This content originally appeared on diaTribe. Republished with permission.

By John Carr

Lifestyle changes like food plan and exercise are key to the prevention and management of diabetes-related complications like foot disease. Here’s why it’s essential to be proactive about footcare, plus suggestions for exercising safely with peripheral artery disease.  

It’s change into increasingly clear that diabetes exerts much of its devastation on blood vessels, each large and small. The damage in larger arteries is usually a dramatic process with severe health complications like heart attack, stroke, and kidney failure.

Years prematurely of those major catastrophic events, there may be a silent, smoldering inflammatory storm within the partitions of the tiniest blood vessels where nutrient and waste exchange takes place. This damage is at its worst in small blood vessels farthest away from the guts and lungs: the feet.

The advantages of physical activity are wide-ranging and well-established. And nowhere is that this more true than in individuals with diabetes. Nonetheless, when problems with the feet develop, it could possibly discourage and stop exercise. Listed here are some strategies for exercising safely and protecting your feet, especially if you will have neuropathy or peripheral artery disease from diabetes.

How does diabetes injure the foot?

In individuals with diabetes, foot problems arise from elevated glucose levels. High circulating blood sugar levels compromise oxygen delivery, disturb nutrient exchange, and permit toxic waste products to gather, causing inflammation. While this will occur anywhere within the body, nerves within the feet are particularly susceptible.

As many as 50% of individuals with diabetes live with some type of diabetic neuropathy. Nerves might be damaged in two ways: from high blood sugar levels and poor blood circulation. Slowly the nerve degrades, muscle is lost, and eventually the structure of the foot is altered. This ends in things like joint pain, poor function, and ulcers from small injuries that go unnoticed or change into infected.

Foot problems from diabetes can overlap with diseases of larger blood vessels, reminiscent of peripheral artery disease (PAD). Signs of trouble within the feet can often be seen years before a significant artery is clogged. Symptoms include:

• Changes in skin texture and color
• Nail fungus
• Numbness or tingling
• Lack of sensation
• Painful burning toes
• Lack of muscle mass
• Decreased strength

What’s peripheral artery disease?

PAD is a blockage to blood flow in large blood vessels and shares many risk aspects with diabetes-related foot disease. These blockages can occur in people without diabetes too, often on account of inherited cholesterol problems. Signs and symptoms of PAD include:

• Cold feet
• Lack of hair
• Skin changes (thicker, less elasticity)
• Red, shiny toes
• Toenail discoloration and fungal infection
• Calf pain or cramping while walking or climbing stairs

Together, foot disease and PAD are typical problems in individuals with diabetes. Around 50% of individuals with diabetes who develop foot ulcers even have PAD. As well as, living with PAD complicates the healing of ulcers and makes them more more likely to occur.

Reducing disease progression through exercise

It may possibly be hard to maintain up with exercise if you will have PAD or foot issues like ulcers, but board-certified foot and ankle surgeon Dr. Tom Biernacki reinforced the importance of physical activity. One study conducted over a 20-year period showed that those that lifted weights or participated in resistance training (like bands or squats without weights) had a 20% reduced mortality rate.

“When you also had some type of aerobic activity, like walking or jogging, you received an extra 20% reduction,” Biernacki explained. “Imagine that, 40% less more likely to die, just by adding resistance training and aerobic training together.”

Recent research also demonstrates those that exercised demonstrated a greater degree of wound reduction. Importantly, there have been no negative consequences to exercise for the participants.

One other study checked out individuals with freshly healed foot ulcers. One group performed foot-ankle flexibility and resistance exercises 3 times every week at home, and the opposite group received normal care. Only 4 participants who exercised required additional care, while 64% of people that didn’t exercise had ulcers come back.

Studies that show advantages to glucose control, A1C, quality of life, and other measures of fitness follow these two general principles:

1. Body weight, banded resistance, and free weights: Two to a few sessions per week at moderate intensity, 8-10 repetitions for 2-3 sets.
2. Walking, jogging, cycling, or comparable: Three to 5 times per week at moderate intensity, 15-45 minutes (excluding warm-up and cool-down sessions).

Keep in mind that any exercise is best than no exercise. Walking a minimum of half-hour 3 times every week has been shown to be effective in reducing the danger of major vascular events, but this is de facto a bare minimum. Skilled organizations just like the American Heart Association recommend a minimum of 5 days every week – if not day by day.

When you don’t have access to a gym or a treadmill, there are many home-based exercise programs. Some that include outdoor walking have even shown higher results than treadmill exercise. It’s essential to keep in mind that exercise is dose-dependent, meaning that the more you get, the more advantages you’ll see.

Protecting your feet during exercise

Foot injuries and chronic conditions like PAD might be big barriers to exercise. The excellent news is, there are numerous steps people can take to guard their feet and safely get within the advisable amount of physical activity.

Avoid strenuous or high-impact exercises like running long distances, jumping rope, or lifting heavy weights. Aim to exercise in moderate weather or indoors during extreme weather (hot or cold). Try lower-impact exercises like walking, swimming, and cycling.

