Dietary Information

Obesity has reached epidemic levels and has now overtaken smoking as the most important avoidable cause of ill health. By 1994 almost 13% of British men and 16% of women were obese – a doubling since 1980 and this trend has continued. Obesity is associated with high blood pressure, diabetes and many other problems such as arthritis, breathing difficulties and depression. Almost 80% of people with Type 2 diabetes are overweight or obese at diagnosis although the majority of people are unaware that obesity is a risk factor for diabetes.

What is the difference between obesity and being overweight?

• Obesity is having a body mass index (BMI) greater than 30
• Over weight is having a BMI of between 25 and 30
• Acceptable weight is having a BMI between 20 and 25
• Underweight is having a BMI of less than 20

BMI is your weight in kilograms divided your height in metres squared (7kg = 14pounds). A much simpler definition of obesity is a waistline over 40 inches in men and over 35 inches in women!

Fats
Looking at the fats we eat is a very important part of healthy eating to reduce the risks of heart disease and to keep blood cholesterol levels down. As people with diabetes have an increased risk of heart disease, it is particularly important to understand about the fats in our diet.

Fats provide some of the energy our bodies need but the healthy eating guidelines recommend that we should eat less fat, especially saturated fat in order to reduce this risk of heart disease. This can best be achieved by eating a varied diet with plenty of fruit, vegetables, whole grain cereals, pasta, rice and potatoes.

For more information on losing weight, please visit the NHS Choices website:

NHS Choices: lose weight

NHS Choices: good food and diet

What is Fat?

• Fats come in both solid and liquid forms – solid fats include butter, lard and the fat visible on meat. Liquid fats include sunflower, corn and olive oils.
• Fats can also be divided into visible and invisible fats. Visible fats, such as butter and the fat on meat are easy to spot and cut out. But invisible fats, such as those in cakes, biscuits, dairy foods like cheese and fried foods are more difficult to see and we may not even be aware that they are present in some foods.
• Fats can also be divided into four types – polyunsaturated fats, saturated and trans and monounsaturated fats.

Polyunsaturated fat – Comes mainly from vegetable sources such as sunflower oil or seeds and is also found in oily fish such as mackerel or sardines. There are two different groups of polyunsaturates containing fatty acids that are essential to our health. They must be obtained through the diet we eat because the body cannot make them. The type of polyunsaturates found in the oils can reduce blood cholesterol levels, but that found in oily fish appears to have no effect on blood cholesterol, although they do make the blood less ‘sticky’ which in turn, makes the blood less likely to clot and block the blood flow to the heart.

Saturated fat – Is found in foods from animals such as meat, cheese, butter and cream. Many baked goods such as cakes, biscuits and pastries are also high in saturated fats. Excessive intake of these fats can increase the ‘bad’ cholesterol levels [LDL] and heart disease.

Trans fat – Also called ‘hidden fats’ or ‘trans fatty acids’, behave in a very similar way to saturated fats and they too have been linked to raised ‘bad’ cholesterol levels [LDL] and heart disease. They are made from vegetable oil and found in nearly all convenience foods but also occur naturally in some dairy products, in beef and lamb. Just one gram of trans fat a day can increase the risk of heart disease. It is not difficult to eat one gram a day – a KFC of crispy strips of chicken and fries, McDonalds McNuggets and fries or a Burger King Whopper with fries all contain significantly more than this.

Trans fats are being cut from many well known brands such as Horlicks, Mars and Weetabix but beware because it is not compulsory for manufacturers to list trans fats on their food labels.

Monounsaturated fat – This is found in significant amounts in most types of nuts, oily fish, avocados and olive oil. It does not raise blood cholesterol and there is some evidence to show that it may also help to reduce cholesterol levels.

More facts about fats
This information takes the next step and looks at what the food manufacturers do when they produce lower fat versions of standard foods that are high in fats, such as cheese, mayonnaise, biscuits and crisps. It is often the fats in foods that make them taste so nice, smell nice and give a creaminess to the texture, so manufacturers use a ‘fat replacer’ to make them taste better and attractive enough for us to want to eat them. Other low fat products such as skimmed milk, do not have fat replacers as the fat content is reduced by simply removing the fat eg in low fat crisps the fat content is lowered by reducing the amount of fat left on the crisps, leaving the actual contents of potatoes, vegetable oils and salt the same. Needless to say, the food manufacturers have spent years finding fat replacers that satisfy our taste buds and there are different ways of doing this.

Mimicking the effect – These fat replacers are designed to mimic the texture and effect of fat. They are usually based on carbohydrates and proteins and may be extracts of fruits, oats or seaweed. They are listed on the food labels as whey powder, gelatin, lecithin, starches, carrageenan, cellulose, guar gum, locust bean gum and maltodextrins. These additives are also used in standard foods but they have a more critical role to play in low fat foods. These types of fat replacers cannot usually be used in frying or baking because the heat affects them.

In some foods water and fats are mixed into an emulsion to give the impression of creaminess but when the fat is reduced the consistency is not the same so emulsifiers are used [eg lecithin] in spreads sauces and salad dressings.

Fats also have a slippery feeling in the mouth and protein replacers, such as milk protein whey, are used. The small particles of protein in the whey act like ball bearings and slide over each other to feel like fat on the tongue. These are used in yogurts, ice creams and mayonnaise.

Modifying the fat – new technology has focused on developing fat-based fat replacers that work in the same way as fats. They have the same textures as fats but can be used for frying and baking. They have been chemically modified to give fewer calories than standard fats. These sound promising but there are some problems yet to be solved because one product, Olestra approved in the US but not used in the UK, is not absorbed into the blood stream and passes out of the body unchanged. This can cause unpleasant side effects.

Hopefully this will help you to know a little bit more about the products you are buying to try to reduce your fat intake. However, having written the article I feel generally quite put off all food for the moment!

Low Glycaemic Index Diets Better for Weight Loss

A Cochrane systematic review from Australia found that the low glycaemic index diet [GI] is satisfying and has proven benefits. The glycaemic index ranks foods rich in carbohydrate based on their effect on blood sugar levels.

Low GI foods, such as lentils, sweet potatoes and apples produce more consistent blood glucose levels compared to high GI foods such as white rice and French fries. Previous studies suggest that keeping blood sugar levels steady throughout the day may stimulate more weight loss so the reviewers evaluated randomized controlled trials that compared weight loss in people eating foods low GI foods to weight loss in people on higher GI diets or other types of weight loss plans. The conclusions were:

• Those eating low GI foods dropped significantly more weight – about 2.2 pounds more than those on other diets.
• Low GI dieters also experienced greater decreases in body fat measurements.
• None of the studies reported adverse effects associated with consuming a low glycaemic index diet.
• The low GI diet is more satisfying than other diets so people are less inclined to feel hungry and therefore are more likely to maintain this diet than other strict diets on which they feel hungry.
• Low GI diets appear to be effective even in obese people – obese low GI dieters lost about 9.2 pounds, compared with about 2.2 pounds by other dieters.
• People eating low GI foods experienced greater improvements in total blood cholesterol and LDL [bad] cholesterol.

