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Every person who has diabetes, no matter how well controlled or uncontrolled should have a relationship with a podiatrist. That relationship may be a foot examination twice a year. It may be a weekly visit to treat a diabetic foot ulcer. The point is, if a foot concern arises, you have who to see about it. My name is Dr. Andrew Schneider, and I'm a podiatrist in Houston, Texas. 

So, what is diabetes? Diabetes is an endocrine disorder where the pancreas does not produce enough insulin. Insulin is a hormone that's vital to provide energy, and it's provided by breaking down sugar to provide the energy to the cells. When enough insulin isn't produced, or the cells don't respond to insulin, it leads to an increase of sugar in the blood. Too much sugar in the blood, it can cause a variety of health issues. These include heart disease, vision loss, and kidney disease. In fact, it's the number one cause of kidney failure, lower limb amputations and adult blindness. Over 34 million Americans have diabetes, and 20% of them don't even know they have it. In the last 20 years. The number of people diagnosed with diabetes has doubled. 

There are three types of diabetes. The first is #Type1Diabetes. It's usually diagnosed in children, teens, and young adults. It's an auto-immune disorder and it stops your body from making insulin. If you have Type 1 Diabetes, it's required that you take insulin daily. There's no known way to prevent Type 1 Diabetes. 

The second type is the more common type or #Type2Diabetes, also known as adult onset diabetes. In Type 2 Diabetes, insulin is not well used in the body and can't regulate the blood sugar levels well. Type 2 Diabetes can be prevented with a healthy lifestyle by maintaining a healthy weight and with exercise. 

And the third type is Prediabetes. Prediabetes is when blood sugar levels are higher than normal, but not high enough to diagnose with Type Two Diabetes. It raises your risk of developing Type 2 Diabetes, heart disease, and stroke. Prediabetes can be reversed with healthy lifestyle changes, though. 

So, where does a podiatrist fit in with all of this?

With diabetes, there are three conditions that form a sort of unholy triad. They include peripheral vascular disease, which is reduced or absent circulation to the feet. Peripheral neuropathy, which is nerve damage to the extremities and it can lead to numbness in the feed or a stinging ,burning pain. We'll talk about more about peripheral neuropathy in a future video. You also have immunopathy, which is the reduced capacity to heal from an injury. A combination of these three effects of diabetes can spell disaster. 

Here's a scenario. You have diabetes with numb feet and poor circulation. You develop a simple callus beneath your foot. As you continue to walk on it, the pressure increases and the callus grows in size. Now, ordinarily a callus this big would become painful, but because you have numbness in your feet, you didn't feel anything. The pressure of the callus ends up being too much. Because of the poor circulation and your reduced ability to heal, the callus breaks down and creates a hole on the bottom of the foot. This is called a diabetic foot ulcer. It's a precursor of a skin and bone infection of the foot. It's also very difficult to heal. We'll discuss this condition at length in a video later this month. 

Before I wrap it up, I want to talk for a minute about poor circulation to the feet. Also known as PAD, #PeripheralArterialDisease. PAD does not only affect people with diabetes, although diabetes does increase the risk of developing PAD. PAD is caused by a blockage of the arteries traveling down the legs. It can restrict the blood flow to the feet. Peripheral arterial disease can cause severe issues in the lower extremity, but a key to preventing problems is early detection. In our office. We use a test called the Smart ABI. ABI stands for ankle brachial index. It compares the blood pressure in the arm to the pressure in the ankle. This is a simple, computerized test that takes only a few minutes. The results are so important, however. It'll tell me if there's a potential blockage in the arteries. If the test shows a potential issue, I can refer you to a specialist for a more comprehensive workup. The good news is if we catch a problem early, it's usually a minimally invasive procedure to clear the arteries and restore blood flow.