World Diabetes Day and how to protect your feet

Angela Davis

Sunday, November 11, 2018

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AS World Diabetes Day approaches on Wednesday, it is important that we reflect on how this condition affects us here in Jamaica and throughout the world.

Let us start with the facts as documented by the World Health Organization:

• In 2014, the number of people with diabetes worldwide was 422 million. In Jamaica the figure stood at approximately 200,000 between the ages of 15 and 74, and 10,000 children under the age of 15. In all categories the figures are rising exponentially.

• Diabetes is a major cause of blindness, kidney failure, heart attack, stroke, and limb amputation.

• In 2016 an estimated 1.6 million deaths worldwide were directly caused by diabetes, making it the seventh leading reason for death. Almost half of these deaths occur before the age of 70. In Jamaica, diabetes-related illness is the second-leading cause of death in people under 70.

On a positive note, diabetes can be treated and it's consequences often avoided or delayed with diet, physical activity, medication, lifestyle changes, and screening.

So, what is diabetes? Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is the hormone that regulates sugar in the body and, if left uncontrolled, can cause damage to the organs.

Type 1 diabetes is characterised by deficient insulin production and requires daily administration of insulin. Type 2 diabetes occurs due to the body's ineffective use of insulin. This is the most common form of the disease and is largely due to obesity and inactivity. Gestational diabetes occurs in pregnant women. This usually subsides after the birth of the baby but the mother and child are at an increased risk of getting type 2 diabetes.

The main parts of the body affected by the disease is the lower limbs. High levels of sugar in the blood can lead to damaged nerves and blood vessels. Diabetic foot syndrome is the presence of several diabetic foot pathologies like infection, ulceration, and neuropathic osteoarthropathy.

When the nerves are dysfunctional patients have a reduced ability to feel pain, which means minor injuries may remain undiscovered until they become major problems. Research shows that the estimated chances of a diabetic patient getting a foot ulcer throughout their lifetime can be as high as 20-25 per cent. Along with nerve problems, many patients may have arterial disease, which causes poor circulation.

About half of patients who have a foot ulcer will also have compromised arterial circulation. In severe cases amputation may be indicated as a result of underlying infection, and tissue death.

How can we prevent such unfortunate outcomes? Patients are advised to follow the tried and tested guidelines listed below.

• Visit your podiatrist or general practitioner for regular check-ups. Patients often only visit when a problem has got out of hand but many things are preventable with early intervention, and issues may be spotted and rectified if caught in time. It is recommended that people with diabetes and no complications should have their feet checked every 6 months. If there are problems, the podiatrist will indicate how often you need to be seen.

Patients should urgently seek help if they notice a break on the skin, discharge seeping from a wound, a change in skin colour, blistering or swelling.

• Take care of your diabetes and ensure that your sugar levels lie within the safe margins.

• Do not smoke.

• Do not walk barefooted under any circumstances.

• Do not treat corns or calluses yourself; do not use remedies that you can buy at the pharmacy.

• Bathe your feet daily in lukewarm water. Dry carefully between your toes.

• Inspect your feet daily.

• Wear fresh, clean hosiery daily.

• Moisturise your feet twice a day. Avoid the area between the toes as it may encourage fungal infections.

• Cut your nails with care. If they are thick or awkward to cut, seek help from a medical professional and not a nail technician. Follow the gentle curve of the nail and file the corners.

• Before putting on a pair of shoes, shake them out. You never know what could have crawled inside or if a foreign object is present.

• Wear wide-fitting, supportive shoes that are preferably leather.

• Eat a healthy, balanced diet and keep active.

On a final note, it is estimated that approximately 54,000 Jamaicans have diabetes and are unaware of it.

If you show any signs of the disease such as excessive urination, excessive thirst, rapid weight loss and persistent skin infection, see your doctor immediately to get tested. If you are diagnosed, a treatment plan will be formulated for your particular needs.

Control your diabetes, don't let it control you!

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293- 7119), Mandeville (962-2100), Ocho Rios (974-6339), Kingston (978-8392), and Savanna-la-Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.

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