The message really is that the success of low glycaemic diets lies with the person’s willingness to comply with its nutritional principles.

Ref 1. Low glycaemic index or low glycaemic load diets for overweight and obesity.
Review, Thomas, DE, Elliott EJ, Baur L. Cochrane Database of Systematic Reviews 2007, Issue 3

Just Follow The Rules, Not Easy!

By Jenny Hirst

One report maintains that most of the benefits from weight loss achieved through dieting come with the first 5-10kg lost, but because dieting is stressful, 90% of people fail to achieve this, or if they do, they usually put the weight back on within a year. People with diabetes are no different to the rest of 90% of the population who fail. Or are the incentives of the long-term complications sufficient to keep people with diabetes on the straight and narrow year in and year out, especially for those who not only have to adhere to the healthy diet but also to a weight reducing diet too?

I am sure that for some people, looking to the future is sufficient to enable them to stick to the diet, but not for everyone nor is it sufficient to just hand out a diet sheet and an explanation of what people should do. If you are 15 years old ‘the future’ looks a long way off when all your pals are eating burgers at 3 o’clock in the afternoon. If you are 45 years old when diagnosed, you have a lifetime of eating habits, and possibly drinking habits, that have to change. A diet sheet alone does not bring about these changes.

For me, as the mother of a child, now grown up, diet always produced conflicts and guilt.

Conflicts and guilt
My memory of meeting a dietitian for the first time was when my daughter was in hospital 34 years ago at diagnosis. I couldn’t believe my eyes – she was very pleasant with an attractive face and she kindly went through the diet with me which, in those days, was very different and much more restricted. But she was, to put it bluntly, fat. I realise that Mum’s are sensitive at diagnosis but I could hardly contain my anger! How dare she tell me about the need for a strict diet for my little girl, which as she pointed out, would be healthy for the whole family, when she was fat?

She then told me to cut out all sweet stuff, cakes, puddings and above all thickening in the gravy. I know this sounds ridiculous now but she said it! It caused me real problems because I was brought up in Yorkshire and was taught from very early days that the way to a man’s heart was through his stomach and what could be better than roast beef, Yorkshire pudding and good thick gravy? Remember I had a husband and a son to think of as well as my daughter, so I really had great conflicts going on in those first few months.

What was I to do?

• I couldn’t give my daughter thickened gravy.
• I couldn’t give her different gravy from the rest of the family and make her ‘different’. I couldn’t give the men thin gravy as it was against all my Northern teachings – I might lose a husband and my son would never learn the value of good thick gravy!
• I couldn’t disobey the dietitian.

In the end I resolved the conflict and we all had good thick gravy but this then left me with a huge sense of guilt because I was disobeying the dietitian’s orders. I always felt that I should confess at the clinic, but I never did.

So diet and dietitians have always made me feel pretty bad. The dietary advice conflicted with my cultural background and I had difficulty resolving this. Whichever way I had resolved it within the family, I would have felt guilty. The fact that I did not confess my disobedience at the clinic just added to this guilt.

Feeling inadequate, confused and a bit dim!
To add to this, dietary information always makes me feel pretty inadequate, confused and a bit dim. They keep changing the goal posts! I realise that knowledge has improved over the years and there is research to show the benefits of the present healthy eating recommendations but we do seem to be getting mixed messages.

• If we are supposed to eat the healthy diet recommended for the rest of the population, why do diabetes magazines have pages of recipes in glorious technicolour?
• Why did we stop counting carbohydrates? Well some of us never did and it is interesting that carbohydrate counting appears to be coming back!
• How are the newly diagnosed supposed to balance their insulin and their food if they don’t know the carbohydrate content?
• Now we also have the glycaemic index and I have to admit that the title alone is a total turn off for me.
• What is wrong with talking about simple things like fast acting or long acting carbohydrates, fats and proteins?

So if you are feeling the pressures of the diet for your diabetes, you are not alone!

Here are just a few of the things I have learnt over the years:

• Dietary information needs to be simple. We need to know the basic food information about carbohydrates, fats and proteins in a language that we, the patients or carers, can understand.
• If you are a man with diabetes and your partner does the cooking, she needs to know what you should and should not eat to avoid undue anxiety on her part from lack of dietary knowledge. If you are a woman with diabetes, then you probably feel the pressures to cook ‘ordinary’ food for the rest of the family and this may make diet more difficult for you.

To our health professional advisers I say:

• Don’t expect too much of us. Set targets that we can achieve so that we don’t always feel to be failing. Recognise that if we know what we should do, and don’t do it, we probably feel bad about ourselves anyway, so don’t be judgmental.
• Recognise that changing eating habits may cause confusion, conflict and guilt for all sorts of reasons – cultural, social or work circumstances. That bingeing on sweet stuff can be a compensation for frustration, sadness or boredom in people with diabetes just as much as those people without it.
• Recognise that some rules do actually make it easier for people than to just have a system of ‘healthy eating’. Too much freedom can cause confusion and anxiety, whereas rules can give a sense of security.
• Remember that just because healthy eating is good for everyone, does not make it easier for people with diabetes. We do not really have a choice, unlike the general population, so this does make it different and more difficult. We HAVE to eat a healthy diet.

Planning to Lose Weight?

By Katharine Morrison – a GP with a son who has Type 1 diabetes

Becoming and keeping slim is of even greater benefit to people who have diabetes than the general population. Abdominal obesity promotes insulin resistance and insulin resistance promotes abdominal obesity. Worsening of blood sugar control and the insidious death of overworked pancreatic beta cells results.

Most people know what to eat and what not to eat to stay thin. They just don’t follow their plan consistently enough says weight loss doctor Stephen Gullo. He asks his patients, “Do you really love this food so much that you want to wear it?”

He has many tips and strategies to help people succeed and these are published in his best selling book, “The Thin Commandments.”

Keeping a written record of all the food you consume is a good starting point. Instead of grazing throughout the day or alternatively delaying and missing meals he recommends planned eating about every four hours. The food of course cannot be any old thing that is around. You must plan ahead. A simple and obvious thing to do, isn’t it?

Yet, many things seem to get in the way of such a straightforward action plan. Emotional eating, food cravings, distractions, huge portions, just plain boredom. Every meal is a weight losing, gaining or maintaining opportunity. You have the choice.

