DID YOU know that globally, every 30 seconds, a lower limb is lost to diabetes, beginning with a foot ulcer, and that 25 to 90 per cent of lower extremity amputations are diabetes-related? Furthermore, did you know that a person with diabetes has a 15-25 per cent lifetime risk of developing diabetic foot ulcers, and a 50 to 70 per cent recurrence rate.  This means that even if the ulcer heals in the first place, it can be expected to surface again.
According to Dr. Carlos Martin, Head of the Diabetic Foot Centre at the Georgetown Public Hospital Corporation (GPHC), such ulcers can take as long as 11-14 weeks to heal, and invariably precede amputation in 85 % of the cases.
But even more disconcerting is the revelation that where there is amputation of one leg, 50% of those amputees, within the first five years, would have either had a second leg amputation or be dead.
“That’s why you really need to prevent that ulcer,” Dr. Martin advises, adding that it is the main objective of the Diabetic Foot Clinic at the GPHC. At the GPHC, diabetes is the most common cause for persons being admitted to the Surgical Wards.  
And where previously the patients admitted for amputations were around middle-age and upward, today, many persons in their thirties are having major amputations, he disclosed, adding that Guyana’s cases for amputation are about one decade ahead of other parts of the Caribbean. 
He is therefore admonishing persons that where diabetic ulcers are concerned, “leave nothing to chance,” because, as we said in our last edition:  “Give diabetes an inch, and it could take your foot.”

Dr. Martin, who, prior to the establishment of the GPHC’s DFC, has been doing approximately100 major foot amputations (from the ankle upwards), said:  “If we were to talk about amputation of toes and other lower extremity limbs, it would literally run into close to 1,000,” per year.

Treat the Cause: The whole patient
At our local DFC, Dr. Martin stressed, the medical team emphasizes the importance of treating not just the “hole in your foot,” but the whole person. This is so particularly since the most important predictor of foot ulceration is neuropathy, a condition having  to do with the sensory loss of protective sensation (LOPS). Hence, factors leading up to the cause are considered.

Foot Care
People with diabetes, and more so neuropathy, need to take special care of their feet. The nerves to the feet are the longest in the body and are the ones most often affected by neuropathy. Because of loss of sensation in the feet, sores or injuries may not be noticed, and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers.
Diagnosing diabetic neuropathies
Doctors diagnose neuropathy on the basis of symptoms and a physical exam. During the exam, your clinician may check blood pressure, heart rate, muscle strength, reflexes, and sensitivity to position changes, vibration, temperature, or light touch. 
The best way to prevent neuropathy is to keep your blood glucose levels as close to the normal range as possible. Maintaining safe blood glucose levels protects nerves throughout your body.
Likened to a ‘one-stop-shop’, the DFC at the GPHC also checks and monitors the patient for Hb, A1C, blood pressure, Total cholesterol, HDL cholesterol, LDL cholesterol and Triglycerides.
Applying what is called the ‘60-Second-Screen’ for High Risk diabetic foot, the medical team will check to determine whether there were previous ulcers and active ulcers; previous amputation; or for deformity; pedal pulses; flexibility of joints, ankle, large toe, ingrown toenails, blisters, fissures (cracks), among other things.

Healthy diet and exercise
A healthy diet and exercise plan are key to managing your condition and controlling your weight.  Since food raises blood sugar, be sure to pay attention to your diet, and avoid those foods which build on your blood sugar.
Your blood sugar level will be classified as high/normal/low, depending on how your body absorbs and uses glucose for energy. After food is digested, glucose passes into the bloodstream, where it is used by tissues and cells for growth and energy.

UNDERSTANDING HOW INSULIN WORKS
But before glucose can be made into energy, it has to get into your blood cells. This process is helped through the activity of insulin, made by an organ called the pancreas.  Insulin helps the body absorb and use the glucose for energy.  Essentially, it acts as a key, and opens tiny doors in those cells to let glucose in from your bloodstream.
Once glucose enters the cells, then the amount remaining in a person’s bloodstream goes down.  If, on the other hand, your pancreas is not producing sufficient insulin, or the insulin it produces is not being used efficiently, then the amount of glucose in the bloodstream remains outside the shut doors of the tissues and cells, resulting in a buildup.  This is what results in a high blood sugar reading. 
Noting that getting diabetics to eat in moderation and to avoid foods that are not good for their health condition is an uphill task, Dr. Martin conceded that most diabetics are ‘see-food eaters’ – they eat food as they see it, and as it appeals to them, regardless of the consequences.  The GPHC’s DFC, conscious of this situation, places great emphasis on counseling their patients on correct eating habits for diabetics.   At the Centre, Ms. Jackie Williams has responsibility for nutritional counselling.

BASIC NUTRITIONAL GUIDELINES

•    Control your total carbohydrates
•     Choose foods low in fat
•     Eat more high-fibre foods
•     Control your portion sizes
•     Eat meals around the same time, and about the same amount daily
Monitor blood glucose regularly

MAIN NUTRIENT SOURCES
Carbohydrates
•      Staples  (bread, cereals, rice, pasta)
•      Fruits (fresh, canned, dried
•      Milk
•      Legumes and nuts  (peas and beans)
•      Vegetables, fibre

Food from animals:  Meats, cheese, milk, eggs
Food from plants:     Peas and beans
Fats  & oils:               Oils, nuts, salad dressings