Diabetes Affects Skin

Why Diabetes Affects skin.

Diabetes Mellitus is a group of metabolic diseases that share the phenotype of hyperglycemia. The metabolic changes associated with diabetes causes secondary pathophysiological changes in multiple organ systems including the skin. What that means in plain English is if diabetes itself is not enough to cope with it is often accompanied by all sorts of unwelcome skin eruptions. All medications for diabetes which control the glucose levels affect the skin, in both diabetes type I and type 2 diabetes. The most distressing effects can be seen in type I diabetes after prolonged use of insulin. That does not mean that type II diabetes sufferers get off scot free, they don’t. There is always a correlation between diabetes and the skin. It is always a matter of time before diabetes affects skin condition.
Diabetes Affects Skin Diabetes and skin eruptions.
The diabetics who managed to control their blood sugar level and do not have massive spikes of glucose tend to have fewer problems than those that don’t. Very few diabetics get off without any long or short term skin eruptions.
Diabetes affects all the organs of the body. As the skin is the largest organ it makes sense that a lot of the manifestations and complications of diabetes can be seen on the surface area of the skin.
It is important for diabetics to be aware of changes in their skin, the changes may be acne, discoloration of the skin tone or a thickening of the skin. One of the many side-effects of insulin is that it helps to maintain good skin condition.Lack of insulin in both the short and long-term means that wounds take longer to heal. Whereas a normal person may start to develop a scab an hour after a graze, a diabetic may not be so fortunate. A sugary syrupy secretion will very likely seep out of the wound and this makes it difficult for a scab to form.
Sadly this is not the only effect of reduced insulin because the open wound makes it easier for infections to get inside the body. Very often medical staff are not monitoring these cutaneous changes, so it’s important that you are aware of them yourselves. Changes in the skin can also be a warning sign that there is already a glucose intolerance. One of these indicators is dry flaky itchy skin. Another is “acanthosis nigricans” this nasty sounding skin condition doesn’t hurt. It can be seen clearly a darkening of the skin around the armpits or around the neck. So the fact that it doesn’t hurt is no comfort it can be very disfiguring.
Either of these two conditions should be taken as a warning sign. If you have either of them then it would be wise to go and ask your doctor to check your sugar levels. Acanthosis nigricans is not always linked to glucose intolerance, there are other conditions which can cause it but in the vast majority of cases the culprit is glucose, and as we have seen diabetes affects the skin.

The bacterial infection Staphylococcus is quite common when glucose levels are not stable. They usually occur around hair follicles. That means around the eyelashes which often results in styes at other times when the hair follicle becomes inflamed an eruption which resembles a boil flares up. The only control and treatment for this condition is antibiotics.
Candida albicans” is a fungal infection and it is often a precursor of diabetes. The infections are more prevalent between damp moist folds of the skin. Athlete’s foot often occurs between the toes and ringworm is a ring-shaped red patch or blister which usually appears in the groin abdomen and chest and feet. Candida albicans is also a vagina infection and can be an indication of a glucose imbalance. All of these fungal infections are unpleasant, but they can be treated. Mucormycosis is another fungal infection which is potentially fatal. It begins in the nose and then spreads to the eyes and from the eyes to the brain.
In the long term, the only real control for the skin infections is maintaining healthy glucose levels. That means being aware of what you eat and reducing your carbohydrate intake. Scaly dry skin can be caused by poor circulation and it can be helped by a topical moisturizing cream. Without taking control of your diabetes, all of the skin conditions can return.Minimize how diabetes affects the skin.

Foot care for Diabetics – The Frightening Statistics

foot care for diabetics

foot care for diabetics

Each week in England there are around 120 amputations in people with diabetes. The majority of diabetes-related amputations are caused by a “foot attack” – a foot ulcer or infection failing to heal. When people with a foot attack get rapid access for treatment by a specialist multi-disciplinary team this has been shown to promote faster healing and fewer amputations, saving money and lives. Amputation is not only devastating in its impact on the person with diabetes and their family, leading to loss of independence and livelihood, It is also expensive for the NHS.