It can be difficult to deal with carbohydrate and other cravings especially if you are sleep deprived or stressed. A high protein or high fibre breakfast can help. Protein shakes are portable and can blunt that sweet tooth. It is much easier not to buy food that you overeat rather than attempt to resist it once it is in your cupboard. High sugar or fructose plus fat seems to be the worst combinations for craving which stimulates fat storage. This combination is widely available in processed and fast foods.

Many people are quite frugal eaters till they get home at night. By then they are starving and then there is no holding back. An afternoon snack around 4 pm can help especially if it is of the filling high protein/high fibre type. Following this with an evening meal with high fibre vegetables, salad, and an adequate amount of protein will keep you going till morning without over doing the calories.

Hunger outside with meal times usually means you have underdone the protein or overdone the rapidly acting carbohydrate at the previous meal. Your daily protein requirement can be worked out by dividing your ideal weight in kilograms by six. If a woman weighs 60kg for instance she will need 10 oz of lean protein a day split between meals and snacks as a minimum. One egg is around one ounce of protein if this makes size estimation more meaningful.

When you shop for food go on a full stomach and don’t buy naughty things for “someone else”. Make a list and stick to it. For many people internet grocery shopping can help. What things do you find difficult to resist?

Apart from not actually buying and eating the stuff what else can you do to take your focus away from food? Social activiies, exercise, self soothing activities and house and garden work are all possibilities. “Why are they so unattractive compared to eating a tube of Pringles in front of the telly?” I can’t help but ask myself.

Dr Gullo insists that your lifelong success at weight control depends on how well you handle the foods that tempt you the most. For each food you have any sort of problem with you need to decide whether you can truly limit your consumption to special occasions or whether you need to eliminate that food entirely. This may seem rather harsh, but for virtually everyone a complete ban is actually easier than a plan to moderate consumption. It is an addiction after all.

Here are three tips to control cravings:

1. Is it hunger? Eat cold meat or a boiled egg.
2. Desperate for something sweet? Rinse your mouth out with dry wine, lemon juice or vinegar.
3. Desperate for something salty? Eat something sweet like a square of high cocoa chocolate or suck an artificial sweetener tablet.

If you do go ahead and guiltily get tucked into your personal equivalent of my Pringles problem, what do you do next? Many people will do the manana, manana thing. I’ve done it now, so I may as well have toasted cheese, the kids’ smarties, the leftover quiche and start again tomorrow. No. No. No. Says Dr Gullo. You must get back on the wagon right away. This is not your last meal. There are lifetime consequences on your health you know. You need to eat foods that you like and are nutritious and that fill you up. And you must do this consistently.

The best foods to fill you up are white meat, fish and seafood, high fibre low starch vegetables and eggs. High calcium dairy foods, grapefruit and cinnamon can also enhance weight loss. Removing unnecessary fat from you meals by attention to cooking methods. Removing dressings and sauces also helps. Be careful to avoid alternatives such as “lite” dressings that are bulked out with sugar. Just cut them down.

Drinking water, eating meals that contain a fixed amount of calories and exercise are all strategies that help weight loss.

As we know the first and last three minutes of our lives are the most dangerous. And it’s a bit like this when you go into a restaurant. In the first ten minutes you are choosing what to eat and drink and are possibly getting stuck into the bread and butter. In the last ten minutes you have the desserts and cheese and biscuits and the bill to contend with.

Once you are a weight you are happy with it can be just as hard to keep it off. To do this you need to keep to your good habits and not go back to your self defeating ways. Remember that it will be the same old stuff that is likely to trip you up. You may have lost a lot of weight but you will never lose your vulnerability to the old habits.

As a society we do tend to reward ourselves with food as we celebrate life events and relieve our misery over daily events. How can you reward yourself differently? How can you promote healthy eating habits to get the best out of your life?

Eating Disorders

Eating disorders are bad news for anyone but an eating disorder with diabetes is particularly serious.

Basically eating disorders are serious preoccupations with food, weight and/or body image. Clinically there are 3 types:

• Anorexia – self starvation triggered by an extreme fear of gaining weight.
• Bulimia – a binge/purge cycle stemming from a fear of gaining weight.
• Compulsive eating – bingeing thought to be caused by a need to numb negative emotions and negative self-image.

However, there is a range of eating disorders that happen to people with diabetes that do not fit into the ‘clinical’ definitions but need recognition.

A study published in the BMJ showed that teenage girls with diabetes are twice as likely to suffer from eating disorders as non-diabetic girls of the same age. Experts warn that intensive care treatment, which can cause weight increase, may be a contributory factor in the higher rates of eating disorders amongst young women with diabetes. They also warn that girls with diabetes and with eating disorders are at greater risk of the early complications of diabetes with a threefold risk of permanent eye damage.

1545 Canadian girls between the ages of 12 and 19 were studied and they found that girls with diabetes were 2.4 times more likely to have an eating disorder. 10% met the medical criteria for diagnosis of an eating disorder compared with 4% of young women without diabetes. Even more worrying, a third of the girls admitted to binge eating and 11% said they had either under dosed or stopped taking their insulin at some stage. [BMJ June 9 2000]

The following story by Michelle Tichy will be of interest to many but especially parents of children and young people with diabetes and to those affected by one of the eating disorders that we hear so much about. We are grateful to Michelle for sharing her story with us to not only help others in similar positions but to help give all of us a better understanding of these problems. The views are those of Michelle and are not necessarily those of IDDT, but we welcome this first-hand experience:

I was diagnosed with Type 1 diabetes in February 1982 – I was 7 years old. The first couple of years were OK aside from adjustments to the new routine and my parents increased fighting. I guess I blamed myself for their fights, I was always putting myself in the midst of these fights and often I tried to deflect their anger at each other on to myself. By the time I was 11, it was clear that they were headed to separation and divorce.

My response to the pain this caused me was self-inflicted pain and a warped perfectionism. I developed an eating disorder that can best be classified as ‘borderline anorexia’ in that my symptoms were: rigid food rituals, strict rules about the amount of food eaten, purging, excessive exercising and extreme fear of gaining any weight. At the same time I developed a fanatical fear of ever getting high blood sugar, so I ran normal to low. My eating disorder continued for the next 7or 8 years, made worse by puberty and I actually delayed menses until 6 months after I turned 15 which can be considered a symptom of anorexia. Since my weight never went below normal, the only clinical diagnosis I ever received was ‘borderline anorexia’ and this was inaccurate because of the purging bulimia. This is one reason that I choose not to use clinical definitions for eating disorders that do not take into account the realities of all sorts of eating and body image problems.

My eating disorder was never caught by any of my doctors, in fact I was their star diabetic patient because I kept my blood sugars so close to normal! Even the dietitians missed the fact that I was barely eating enough to continue functioning. I never lied to any of them but I never offered any information to them about my Eating Disorder.