If you will have an ulcer or open injury, let your feet rest for a day and stick with back and arm workouts like chair exercises. Avoid lifting heavy weights if you will have an ulcer or open wound. For individuals with neuropathy and PAD, a part of proactive foot care means checking your feet every day.

Be sure that feet are clean and dry before exercising. Wear shoes that fit properly and offer support. Running stores often have great options and specialists to aid you find the right pair, even if you happen to’re not a runner. Wear polyester or breathable socks that may keep your feet dry during physical activity. Drink numerous water before, during, and after activities to maintain hydrated and keep your body temperature balanced.

Other ways to avoid foot problems

Individuals with diabetes need to begin early to protect against PAD or foot-related issues. That’s because once symptoms like burning toes, cramping calves, and lack of sensation appear, the disease is already present and it becomes harder to treat.

Together with exercise, listed below are steps you may take to stop future problems or decelerate disease progression.

Manage glucose levels

The underlying problem that drives damage within the lower extremities is elevated glucose. Excess blood sugar (hyperglycemia) overwhelms cells that line arteries, triggering a cascade of negative events. Just like other major, devastating complications of diabetes like vision problems and kidney failure, higher control of blood glucose and improving time in range is the place to begin.

Biernacki emphasized early lively involvement in foot care and has observed in his own practice real improvement in neuropathy symptoms by simply getting glucose levels under control.

“When people have very high blood sugar for some time and it drops with treatment, over about three months symptoms can improve significantly,” he said. “A part of that is reversible just by taking your medications properly and improving your food plan, which incorporates getting the best nutrients, vitamins, and eating proven anti-inflammatory foods.”

Keep watch over cholesterol

One other essential aspect of stopping poor circulation (especially in larger blood vessels) is identifying and reducing any cholesterol abnormalities.

Cholesterol management often requires medication to realize advantages. Luckily, lots of these medications have been used for a very long time and have a very good track record with few uncomfortable side effects. Your doctor may use multiple medications to aid you reduce the danger of catastrophic events like a heart attack or stroke. The precise medicine will depend upon the person’s unique profile.

Monitor blood pressure

Prolonged, elevated blood pressure makes blood vessels stiff and unresponsive. It also contributes to the inflammatory storm triggered by high blood sugar and cholesterol abnormalities, which directly damages arteries and nerves and might result in diabetes-related foot disease.

Around 78% of individuals with type 2 diabetes have hypertension, which accelerates the progression of vascular diseases. Together with getting exercise and maintaining a food plan wealthy in fruit and veggies, treating hypertension can also require medication.

Quit smoking

Smoking, especially tobacco in cigarette form, is incredibly bad in your arteries and accelerates nerve damage. Smoking is the primary explanation for large artery disease, with 80% of individuals with PAD who’re lively or former smokers at an increased risk of all major catastrophic events.

Smoking also contributes to the event of diabetes, interferes with the effectiveness of insulin, and increases the risk of foot disease. In individuals who have already got foot disease, smoking further increases the risk of amputation.

Quitting tobacco might be very difficult due to its addictive qualities. Few persons are in a position to stop on their very own and most require a supportive program that features counseling and drugs. The American Thoracic Society Clinical Practice Guideline strongly recommends using Chantix (varenicline) to quit smoking.

Eat a healthy food plan

There are some easy and specific changes to your food plan that could make an actual difference. One easy change in your food plan that can lead to substantial health advantages is the addition of fish wealthy in omega-3 fatty acids.

“Oily fish consumption could be very clearly related to reduced risk of heart problems and mortality from heart problems. And this is especially strong in those that’ve already had heart problems,” said Dr. Sara Berry, a cardiovascular nutrition specialist at King’s College of London.

By eating two or more portions of oily fish per week, you may reduce your risk by a whopping 80%. Examples include:

• Salmon
• Sardines
• Atlantic mackerel
• Cod
• Herring
• Lake trout
• Canned, light tuna

Balance out your food plan with foods wealthy in antioxidants and nutrients, including leafy green vegetables, whole fruit, nuts and seeds, and lean protein.

What if I’m already experiencing pain or numbness in my feet?

This can be a real problem and one which too many individuals with diabetes struggle with.

“Individuals are afraid to get their feet taken care of because they think it’s gross. It’s not gross. I’m telling you, we see this on a regular basis and you would mainly save your lifetime mobility,” said Biernacki.

“It’s ridiculous what number of patients are available in and with an easy visit, they begin walking and say that is the perfect I felt in 20 years. Seeing a podiatrist early can really help,” he said. “The great point is that just about every insurance in America covers foot care because they recognize that going to see a podiatrist saves them billions of dollars.”

Diabetes-related foot disease and PAD are to be avoided in any respect costs; it’s a step into quicksand. The most effective strategy to keep yourself secure and healthy is to begin from the bottom up. By taking good care of those feet, you’re also taking good care of your kidneys, eyes, brain, and heart.