In my book, Keep the Legs You Stand On; I discuss the psychological aspects or the attitude of patients with diabetes concerning their own foot health. As in many other areas that science statistically defines health issues, we can classify patients’ thoughts or attitudes about their “foot health destiny” in the bell shaped curve. On one end are the patients who feel resignation. That no matter what they do they are going to lose their legs. They think, “my aunt lost her leg, my dad lost his leg, and I am going to lose my leg, too. There is nothing I can do about it.” On the other end of the bell shaped curve are patients who feel denial. They think, “that is never going to happen to me. Even though my bother lost his leg and my aunt had an ulcer where she lost her toe, that is never going to happen to me.”
But wait, what about all the folks who are in the “shades of grey” in the middle of the bell shaped curve? Perhaps they have not made up their minds or formed an opinion about the consequences of their diabetes, the management of their blood sugars, and how those actions will affect their foot health destiny?
Every day in my clinic I receive patients with diabetes and listen to the problems they share with me about their feet and legs. A crucial part of understanding their foot problems is to understand their attitudes concerning their blood sugar levels and how they manage them. As far as their foot problems are concerned, most of these patients feel that their foot or leg pain or problem walking is centered in their foot, and may not realize that there may be other reasons for their problem that are not related to their foot.
I often think to myself about the old spiritual song, “Dem Bones,” taken from Ezekiel 37:14 and whose melody was written by James Weldon Johnson. “The hip bone is connected to the thigh bone, the thigh bone is connected to the leg bone” and so on…. I know that one of the reasons these diabetic patients have pain and difficulty walking may be due to a totally non-foot related, but a medially connected problem called diabetic sensory neuropathy. This neurological problem is caused by chronically elevated blood sugar levels and can be the cause of foot pain and numbness AT THE SAME TIME.
A review of my patient’s lab work is critical to understanding how they have been taking care of their bodies. Specifically, I look at their “glucose” or “random blood sugar levels” and their Hemoglobin A1c
(Or A1c test for short) results. Most people know that a random blood glucose test is the blood sugar reading taken by a finger stick test that tells us what the blood sugar level is AT THAT MOMENT. But few people know that the A1c test tells us the AVERAGE blood sugar level for the PAST 3 MONTHS. Why is this important?
CHRONICALLY ELEVATED BLOOD SUGAR LEVELS CAUSE VASCULAR AND NEUROLOGICAL DISEASE IN THE PATIENT WITH DIABETES.
Many diabetic patients universally misunderstand this fact. Elevated blood sugars cause the smallest arteries in our body to become narrowed or even closed. These arteries, called arterioles, are most commonly found in the retina in the back of the eye, in the kidney, and along the nerves that run through the legs to the foot. When these smallest arteries stop functioning, the results are tragic. The patient with diabetes goes blind, loses kidney function and many need renal dialysis treatments to stay alive, and loses protective sensation to their foot and causing both numbness AND pain to their foot that may not be responsive to treatment even with strong narcotic pain medications.
So, when I speak with a patient who has both foot pain AND chronically elevated blood sugar levels I always suggest that there are 4 basic reasons for this problem:
1. Cheating on their diet
2. Eating too much of what they are “allowed” to eat
3. Not taking the correct dose of their medication at the correct time
4. Not taking their medication at all.
Let’s focus on issue #1, Cheating on their diet.
Now the thinking of most patients is, “If I cheat and eat pasta today, my leg is not going to fall off. If I cheat and drink a sugary soda tomorrow, my kidneys are not going to shut down. If I have a small piece of peach pie over the weekend, I am not going to go blind.”
And they are right, none of these consequences of their actions are going to happen right away, but in the longer view of their diabetes and their foot health destiny, they are dead wrong.
It is the chronically elevated blood sugar levels (any level over 120 for the random blood glucose and any level over 7 for A1c) that will eventually lead to the catastrophic results of blindness, kidney dysfunction, and foot pain or numbness that can lead to foot ulcer, soft tissue infection, bone infection, and amputation.
So, if you are still undecided about your foot health destiny, or have never considered the effects of chronically elevated blood sugars on your feet and legs, remember that:
ONLY YOU have the power to decide how you want to live your life, and
ONLY YOU make the decisions about your diet and controlling your blood sugars, and
ONLY YOU can decide if you want that pasta, that soda, or the piece of pie and if that moment of food gratification will be worth the long term consequences of pain or disability to your feet and legs.
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Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