I cannot pin point the cause of my eating disorder to one thing specifically, the following are the main causes I see:

• Indoctrination by doctors on the importance of diabetics being thin.
• Society’s standards of beauty.
• Stress/perfectionism.
• My family falling apart.

I have been in recovery now for 3 years – it is rough at times.

My view of the connections between diabetes and eating disorders.
People with Type 1 diabetes have eating restrictions placed upon them by doctors generally from diagnosis. They are told to follow a specific diet and from my experience as a 7year old, it felt like I had been locked into a cage and was only allowed to eat certain things, none of which was ‘fun stuff’. Some of my diabetic friends who were diagnosed as adolescents felt direct pressure to be fanatical about food and their weight. It seems to me that direct pressure from doctors to be thin and constantly concerned about food is a clear way to create the groundwork for eating disorders. My assertion is validated by research on diabetics and other young people with chronic conditions which has shown that young diabetics have a higher probability of developing eating disorders than those in the same age group who have no chronic illness.

More common eating disorders related to diabetes:

• Running high blood sugars [hyperglycaemia] so that your body produces ketones and in doing so, there is weight loss.
• Reduction of insulin dosage so that you run high blood sugars and so that you don’t have to eat very much.

My views on being healthy with diabetes and avoiding or overcoming body image problems and eating disorders

• Know yourself and what it feels like to be high or low.
• Respect yourself, neither an eating disorder nor ignoring diabetes is healthy.
• Doctors are resources to keep you healthy. If you don’t trust yours enough to be able to talk to them, maybe you need a different one.
• Try to be the best you can – not some societal ideal.
• Remember to try to get something from each food group at each meal.
• Do everything in moderation from food to exercise. Find activities you enjoy to both ‘de-stress’ and be active [walking tennis etc]. Try meditation or yoga for stress relief and getting to know your body.
• Find people to talk with about your insecurities. Join a support group.

Alcohol and Diabetes

Did you know that alcohol lowers the blood sugars?
Well, it does and naturally this can result in a hypo. The tendency to hypo after alcohol can last up to 4-6 hours and after a real ‘binge’ blood sugars can remain low for a couple of days. The carbohydrates that the drink may contain do not offset the blood sugar lowering effect of the alcohol, so do not count these as part of your carbohydrate consumption and assume you will be OK.

In addition to the risk of hypos, alcohol impairs your judgment so you may not realise that you are having a hypo and therefore you will not treat it with sugary food. Furthermore, your friends may not realise that you are hypo and may simply assume your ‘odd’ behaviour is because you are drunk. This is a dangerous situation and can result in a severe hypoglycaemic attack, unconsciousness, seizure and hospitalisation.

Having diabetes does not mean that you cannot or should not drink alcohol because this can seriously affect your social life. However, it does mean that you should:

• Only drink in moderation – sensible advice whether you have diabetes or not.
• Learn by experience how alcohol affects you – everyone is different.
• Take the appropriate steps to prevent a hypo and if necessary lower your insulin dose at the meal prior to going out for a drink.
• The best time to drink is with a meal.
• If you are not having a meal with your alcohol, then it is a good idea to nibble carbohydrate [eg crisps] throughout the evening.
• Never drink alcohol before a meal.
• Have an extra bedtime snack before going to bed. Remember the alcohol could lower your blood glucose during the night while you are asleep, resulting in a night hypo. The alcohol may also make you sleep more soundly and so hypo warnings may not wake you.

Exercise and Your Heart

Physical activity is good for your heart. This message is one that must have reached almost everyone but is it a message that many of us choose to ignore? Maybe we hear it so often that it just washes over us and we ignore it, as was the case with the early heavy advertising about AIDS and safe sex. It may simply be that for those of us that are couch potatoes, the very thought of ‘physical activity’ is quite off-putting! Or for many of us with busy lives, just the thought of trying to fit in time for ‘exercise’ is exhausting!

Maybe it’s the words ‘exercise’ and ‘physical activity’ that put us off because they conjure up visions of fit, lithe people visiting a rather expensive gym three times a week! Perhaps the messages would be more effective if they excluded the words ‘physical activity’ and ‘exercise’ and simply encouraged us to introduce more activity into our existing lives so we actually achieve greater activity and the health benefits almost without realising it!

According to the British Heart Foundation, although 7 out of 10 adults in the UK do not take enough regular exercise to achieve health benefits to protect their heart, but 8 out of 10 adults actually think that they are fit.

So what are the benefits for you from taking more exercise?

• Physical activity halves the risk of developing coronary heart disease.
• In people that have already had heart attacks, those who have been physically active are twice as likely to survive the heart attack compared to those people who have not been active.
• Physical activity reduces the risk of having a stroke, helps to lower blood pressure.
• It reduces the risk of Type 2 diabetes and osteoporosis.
• It helps to reduce weight in people that are overweight or obese.
• It can help to relieve stress, make you feel better and it can be enjoyable.

Facts:

• There is no level of activity that has to be achieved to gain health benefits.
• The largest gain in health benefits from increasing physical activity levels, is in people who are inactive and who start to take regular exercise or physical activity eg walking, cycling, dancing or swimming.

The major risk factors for coronary heart disease are:

• Smoking
• High blood pressure
• High cholesterol levels
• Lack of exercise

Other factors that may affect your risks of having a heart attack:

• Too much alcohol
• Excessive salt intake
• Obesity

The scientific evidence
A review, published in the Annals of Internal Medicine [April 2002], of 54 clinical trials involving 2,419 previously sedentary adults concluded that regular exercise reduced the systolic blood pressure [the top number] by an average of 4 and diastolic blood pressure [the lower number] by an average of 2.6mm Hg. The results add to the evidence that exercise is important for treating high blood pressure and for preventing it occurring in healthy people.

While the study did not show what level of activity was ideal for lowering blood pressure, results of various types of aerobic exercise at all frequencies were beneficial to people who were previously sedentary – in other words any activity is better than none. US officials are advising that people should have at least 30 minutes of moderate exercise on 5 or more days of the week.

The cause of coronary heart disease
It is caused when the arteries that supply blood to the heart become narrowed due to a gradual build up of fatty tissue [atheroma] within the walls of these arteries – this condition is called atherosclerosis. A heart attack is caused if a blood clot forms over the artheroma. The development of this fatty tissue, or atheroma, is caused by the cells in the coronary artery walls taking up cholesterol and this is the beginning of the narrowing of the arteries. As we all know, some of the body’s cholesterol is formed from the fats in the food we eat but it is important to remember that there are two types of cholesterol – the good and the bad!

LDL cholesterol [bad] forms the atheroma.

HDL cholesterol [good] removes cholesterol from the circulation and appears to have a protective effect on the heart.

So ideally we should have a lower levels of LDL cholesterol and higher levels of HDL.

Why is physical activity important for your heart?

