million we have no Podiatry Residency training programme on ground. We at Rainbow Specialist Medical Centre saw this gap, and understanding that prevention is better than cure for diabetes related foot problems, after several unsuccessful attempts, we embarked upon empowering healthcare workers looking after persons living with diabetes since 2013 in basic preventive foot care. This gave birth to the Diabetes Podiatry Initiative, Nigeria.”
She explained that the initiative finally kicked off in partnership with the Podiatry Institute Decatur, Georgia, USA and held the first workshop in Lagos in March 2014.
“Thereafter, we gained the support of the World Diabetes Foundation, which also shares the vision of healthy feet for all persons living with diabetes, and held the second workshop also in Lagos in August 2015. The Rainbow Specialist Medical Centre, the Podiatry Institute and the World Diabetes Foundation are together building local capacity in diabetes foot care in Nigeria.
Public health concern
“Currently 11 hospitals in Lagos state- three Lagos state owned, five federal governments owned, one not- for profit organisation owned, and two private hospitals are benefiting from this initiative. We also through this initiative hope to sensitive all stake holders and policy makers in the health industry of the need for establishing a structured foot care training programme in Nigeria.
“A person with diabetes has high blood glucose either because they are not producing enough insulin, or because the body does not respond properly to insulin – the hormone that gets digested blood sugar from the blood to the cells where they are needed.” There are three main types of diabetes. Type 1 diabetes, appears very suddenly, and persons affected cannot produce insulin. Without insulin a person with type 1 diabetes will die.
Type 2 diabetes can be present without giving any warning signs to your body. It may only be discovered incidentally during routine check up, or when complications like eye problems and non-healing foot ulcers develop. Gestational diabetes is first detected during pregnancy, and may lead to health problems in both the unborn child and mother. It will also later on in life puts the mother and child at an increased risk for developing type 2 diabetes.
The good news however is that with correct information and good self management, along with correct support, persons living with diabetes can have productive and healthy long lives.
Prevention tips for diabetic foot
First, control your blood sugar levels. Good foot hygiene is also crucial. Check and wash your feet every day. Keep the skin dry, soft and smooth.If you can see, reach, and feel your feet, trim your toenails regularly. If you cannot, ask podiatrist to trim them for you. Wear shoes and socks at all times. Protect your feet from hot and cold and keep the blood flowing to your feet