Have you heard of diabetic foot and diabetic hand? What are their symptoms?

Author: Wu Weiwei, Chief Physician of Beijing Tsinghua Chang Gung Hospital affiliated to Tsinghua University

Reviewer: Li Guangwei, Chief Physician, Fuwai Hospital, Chinese Academy of Medical Sciences

Vice Chairman of the Chinese Medical Association Endocrinology Society

Diabetic foot is a pathological condition that develops after diabetes develops to a certain stage, generally involving the nervous system and vascular system of the foot. If it involves the nervous system, it is called diabetic peripheral neuropathy; if it involves the vascular system, it is called diabetic peripheral vascular disease.

1. Why does diabetes cause nerve and vascular diseases?

The reason why diabetic neuropathy or diabetic vascular disease occurs is because the blood is in a state of high blood sugar for a long time.

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Long-term high blood sugar may affect nerve tissue, causing ischemic changes in nerves, microvascular changes, and nerve edema, which will lead to diabetic neuropathy.

Long-term high blood sugar can also cause damage to the arterial intima and produce atherosclerotic plaques. As the disease progresses, the plaques gradually increase in size and thicken, blocking the arterial lumen and causing diabetic vascular disease.

Therefore, hyperglycemia is a crucial factor in the entire course of diabetes. Controlling blood sugar at a normal level is a key factor in avoiding or delaying the development of diabetes to diabetic foot.

2. How long does it take for diabetic foot to appear?

Medically speaking, there is no absolute defining time. It mainly depends on the course of diabetes development. Of course, it is also related to the patient's own factors and blood sugar control.

Generally speaking, if diabetes develops for more than 10 years, neurological symptoms will gradually appear. If it lasts longer, blood vessels will gradually be affected, and lower limb arteries will narrow, plaques will form, leading to vascular occlusion, and even lower limb artery thrombosis, leading to ischemia of the foot and ischemic diabetic foot. Once this develops to this point, it is quite dangerous.

The incidence of diabetes in our country is relatively high. If the disease lasts for more than 10 years, the proportion of diabetic peripheral neuropathy and vascular disease is very high, up to 20%.

3. Diabetes can cause diabetic foot. Will it affect opponents?

Diabetic hand does exist. Some diabetic patients will experience muscle atrophy and nerve sensory disorders in their hands after a long course of the disease. In fact, this is also caused by peripheral neuropathy or peripheral vascular disease.

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Why don’t we usually talk about diabetic hand?

Because compared with feet, hands are closer to the heart and have relatively richer blood supply; in addition, hands generally move more frequently, such as writing, eating, and dressing, and the hands are always moving.

The feet are much farther away from the heart than the hands, so the blood supply is relatively less; in addition, the feet are relatively less exercised, especially among the elderly, who do not like to exercise and lack exercise for their feet.

The combination of these factors makes the incidence of diabetic foot much higher than that of diabetic hand.

4. What are the symptoms of diabetic foot?

Diabetic foot is divided into diabetic peripheral neuropathy and peripheral vascular disease.

Peripheral neuropathy, damage to sensory nerves, causing numbness, coldness, and dullness of senses; damage to motor nerves, manifested as inflexibility and movement disorders of the feet, and some people may also experience foot drop.

Peripheral vascular disease is clinically divided into four stages.

The first stage is the early stage of mild clinical symptoms, with vascular lesions causing symptoms such as coldness, pain, and numbness;

The second stage is called intermittent claudication. The blood vessels are diseased and blocked. If you don't exercise, the blood supply is barely enough. When you walk, your feet need more nutrition and oxygen. As a result, nutrients cannot be delivered to the leg muscles in time, causing calf pain and inability to walk. It is often manifested as discomfort, cramps or pain in the calf when you walk 200 or 300 meters. You must stop and rest for a few minutes before you can walk again. This is called intermittent claudication.

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The third stage, called the resting pain stage, is when the symptoms become more severe. The legs will feel painful even when not walking, especially in the dead of night or when sleeping. The pain is unbearable. Some people have to hold their feet to fall asleep, and it hurts even when they are not moving.

The fourth stage, such as ulcers, pus discharge, infection, and long-term failure of foot wounds to heal, is called the ulcer stage.

Once the condition develops to the rest pain and ulcer stages, it becomes very dangerous and the patient may face the risk of losing his foot and requiring amputation.

Patients with diabetes for more than 10 years may experience numbness, pain, intermittent claudication in their feet, or pain even when not walking. At this stage, you must be aware that diabetic foot may have occurred, and treatment should be started as soon as possible during the intermittent claudication period.