Research indicates the following:

• Physical activity appears to raise HDL [good] cholesterol levels but does not affect LDL cholesterol levels.
• It helps to prevent blood clotting and so reduces the risk of a heart attack.
• It helps to lower blood pressure and also to prevent high blood pressure from developing.
• It helps to reach and maintain a healthy weight.

Physical activity and diabetes

Facts:

• Men that have diabetes are 2 to 3 times more likely to develop coronary heart than men without diabetes.
• Women with diabetes are 4 to 5 times more likely to develop it than women without diabetes.
• In people that already have diabetes, physical activity can reduce the amount of medications needed or reduce the insulin dose.
• Moderate, rhythmic exercise seems to reduce the risk of people developing Type 2 diabetes in middle age.

Two main types of activity
Aerobic activity – this type of exercise benefits your heart. It is any activity that is rhythmic and repetitive eg walking, swimming, cycling, dancing which increase the body’s demand for oxygen so making the heart and lungs work harder and more efficiently.

Isometric exercise – this increases muscle tension without moving a joint eg pushing against a wall. Isometric exercise does not help the heart and circulation. It should be avoided by people with heart disease or high blood pressure because it can increase blood pressure so putting the heart under stress.

Is it safe to start exercising?

• If you already have had a heart attack or any other heart condition such as angina or you have high blood pressure, you should always discuss with your doctor how much and what sort of exercise you should do. There are certain heart conditions where exercise may not be advisable.
• Always stop exercising if you get any pain or feel dizzy, sick or unwell. If the symptoms don’t go away or come back later, see your doctor.
• It is unsafe to exercise when you have a viral infection such as a sore throat.
• It is always sensible to gradually build up your physical activity in terms of both the time spent and the intensity. A sudden increase in exercise, especially vigorous exercise can be dangerous especially in middle aged people.

Diabetic Neuropathy

What is Diabetic Neuropathy?
Neuropathy Affecting The Feet
Advice on Cutting Your Toenails
Symptoms of Neuropathy Affecting Your Feet and Hands
Heel Fissures
Charcot Foot
Wrong Sized Shoes
Neuropathy and Antidepressants
Diabetic Holiday Foot Syndrome
Patient and Family Carer Experience
Diabetes and Hearing Loss May be Due to Neuropathy
Gastroparesis

 

Back to Related Health Issues

What is Diabetic Neuropathy?

From early diagnosis of diabetes, most people are told to look after their feet because of the risks that long-term diabetes or poorly controlled diabetes, can cause nerve damage. This is just one form of diabetic neuropathy but probably the most common and well known form.

Neuropathy means damage to the nerves supplying any part of the body but is usually divided into two categories peripheral neuropathy or autonomic neuropathy.

• Peripheral neuropathy affects the nerves supplying the skin and muscles.
• Autonomic neuropathy affects the nerves supplying the organs such as the bladder, bowel or heart. It can damage the nerves responsible for controlling blood pressure, sexual function etc.

Neuropathies fall into two broad groups

• Diffuse neuropathy affecting many nerves either the sensory or the autonomic nerves. This is the most common form and is the one that can affect the feet.
• Focal neuropathy affecting individual nerves – for example, this is the type that can cause impotence.

Diabetic Neuropathy

What is Diabetic Neuropathy?
Neuropathy Affecting The Feet
Advice on Cutting Your Toenails
Symptoms of Neuropathy Affecting Your Feet and Hands
Heel Fissures
Charcot Foot
Wrong Sized Shoes
Neuropathy and Antidepressants
Diabetic Holiday Foot Syndrome
Patient and Family Carer Experience
Diabetes and Hearing Loss May be Due to Neuropathy
Gastroparesis

 

Back to Related Health Issues

Neuropathy Affecting The Feet

Care of the feet is very important for people with diabetes because of the risk of diabetic peripheral neuropathy. Systematic and regular foot care has been shown to reduce ulceration and limb loss by up to 50% and almost half of all diabetes related admissions to hospital are for problems related to the leg and foot.

Prevention is always better than cure and so obviously it is important to have regular checks of your feet by health professionals and to regularly examine your feet yourself.

The golden rules for looking after your feet.

• Never go barefoot.
• Wear good fitting shoes – not tight or worn.
• Break in shoes gradually and make sure they don’t rub.
• Keep your feet dry, especially between the toes.
• If you need to use powder, use the unscented varieties.
• Use lotion to keep the skin soft so that your feet do not get dry or cracked.
• Cut your toenails straight across, not deep into the corners.
• Wash your feet daily using luke warm water.
• Do not use heating pads, hot water bottles, iodine, Epsom salts or alcohol.
• Check your feet every day and if there are any problems see your doctor or chiropodist.

Diabetic Neuropathy

What is Diabetic Neuropathy?
Neuropathy Affecting The Feet
Advice on Cutting Your Toenails
Symptoms of Neuropathy Affecting Your Feet and Hands
Heel Fissures
Charcot Foot
Wrong Sized Shoes
Neuropathy and Antidepressants
Diabetic Holiday Foot Syndrome
Patient and Family Carer Experience
Diabetes and Hearing Loss May be Due to Neuropathy
Gastroparesis

 

Back to Related Health Issues

Advice on Cutting Your Toenails

If you have been advised by your consultant or your GP not to cut your toenails yourself, then you should see a State Registered chiropodist / podiatrist. If, however, there is no reason why you should not cut your toenails then here is the way you should do it:

• Follow the shape of the toe when cutting.
• Leave no sharp edges.
• Nails are for protection so do not cut them too short.
• Never cut down the sides.

Diabetic Neuropathy

What is Diabetic Neuropathy?
Neuropathy Affecting The Feet
Advice on Cutting Your Toenails
Symptoms of Neuropathy Affecting Your Feet and Hands
Heel Fissures
Charcot Foot
Wrong Sized Shoes
Neuropathy and Antidepressants
Diabetic Holiday Foot Syndrome
Patient and Family Carer Experience
Diabetes and Hearing Loss May be Due to Neuropathy
Gastroparesis

 

Back to Related Health Issues

Symptoms of Neuropathy Affecting The Feet or The Hands

• Tingling or buzzing in the feet [called parathesia] that is often worse at night making sleep difficult.
• Pins and needles [called dyesthesia] which can become intense pain or an intense burning sensation and is described by some people as a painful numbness. It can be intermittent or constant according to how much nerve damage there is and which nerves are affected.
• Muscle pain. This is different from the above in that it is more diffuse and more like cramp.
• Loss of temperature perception – the hands and feet are less sensitive to heat and can be very sensitive to cold.
• Exaggerated sensitivity in the skin [called hyperesthesia] – an unpleasant sensitivity to skin stimulation, just wearing socks or tights can be very irritating to the skin. It seems like an allergic reaction but there are no changes in the appearance of the skin and nothing to actually see. Just minor damage to the skin can be very painful.

