Type 2 Diabetes & Foot Ulcer Prevention

This is a guest post from Gayle Morris. Know more about the author at the end of this article.

According to the American Diabetes Association, 10.5% of the population in the U.S. had diabetes in 2018. Nearly 26.8 million people went undiagnosed in the same year. In 2017, diabetes was the seventh leading cause of death. These numbers may actually be even higher, as many experts believe death from diabetes is under-reported.

What is Type 2 Diabetes?

Type 2 diabetes is a health condition related to lowered function of a person’s pancreas, resulting in high glucose levels, also referred to as high blood sugar. The pancreas produces a hormone, insulin, that helps blood sugar move from inside your blood to your cells. As opposed to type 1 diabetes, type 2 means that a person’s pancreas produces some level of insulin, where type 1 means a person’s pancreas produces no insulin at all. Additionally, type 2 diabetes is often caused by nutrition, exercise, and other lifestyle factors, while type 1 diabetes is usually unrelated to these behaviors and comes on more randomly.

If a person consistently eats a diet high in glucose, fructose, and carbohydrates, his or her pancreas must continue to produce insulin to move sugar into the cells, or store it as fat. In some cases, the pancreas starts to slow the secretion of insulin due to overexposure to glucose. In other cases, the cells are exposed to so much insulin they begin to need more and more to do the same job, called insulin resistance. This is the basis of developing prediabetes, which can lead to type 2 diabetes if left unchecked.

Sugar Intake and Type 2 Diabetes

Reducing sugar intake is typically the first suggestion a physician will offer for patients looking to curb prediabetes and type 2 diabetes through lifestyle changes.

Since different forms of sugar can be found in nearly every processed food on the market, it isn’t hard to accidentally overdo it. One study found that 60% of diets in the US come from “ultra-processed foods,” many of which contain hydrogenated oils, emulsifiers, added flavors, colors, sweeteners, and – you guessed it – sugar. In fact, the study cited these ultra-processed foods as the main source of added sugar in a person’s diet in the US.

Many people may be surprised to find that there is a sinister science behind these processed foods and high levels of added sugars. Of course, food companies are in the business of selling as much of their product as possible, so they work hard to find “bliss points,” or the amounts of added sugar, salt, or trans-fat to optimize the taste of the product. There is, similarly, a science behind finding the perfect “crunch” in a potato chip or the perfect mix of salt and sugar in a cereal bar – a major detriment to public nutrition.

Foods that had no added sugar in the past are often now expected to taste sweet. This extra sugar triggers damage to a person’s cells and minute organelles inside the cells, which can lead to lasting issues, including type 2 diabetes. One of the organelles directly damaged by sugar is the mitochondria, considered the powerhouses inside nearly every cell in the body.

When these structures are damaged, it can lead to many different health conditions. The list of cardiometabolic conditions include obesity, high blood pressure, heart disease, and type 2 diabetes, among others. Each of these contribute to the development of and difficulty healing a major health issue in chronic wound care – diabetic foot ulcers.

The High Cost of Diabetic Foot Ulcers

Diabetic foot ulcers are the most common foot diabetes complication, also leading to devastating consequences for the patient, families involved, and society as a whole. At least 50% of all amputations in the U.S. happen to people with diabetes, and most are from an infected foot ulcer and number may even be closer to 80% of all amputations in the U.S. Worldwide, someone has an amputation from a diabetic complication every 20 seconds.

With how common they are, it’s no question that diabetic foot ulcers come with a significant financial burden to society:

Diabetic Neuropathy and Treating Diabetic Foot Ulcers

Although the foot ulcer is neuropathic in origin, most amputations are actually the result of infection and peripheral artery disease. Many people with diabetes lose sensation in their lower extremities, due to nerve damage from high blood sugar. This is called diabetic neuropathy. The initial injury to the foot that starts as an ulcer may go unnoticed in cases of diabetic neuropathy, since loss of feeling is usually a factory. As a result, it’s categorized as neuropathic.

Fortunately, with proper wound care, a diabetic foot ulcer is treatable. According to a study, specialist wound care physicians are able to decrease wound infections and amputations in non-healing wound patients by 86%. In addition, patients treated by an interdisciplinary wound care team have seen significantly-reduced hospitalization, healed faster, and cost Medicare less to treat.

For successful treatment of a diabetic foot ulcer, key factors must be implemented by a wound care team, including blood sugar control, management of malnutrition, appropriate debridement, reducing friction and pressure, treating current infections, and other relevant mental health or otherwise-related factors.

As with most chronic wounds, an ounce of prevention is worth a pound of cure. Teaching people with diabetes to inspect their feet daily, use recommended foot creams, and take care to always wear appropriate socks & shoes, and to keep their blood sugar under control are the first steps in the prevention of a diabetic foot ulcer. However, once a wound has been established, early treatment by a team of expert wound specialists can also help reduce the financial and emotional burden associated with long-term chronic wounds, infections, and limb amputations.

About the Author

Gayle Morris is a freelance writer that’s been writing on health and wellness for over ten years. She spent over 20 years as a certified nurse and nurse practitioner before hanging up her stethoscope and picking up the pen.  

As a nurse, Gayle cared for patients at Cincinnati Children’s Hospital, Riley Children’s Hospital, Chicago Children’s Hospital (now Lurie Children’s Hospital), and at Methodist Hospital in Indianapolis. As a PNP, she worked at Mary Free Bed Rehabilitation Hospital in Grand Rapids, MI.