Over £119 million is spent each year in England on diabetes-related amputations. Currently the numbers of amputations are rising from 5,700 in 2009/10 to over 6,000 in 2010/11. It is projected that there will be over 7,000 amputations in people with diabetes in England by 2014/15 if urgent action is not taken to reduce these¹. Only 50 per cent of people with diabetes who have an amputation survive for two years. The relative likelihood of death within five years following amputation is greater than for colon, prostate and breast cancer. The most shocking fact of all, however, is that most of these amputations are preventable. In areas where foot care for diabetics is in place there are fifty percent less amputations. Foot care for diabetics changes on a daily basis and diabetics have to be able to have immediate access to foot care clinics.

This is why Diabetes UK, the Society for Chiropodists and Podiatrists and NHS Diabetes are promoting the commissioning of an integrated foot care pathway through the Putting Feet First campaign. The pathway would ensure that in the event of a “foot attack”, those people with diabetes who are at increased risk of foot problems get identified and then fast-tracked to the specialist team that can expertly assess and treat them.

Last year a group of diabetes specialists met to pool their expertise and concluded rapid access to specialist assessment and treatment for all those with a foot problem would make all the difference in achieving the goal of reducing amputations by 50% over the next five years.

AMPUTATIONS

Improving diabetes foot care and reducing amputations saves lives and saves money. It also impacts considerably on health outcomes:

• preventing people from dying prematurely

• enhancing quality of life for people with a long-term condition

• helping people recover from episodes of ill health or injury

• ensuring a positive experience of care

• protecting people from avoidable harm.

A root cause analysis of every amputation across 13 London hospitals was conducted in April and May 2012 and examined 27 patient data sets. The results suggested a lack of integration of the pathway across primary and secondary care – only 54% of those having  a diabetologist with expertise in lower limb complications

• a surgeon with expertise in managing diabetic foot problems

• a diabetes specialist nurse

• a specialist podiatrist

• a tissue viability nurse.

There had been no improvement from the previous year.

Recommended Daily Foot care for Diabetics

Check their feet every day

Be aware of loss of sensation.

Look for changes in the shape of their foot

Get your toenails cut properly and safely

Wear shoes that are comfortable and a good fit, shoes should not rub.

Keep an eye on your blood sugar

At least once a year have your feet professionally checked

Do not try and get rid of corns yourself the plasters that remove corns are not good for diabetics and never use a knife with a blade to remove corns.

These shocking Facts illustrate  that diabetics have to be aware of basic foot care. This applies not just to type 1 diabetics who are at risk of amputations because in the long term injected insulin lodges in the extremities, ie the toes.

Even something as simple as hard skin can lead to an infection because if it is not removed the skin can crack and lead to an infection. What makes these foot care figures so appalling is the fact that it has to be cheaper for the local authorities to provide foot care for diabetics, than the surgical costs of an amputation.

For more information about diabetic complications see our other articles.

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Diabetes Impacts Eyes

A normal eye-before Diabetes Impacts Eyes

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Diabetes impacts eyes because diabetics have an increased risk of developing eye complications which, if left untreated, can lead to poor vision and blindness. However, 98% of serious vision loss from diabetes can be prevented with regular eye examinations and early treatment. Glucose crystals  as a resultant of too high sugar readings are damaging your organs. However, this can be avoided with regular eye examinations.

How does the eye work?

The eye works a bit like a camera. Light enters through the cornea and the pupil before passing through the lens which focuses the light onto the retina. Special cells in the retina detect the light, forming the focused image like film in an old fashioned camera. The image is sent along the optic nerve to the brain. At the centre of the retina is the macula which is responsible for the ‘seeing’ straight ahead part of our  vision while the retina is responsible for ‘seeing’ from the edges of our vision.
A normal eye

Diabetes Impacts Eyes How

High blood glucose levels can cause changes in the shape of the lens which can temporarily cause blurring of your vision. This commonly occurs before being diagnosed with diabetes or when diabetes isn’t well managed. The blurriness usually disappears when blood glucose levels are reduced through appropriate treatment. Therefore getting new glasses should be delayed until blood glucose levels are back within the recommended range.
High blood glucose levels for long periods of time can increase the risk of more serious eye problems in people with diabetes, including:

Most diabetics underestimate the fact that diabetes impacts eyes and sight,  partly because  they do not notice changes in their vision until the condition is very serious, it is essential to have regular eye examinations so that problems can be detected early and treated promptly. Few diabetics get the luxury of early warning signs, often the damage is done before you even begin to get any symptoms.