Ways of dealing with loss of pain sensation
Correct fitting shoes – clearly it is important to have comfortable, correct fitting shoes. Your chiropodist can advise about this. In an article by Rosemary Murray, a nurse with diabetic neuropathy [American Journal of Nursing, Nov 1993] describes her rules about shoes:

• The most comfortable shoes are running shoes because they are made of soft fabric, provide a shock absorbing thick sole and a lace up top for a good snug fit.
• Obviously there are times when she wants to wear ‘proper’ shoes, so when buying new shoes she makes sure that they are not too tight.
• She never wears a new pair longer than 2 hours at first and then inspects her feet for pressure marks or irritations. A hand mirror is useful to ensure that all parts of the feet can be examined. She repeats this to hour test and then gradually builds up her wearing time.
• If the shoes do cause problems, she throws them away and writes off the cost as a small price to pay for avoiding real foot damage.

Ways of dealing with loss of temperature sensation:

Cold
Dealing with increased feelings of being cold in the hands and feet is easy. For the hands, wearing gloves and increasing their thickness in winter helps. For the feet, wearing heavy socks is not always possible but lined socks are available and these are warm but not very thick. For women thick tights are available and quite fashionable.

Heat
Dealing with loss of sensation of heat is more important because failure to do so can result in severe burns. It is not always the obvious burns from hot water bottles that is the problem but judging everyday things like the washing up water or bath water can be difficult. Usually the forearms or the upper arms are more sensitive to heat so running water over them as a test is a good idea.

Bath Alert
This is an interesting device that is particularly useful for people with diabetic neuropathy where the feet have lost the sensations of pain and heat. There is always a danger of scalds if the bath water is too hot and you can’t feel it because of the loss of feelings in the feet. Bath Alert flashes and sounds a buzzer if the temperature of the water goes above 40 degrees Celsius. It also detects the water level and warns if the water has gone above this and the bath is in danger of flooding. It is suitable for use in bathrooms and kitchens and for children and the elderly.

Ways of dealing with painful neuropathy

• The tingling and buzzing sensation is often helped by physical activity – walking or rubbing the affected area.
• Medical gel packs have been found to help some people. The gel pack has to be chilled in a freezer before use and then is placed on the painful area. These can be obtained from leading pharmacies.
• The pins and needles extending to varying degrees of pain is often treated with pain killing drugs but other options are available.
• Pain control clinics are becoming more available and you should ask your doctor to refer you to your nearest one.
• TENS machines are convenient, safe and effective, easy to purchase and cheap to run. They can be used at home without training and they have a demonstrable record of producing pain relief. Unlike many drugs, they have no side effects. TENS stands for Transcutaneous Electrical Nerve Stimulation. The TENS uses electricity to block the pain messages. It is a small battery operated box with two or four self-adhesive pads that attach to the area around the pain. It can be clipped to your clothes and worn at any time. A 20 minute treatment can give pain relief for quite some time. As there are no side effects treatment can be repeated or extended. Research suggests that not only do TENS machines block the pain messages but they also can stimulate the body to produce its own pain-relieving hormones.

Note: TENS should not be used near the heart or front of the neck and should not be used by anyone fitted with a pacemaker. They can be obtained from larger pharmacies but always talk to your doctor first.

You should explore all these options, or a combination of them, perhaps before going down the easy and obvious route of taking large doses of painkillers.

Diabetic Neuropathy

What is Diabetic Neuropathy?
Neuropathy Affecting The Feet
Advice on Cutting Your Toenails
Symptoms of Neuropathy Affecting Your Feet and Hands
Heel Fissures
Charcot Foot
Wrong Sized Shoes
Neuropathy and Antidepressants
Diabetic Holiday Foot Syndrome
Patient and Family Carer Experience
Diabetes and Hearing Loss May be Due to Neuropathy
Gastroparesis

 

Back to Related Health Issues

Heel Fissures

The Isle of Wight Diabetes Monitoring Group, kindly gave permission for IDDT to reprint an article in their magazine, Sweet Pea. The article is by Oliver Davies, Senior Diabetes Chiropodist.

What are heel fissures?
Heel fissures are a common occurrence in all the population, but in diabetes they can cause serious problems if they are not dealt with effectively. They are essentially cracks or splits in the skin often extending through to the dermis [the inner layers of the skin] and are often painful when pressure is applied to the heel on standing. They can frequently bleed and once the fissure opens it is often difficult to get the two edges of the split to knit back together.

With so many people with diabetes suffering from neuropathic damage [causing loss of feeling, commonly in the feet] these fissures often go unnoticed until they have become quite severe. Frequently they can become infected, and where many people with diabetes can suffer with ischaemia [a reduced blood supply] they are subsequently difficult to heal and may ulcerate.

What causes heel fissures?
Invariably heel fissures are symptomatic of dry skin conditions. Loss of innervation [nerve supply] to the sweat glands in the feet can result in people with diabetes having drier skin than the rest of the population. Hot weather, wearing of sandals, inadequate skin care, abrasive hosiery, poor circulation and possibly some forms of medication can all contribute to the drying of skin.

How can I prevent heel fissures?
Generally, after washing or a short soak of the feet, the application of a good moisturing cream should be sufficient to keep skin more supple and hence prevent their formation. The cream should be applied every day, particularly if you have been instructed to do so by your chiropody/podiatry clinic. The Podiatry Department often recommend Aqueous Cream B.P. which is a water based cream that helps to rehydrate the skin [and not just in the feet!] Basically, you can use any moisturising cream providing it is done on a regular basis!

How do I deal with a heel fissure already present?
If on your daily foot inspedtion you discover a crack in the heel, keep a close eye on the area and initiate the daily moisturising routine maybe 2 or 3 times a day. If there is no improvement after a week it is advisable to contact your local Chiropody/Podiatry Clinic and let them assess it and advise you. At the clinic they will be able to apply suitable dressings to heal the fissure and suitable padding materials to prevent the inevitable shoe rubbing that might prevent them healing.

Remember if in doubt about any foot problems always contact your local chiropody/podiatry clinic for advice.

Diabetic Neuropathy

What is Diabetic Neuropathy?
Neuropathy Affecting The Feet
Advice on Cutting Your Toenails
Symptoms of Neuropathy Affecting Your Feet and Hands
Heel Fissures
Charcot Foot
Wrong Sized Shoes
Neuropathy and Antidepressants
Diabetic Holiday Foot Syndrome
Patient and Family Carer Experience
Diabetes and Hearing Loss May be Due to Neuropathy
Gastroparesis

 

Back to Related Health Issues

Charcot Foot

This is a non-ulcerative foot condition that can occur in people with diabetes and is associated with nerve damage [neuropathy]. It is a condition that affects people who have lost their sense of pain in their feet. Pain protects the feet as it warns people that they are doing too much walking, standing or exercising. In Charcot foot the foot changes shape due to destruction of the bones and joints and this is not caused by infection.