Diabetic Retinopathy

  • Non -proliferative

 

The longer you have diabetes, the greater the risk of small blood vessels at the back of the eye being damaged by high blood glucose and high blood pressure. This can result in leakage and often progresses to blockage of the vessels that supply the retina with nutrients. This stage is called non -proliferative or background retinopathy and there may be no noticeable change in your vision.

    •   Proliferative

Without early detection and treatment, non-proliferative diabetic retinopathy can progress and the retina may grow new blood vessels. This advanced stage is called proliferative retinopathy. The new blood vessels are weaker and can bleed onto the retina or the vitreous, the jelly-like centre inside your eye. Vision can be affected, sometimes seriously and suddenly.

The growth of new vessels may also lead to developing scar tissue which can cause further problems such as a retinal detachment. Once these changes occur it is hard to
restore any lost vision and the resulting damage can lead to blindness. Sometimes new vessels may grow on the iris and this can lead to neovascular glaucoma (see below).

Macular oedema

Blood vessels in the macula, the central area of the retina, can leak fluid causing swelling and can result in central vision loss.

Cataracts
Changes or problems in the lens can result in clouding and decreased vision known as cataracts. Although ageing is the main risk factor, people with diabetes tend to develop cataracts more rapidly and at a younger age.
Glaucoma
Glaucoma is an eye disease in which the optic nerve is damaged. The progression of glaucoma is usually slow. Glaucoma can affect anyone but it appears to be more common in people who have diabetes. People with diabetes may also have a less common form of glaucoma which develops as a complication of severe diabetic retinopathy or neovascular glaucoma.
What are the symptoms of diabetes related eye complications?
Often diabetes-related eye complications have no signs or symptoms and there may be no obvious deterioration in vision until the condition is quite advanced. Changes in vision may also be so gradual that you do not notice it for some time.
Where signs and symptoms are present, they can include:

  • Floaters and flashes
  • Blurry, blocked or dim vision
  • Poor night vision
  • Halos around lights or sparkles
  • Sensitivity to light and glare
  • Need for brighter light for reading and other activities
  • Distortion or ‘holes’ in vision
  • Frequent changes in eyeglass prescriptions

If you are a diabetic any change in your vision should be checked by your optometrist, ophthalmologist  or doctor.

Caring for your eyes

  • You should be told as soon as your diabetes is diagnosed that diabetes impacts eyes, Be aware of your personal risk
  • Have an eye examination by an eye care professional when you are first diagnosed with diabetes and then at least every two years (or more often as indicated by your doctor or eye care professional).
  • Examination of your eyes involves viewing the back of your eyes. This will involve adding eye drops to dilate the pupils or taking a photograph of the back of your eyes.
  • If retinopathy is detected, you will need to have your eyes examined more often and you may be referred to a medical eye specialist (ophthalmologist).
  • Notify your eye care professional immediately if you notice any changes in your vision.
  • Keep your blood glucose levels, HbA1c, blood pressure and cholesterol within the recommended ranges. High blood glucose, cholesterol and blood pressure increase the risk of developing eye complications as well as increasing the severity of eye complications.
  • Have regular health checks including blood pressure readings, cholesterol measurements and kidney function tests as recommended by your diabetes care team. Diabetes impacts eyes and other organs.It is important that you discuss the results with your doctor and seek further advice for any results that are not in the recommended range.
  • If you smoke, stop!
  • Maintain a lifestyle that includes regular physical activity and healthy eating to better manage your blood glucose levels.
  • Always take your medications as instructed by your doctor.

Can diabetes-related eye complications be treated?
Most eye complications can be treated successfully if detected early. Early detection and treatment can also prevent eye complications from getting worse. However, treatment generally cannot restore vision once it has been lost. Regular eye examinations and early treatment are therefore important to prevent vision loss.Diabetes impacts eyes in all cases and this is not something you can ignore.