However, it is difficult to detect and is often treated as an infection because areas of the foot become red and swollen. It may also be mistaken for cellulitis. Another problem with diagnosis is that the initial X-ray of the foot may appear normal. Sometimes people are alerted to Charcot foot if they have a history of injuries caused by tripping or falling. If the condition goes untreated or is badly managed, then it can have very serious results. Despite difficulties with diagnosis, immediate diagnosis and putting the foot out of action is essential.

The treatment of Charcot foot is continuous foot care education, protective footwear and routine foot care to prevent the formation of ulcers.

Diabetic Neuropathy

What is Diabetic Neuropathy?
Neuropathy Affecting The Feet
Advice on Cutting Your Toenails
Symptoms of Neuropathy Affecting Your Feet and Hands
Heel Fissures
Charcot Foot
Wrong Sized Shoes
Neuropathy and Antidepressants
Diabetic Holiday Foot Syndrome
Patient and Family Carer Experience
Diabetes and Hearing Loss May be Due to Neuropathy
Gastroparesis

 

Back to Related Health Issues

Wrong Sized Shoes

A study at Dundee University of 100 people with diabetes found that 63 had badly fitting shoes – the wrong size and mainly the wrong width. [Int Journal of Clinical Practice, Nov 2007] People with diabetes who also have neuropathy [nerve damage] can lose the sensation in their feet and so damage from ill-fitting shoes can go unnoticed.

If shoes are too narrow, tight or loose, they can cause blisters or ulcers which can be slow to heal and lead to infections. People with neuropathy may choose shoes that are too tight because the increased pressure makes them feel the right size. In addition, feet get larger and broader in older people but they often continue to buy the same size. The study showed that a third of the patients said they took a different shoe size from the one they were actually wearing, probably due to the fact that shoes sizes vary from maker to maker. It also showed that only 29% of people checked their feet and legs regularly for any sign of damage which could lead to problems and 22% never checked their feet.

There is a call for shoe manufacturers to standardize their shoe sizes and increase the range of width fittings. But there is a clear message here for people with diabetes – having well-fitting shoes may be expensive but not as costly as the damage that can be done by not doing this!

Diabetic Neuropathy

What is Diabetic Neuropathy?
Neuropathy Affecting The Feet
Advice on Cutting Your Toenails
Symptoms of Neuropathy Affecting Your Feet and Hands
Heel Fissures
Charcot Foot
Wrong Sized Shoes
Neuropathy and Antidepressants
Diabetic Holiday Foot Syndrome
Patient and Family Carer Experience
Diabetes and Hearing Loss May be Due to Neuropathy
Gastroparesis

 

Back to Related Health Issues

Neuropathy and Antidepressants

IDDT has had quite a lot of queries from people who have neuropathy [damage to nerves] and are being treated with antidepressants and they find this difficult to understand. The reason for prescribing antidepressants for neuropathy is based on the suggestion that these drugs may inhibit the pain pathways in the central nervous system.
Drugs and Therapeutics Bulletin April 2007

When a simple painkiller, such as paracetamol, is ineffective in treating painful neuropathy, the next treatment is with what is known as a tricyclic antidepressant, such as amitryptyline. Other options are available including duloxetine [sold as Cymbalta and Yentreve] which has been specifically approved for peripheral neuropathic pain. It is recommended that its use is assessed 2 months after starting treatment and then 3 monthly. The trials carried out with duloxetine showed that there was a significant reduction in pain when compared to a placebo [dummy pill].

Diabetic Neuropathy

What is Diabetic Neuropathy?
Neuropathy Affecting The Feet
Advice on Cutting Your Toenails
Symptoms of Neuropathy Affecting Your Feet and Hands
Heel Fissures
Charcot Foot
Wrong Sized Shoes
Neuropathy and Antidepressants
Diabetic Holiday Foot Syndrome
Patient and Family Carer Experience
Diabetes and Hearing Loss May be Due to Neuropathy
Gastroparesis

 

Back to Related Health Issues

Diabetic Holiday Foot Syndrome

Research [ref1] has shown that there is a greater risk of foot ulceration during holidays, especially those taken in hot countries, hence the name ‘Diabetic holiday foot syndrome’. Among 435 people studied, 17 experienced foot lesions during foreign holidays, 10 of whom reported a foot lesion for the first time. The people with holiday foot damage were a younger age, mainly male and their diabetes was of shorter duration than foot lesions of other origins.

The causes of diabetic holiday foot syndrome were:

• direct injury
• unaccustomed exercise
• walking barefoot on the beach or in the sea
• burns from walking barefoot on hot pavements
• wearing inappropriate inflexible bathing shoes.

If you need any more warnings than this, nine out of the 17 people had to be hospitalised for infections as a result of the foot damage and the average stay in hospital was 11 days.

The researchers conclude that there is a need to increased education about foot care at holiday periods and that this should include preventative measures for those people at high risk of foot lesions.
Ref1 Prac Diab Int March 2001 Vol 18 No2

Diabetic Neuropathy

What is Diabetic Neuropathy?
Neuropathy Affecting The Feet
Advice on Cutting Your Toenails
Symptoms of Neuropathy Affecting Your Feet and Hands
Heel Fissures
Charcot Foot
Wrong Sized Shoes
Neuropathy and Antidepressants
Diabetic Holiday Foot Syndrome
Patient and Family Carer Experience
Diabetes and Hearing Loss May be Due to Neuropathy
Gastroparesis

 

Back to Related Health Issues

Patient and Family Carer Experience

Dealing with diabetic foot problems – A dual perspective
By Arabella Melville Research Fellow, NHS Centre for Reviews and Dissemination, York

My partner has been insulin dependent for 48 years. I’m fortunate, as a carer, to have access through my job to detailed and wide-ranging information about medicine and health. Naturally whenever Colin has a difficult problem, I use all the resources available to me to research the problem and seek out the evidence on the effectiveness of treatment options.

We are having to cope with the long-term effects of diabetes, including foot problems and painful neuropathy. I’d like to share what we have learnt.

First how to avoid it
Medical research shows that neuropathy develops later in people who maintain a consistently low blood glucose level through intensified insulin treatment. We have no personal experience of this: Colin wouldn’t be willing to consider all the obsessive monitoring and careful control. While it seems to be true that better control improves a diabetic’s long-term prospects, we worry about what it does to the quality of the greater part of his/her life. It is an individual decision, I guess.

Even with the best control, people who have been diabetic a long time [and even some people who have only just become diabetic] are likely to end up with foot problems.