The most common treatments for eye complications are:

Laser This involves the use of a special form of light of a specific wavelength that is able to heat retinal tissue and blood vessels. This can minimise leakage from blood vessels and cause regression of any new and fragile vessels.
Surgery

A surgical procedure called a vitrectomy is used in cases of advanced retinopathy. It involves the use of fine instruments inside the eye with the aim of repairing the most severe damage caused by diabetic retinopathy.

 

Diabetic retinopathy- Causes and Prevention

diabetic retinopathy

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Diabetic retinopathy is one of the most common complications of diabetes type 1 and diabetes type 2, recent studies by the American diabetic association have found that fifty percent of people with raised sugar levels in the pre-diabetes stage are at risk .

What is diabetic retinopathy?

Diabetic retinopathy occurs when elevated sugar levels damages the tiny blood vessels inside the retina. The retina is the light sensitive part of the eye and it is imperative for healthy vision, which is why blindness occurs when the retina is damaged. Sadly there is very little warning or symptoms before the onset of diabetic retinopathy. Which is why all

diabetic retinopathy
Cross Section of the eye.

diabetics should have dilated eye exam at least once a year. As diabetic retinopathy has four stages, if it is detected early enough there are treatments to halt the progression of the disease so that it does not lead to blindness. If you should see spots of blood or spots floating in your vision, even if it only happens once go and have an eye test, don’t wait for further damage to occur. Sometimes these spots will clear without any treatment, but hemorrhaging can occur in the night and blurred vision is the likely result.

Diabetic retinopathy has four stages:
1. Mild Nonproliferative Retinopathy.

The retina has many small blood vessels and small microaneurysms or swellings occur.

2. Moderate Nonproliferative Retinopathy.

These swellings get worse until they block blood vessels to the retina.
3. Severe Nonproliferative Retinopathy.

The blocked vessels become more swollen which deprives several area of the retina of their vital blood supply, to compensate the retina asks the brain to grow more blood vessels
4. Proliferative Retinopathy.

In the fourth and final stage of diabetic retinopathy new blood vessels develop, but they are fragile, too frail to cope with blood flow and once these blood vessels leak the end prognosis is loss of vision, or blindness.

Another complication is macular edema, the macular is the centre of the retina and it controls straight ahead and sharp vision. Statistically fifty percent of people with proliferative retinopathy also have macular edema.

Even at this stage of blurred vision treatment is possible. The most usual treatment is by laser,the resulting tiny burns seal the blood vessels and prevent further leakage. Sometimes more than one session is needed but most treatments are completed in one session, although practitioners usually leave a gap of several months if both eyes need treatment.
How are macular edema and diabetic retinopathy detected?

The test is normally in two part a test to see how sharp your vision is over distance and a dilated eye examination. Drops are placed in the eye to widen the pupil and then the surface of the retina and optic nerve is examined. The test is not painful but the after affects of blurred vision can linger for a few hours.

What is a vitrectomy?
If you have a lot of blood in the center of the eye in the vitreous gel you may need a vitrectomy to restore your sight. During a local or general anaesthetic
A vitrectomy is performed under either local or general anesthesia.  The vitreous gel is removed because it is clogged with blood, and it is replaced with a saline solution which has a a similar composition to the vitreous gel. Because an incision is made in the eye you may need to wear an eye patch for a time to stop any infections in the eye.

Although both the treatments have a similar success rate, they do not actually cure the condition. The condition will not be cured whilst your glucose levels are elevated. Modern research is looking at ways to inhibit the signals that ask for new blood vessels to be made.
A better prevention is to reduce your blood sugar levels. This will not only prevent diabetic complications in other organs such as the kidney , and prevent nerve damage.

Don’t forget there are rarely any warning sign and if left untreated diabetic retinopathy causes blindness. A simple painless eye once a year can prevent all these complications, if you listen to the video, you will hear that most sufferers’ of diabetic retinopathy will agree that they could have avoided diabetic retinopathy with regular eye checks.