Neuropathic pain. Nobody seems to know what causes it, beyond in the most general terms, nerve damage being associated with fluctuating blood sugar. But the effects are all too familiar to Colin: pain in a variety of forms – scalding or burning, a sensation akin to having a nail driven into the foot or having a toe pinched hard with pliers. It sounds to me like torture. It keeps him a awake at night sometimes and even when he falls asleep, his legs go into spasm and he’s restless.

So what answers have we found?
First the medical approaches. These have been systematically reviewed by the Pain Relief Unit in Oxford. Basically, there are two types of prescription only drugs that work to some extent, for most people. They are tricyclic antidepressants [imipramine and amitryptiline] and anticonvulsants [carbamazapine]. They appear to be equally effective, so if one doesn’t work, you try the other. They also have roughly equal levels of side effects, but overall are pretty safe in the doses used for neuropathic pain. Pain-killing drugs generally are not effective, nor is the application of heat, cold or transcutaneous electrical stimulation. Capsaicin cream may also be effective in some people, but can cause skin irritation.

Colin and I have experimented with others methods, some of which seem effective. We’d be interested to hear from other people who’ve tried these. He takes the herb hypericum [St John’s Wort]; we also use it in foot baths and in the form of hypercal cream [available from chemists and health food shops]. Careful research has shown that hypericum tablets are equivalent in antidepressant action to tricyclic antidepressants, but a lot safer; no formal research has been done of the effects on neuropathy. I suspect that the same parts of the nervous system are affected in similar ways by the two types of product, and that someone will one day demonstrate that hypericum can be helpful for neuropathic pain. We have also tried ibuprofen cream on the foot, and found it worked; but this was a recent experiment that we haven’t repeated because Colin has been free of pain since! We don’t attribute this to ibuprofen – he was only getting the odd twinge when we tried it and the benefit could be due to chance or the placebo effects. But we shall try it again when the pain recurs.

How did we achieve this wonderful pain-free period?
With shiatsu, a Japanese technique in which the therapist uses pressure on specific trigger points to adjust energy flow in the body, like acupuncture without needles. This is another method that has not been tested as a treatment for neuropathic pain by scientific research, but which I believed [from my knowledge of pain relief generally] was worth trying. I would expect acupuncture to be equally effective, but have no experience of it in this context. Shiatsu, carried out by a competent professional therapist, has a dramatic effect on Colin. In our experience, the benefit lasts for about a month, when the treatment has to be repeated.

Ulcers
Inevitably, after many years of neuropathy, Colin’s feet are affected in other ways. When he developed his first ulcer, I was fortunate to have access to the best information through the Research Centre where I work assessing the effectiveness of health care interventions. Some of my colleagues had completed a systematic review of interventions for diabetic foot ulcers and they advised me to find a specialist clinic where Colin could get expert treatment. He had to argue with the GP to go there, but succeeded in the end. He now sees the specialist chiropodist at regular intervals.

The most important aspect of treatment is to take the pressure off the ulcerated area. There are several facets to this:

• The first is the padding over the ulcer itself. I bathe and check his feet at least twice a week and dress any area that starts looking at all red, cracked or blistered, using felt padding held in place by highly porous sticking plaster. I then massage moisturising cream into his feet and this helps to stop sores developing.
• We were given some invaluable advice on socks. He now wears thick, cushioned walking socks inside out and if there’s likely to be a lot of stress on his feet, such as walking around town for an extended period, then he will ear a pair of fine cotton inner socks as well.
• Another way of reducing the pressure is wearing made to measure shoes. These are available on the NHS and they are simply wonderful. Colin has both boots and shoes supplied by the clinic – they fit like gloves, are soft and feel marvellous on his feet, and he wears them all day. Since he got these shoes he has not had any significant ulceration, just little lesions that I can normally treat at home.

Rest
Colin was told very firmly to rest and put his feet up. While we agree that it is important to elevate the feet for part of the day, we dispute the suggestion that he should rest completely. Exercise is very good for him, it’s good for his diabetic control and good for the circulation, particularly in his legs and feet where it is so important. We are convinced that one reason for his continued health is that he takes regular exercise. So he carries on walking every day. The doctors and nurses are amazed at how fast his ulcers heal and the orthopaedic appliance staff are amazed at how often his shoes come back to be repaired.

I checked the research on this question and found there was none. The advice on rest is based on assumptions and beliefs, not scientific evidence. However, I must emphasise that walking is only likely to be beneficial if further damage to the foot is prevented by multiple layers of soft padding and NHS made to measure shoes.

Relieving Joint Pain

Drugs often used to relieve arthritic joint pain [and therefore often used by people with diabetes] are called non-steroidal anti-inflammatory drugs, NSAIDs for short. Ibuprofen is just one example common example of this type of drug. They come in tablet form and also in creams, gels, foams and sprays and these are referred to as topical NSAIDs because they are applied to the skin surface.

According to Health Which in 1998 the prescriptions for topical NSAIDs cost the NHS nearly £20million and there is an additional use because this figure does not include those bought over the counter. The sister journal, Drugs and Therapeutics Bulletin [1999;37:87-88] looked at how effective topical NSAIDs are in relieving chronic arthritic joint pain. Their results produced a recommendation that topical NSAIDs should not be prescribed on the NHS for the following reasons:

• There was little reliable evidence about where the products go in the body after they are put on the skin.
• It is not known how well topical NSAIDs work when used in the long term or how likely they are to cause serious side effects because of absorption into the body.
• What evidence is available suggests that they might be slightly better than a placebo [dummy] preparation at relieving joint pain.
• There is no reliable evidence that they are more effective than standard treatments for joint pain, such as paracetamol or NSAIDs taken by mouth or other topical preparations called rubefacients that work by irritating the skin over the painful area.

We are we using preparations that are easily available to us over the counter and the NHS is paying a high price for those given on prescription. But they are not proven to be effective and even worse there is no science to say that they are safe for long term use.

Diabetic Neuropathy

What is Diabetic Neuropathy?
Neuropathy Affecting The Feet
Advice on Cutting Your Toenails
Symptoms of Neuropathy Affecting Your Feet and Hands
Heel Fissures
Charcot Foot
Wrong Sized Shoes
Neuropathy and Antidepressants
Diabetic Holiday Foot Syndrome
Patient and Family Carer Experience
Diabetes and Hearing Loss May be Due to Neuropathy
Gastroparesis

 

Back to Related Health Issues

Diabetes and Hearing Loss May be Due to Neuropathy

Researchers in Italy are exploring the effect that diabetes may have on hearing loss. Forty seven people with insulin dependent diabetes and still with normal hearing abilities were studied and all of them had impairments in the spiral canal in the ear. These problems usually begin with a lesion in the inner ear spiral canal and can be caused by neuropathy. Previous studies have found that hearing loss is in the high frequency area of the ear with a progressive loss over time.