Hypertrophy occurs when the body’s cells, most often fat cells, become overgrown, creating lumpy skin at the injection site that often resembles scar tissue.
In this case, it is not the body’s immune system responding to the insulin but a physical response to using the same injection site over and over.
The condition is also called lipohypertrophy.
When a site is used so many times, fat deposits accumulate in that area.
Such a site may be more “comfortable” to use because hypertrophy can cause the area to become numb.
However, the lumps that form are caused by abnormal cell growth and can diminish the absorption of insulin at that site. (For more about insulin, see the chapter “Taking Charge of Diabetes.”)
Can the two major skin problems around injection sites be prevented?
Many people with diabetes who inject insulin may prevent lipoatrophy and hypertrophy to some extent by rotating the location of the injection sites.
Some researchers also believe that both skin problems may be caused by the type of insulin used.
Thus, if a person with diabetes experiences either of these problems, then he or she may want to talk to the primary-care physician about the insulin used. ( Note : It is also often recommended that a person with diabetes have his or her injection sites checked by a health care provider now and then for possible infection and these two skin problems.)
What are diabetic foot ulcers?
Diabetic foot ulcers, or diabetic foot sores, are open sores or wounds that are most commonly located on the bottom of the foot. They develop for a number of reasons, including the lack of circulation and feeling in the foot from peripheral neuropathy (such that the wound often goes unnoticed); foot deformities; friction or pressure that irritates the foot; trauma to the foot; and having diabetes for a long time. With a lower blood flow in the feet and higher blood glucose levels (both due to diabetes), the body’s ability to heal is reduced, increasing the possibility of infection and foot ulcers.
Foot ulcers are more prevalent in Native Americans, African Americans, Hispanics, and older men, especially those who have diabetes.
People with diabetes who use insulin, and those with diabetes-related heart, kidney, and eye disease, are also at a higher risk to develop foot ulcers, as are those who are overweight and/or smoke.
Thus, most health care professionals suggest that a person with diabetes check his or her feet every day for possible injury.
If an ulcer is found, seek medical care immediately to reduce the risk of infection. (For more about diabetes and foot problems caused by nerve damage, see the chapter “How Diabetes Affects the Nervous System.”)
Diabetics are more prone to foot ulcers. If left untreated, they can become seriously infected and result in partial or full amputation of the foot.
How are foot ulcers treated?
Health care professionals treat foot ulcers in several ways.
When such an ulcer is found, the treatment includes taking pressure off the area of the foot that has the ulcer.
It may also include gently removing some of the dead skin and tissue from the foot and applying a medication or dressing to the ulcer to help prevent infection.
In addition, there will no doubt be a concentrated effort to manage the person’s blood glucose levels and other health problems, all of which could exacerbate the ulcer.
And although not all ulcers will be infected (especially if noticed and treated right away), those that are infected may need a treatment of antibiotics, wound care (several hospitals have such wound-care facilities), and, if severe enough, hospitalization.
How can a person with diabetes keep a foot ulcer from becoming infected?
There are several ways to try to keep a foot ulcer from becoming infected.
The most important way is for people to keep their blood glucose levels stable.
If they notice an ulcer, after consulting their health care professional to let them know about the ulcer, it is best to keep the wound clean and bandaged.
They should also clean the wound daily and change the bandage or dressing, and avoid walking barefoot, especially outdoors or around the home (dust and dirt can enter and infect the ulcer).
If the wound is on the bottom of the foot and being tended by a health care professional, the patient may be asked to wear special footwear to reduce the pressure and irritation to the ulcer area.
What are the connections among diabetes, foot ulcers, and amputations?
According to the American Podiatric Medical Association, it is estimated that around 15 percent of people with diabetes experience some type of foot ulcer. Of these people, around 6 percent will be hospitalized because of infection and other ulcer-related complications. They also further estimate that around 14 to 24 percent of people with diabetes who develop a foot ulcer will eventually require an amputation and that foot ulceration precedes 85 percent of diabetes-related amputations.
What should a person with diabetes do to keep track of potential foot problems?
Because people with diabetes often experience nerve damage in their feet from peripheral neuropathy and/or peripheral artery disease (for more about peripheral neuropathy, see the chapter “How Diabetes Affects the Nervous System”) or from unnoticed injuries, it is important to check their feet daily (top and bottom, including between the toes) for possible injury. Besides the obvious other rules for maintaining foot health, especially keeping blood glucose levels balanced and maintaining a healthy weight, the American Podiatric Medical Association and other groups involved in helping people with diabetes suggest a daily foot exam that entails the following:
• Check feet for extremes in temperature, either very cold or hot. Keep feet clean by washing them each day. And keep them dry, especially between the toes, after showering, bathing, or swimming or on hot, humid days.
• Examine the skin on the feet (top and bottom) for ulcers, calluses, sores, blisters, dried or cracked skin that doesn’t heal well, or any other unusual skin conditions, especially between the toes. If the person finds it difficult to see the bottom of his or her feet, it may help to use a mirror on the floor or ask a friend or family member for assistance.
• Do not try to remove calluses, corns, or warts on a foot, as over-the-counter products can burn the skin (most contain salicylic acid) and cause an infection, especially for people with diabetes. Ask a health care professional for help with any such skin problems on the feet.
• Do not wear tight socks or pantyhose. When socks, pantyhose, or sandals are removed, check them for blood, which indicates a cut or wound on the foot.
• Maintain footwear (shoes and socks) in good condition and, if possible, have new shoes properly measured so they fit well. There are also special types of socks (most are seamless) for people who have diabetes, usually found in drugstores, as well as some medical supply centers and hospital pharmacies.
• Exercise helps maintain weight and increases the circulation to the feet, but always wear the best-fit athletic shoes or sneakers when exercising. If there are other problems with a foot (or feet), such as bunions, hammertoes, or an internal structural injury, then consider orthotic insoles in shoes and sneakers that are made especially for people with diabetes.
• Be aware of improper fit, irritating seams, or tears in footwear that can irritate the skin. Before putting shoes or sneakers on, check for pebbles or other objects that may rub the skin, causing a wound.
• Try not to go barefoot, especially outside, where objects may injure a foot and lead to infection.
• Test water temperature with an elbow before entering a bath or hot-water soak to prevent burns. Also be aware of potential burns when putting feet near a fireplace, fire pit, grill, radiator, or any other heat source.
• Look for thin, fragile, or shinny skin, which may indicate a decrease in circulation in the feet, especially the toes.
Check around the toenails for ingrown nails, splits or thickening of the nail, or fungal infection (such as athlete’s foot, see below). Ask a health care professional for the best way to maintain nails on the hands and feet to prevent problems.
• Check for signs of neuropathy, meaning loss of sensation in any extremity, feet, toes, hands, or fingers.
• See a health care professional and discuss possible problems that a person with diabetes can have in terms of extremities. If possible for maintenance of the feet, see a podiatrist (the letters “DPM” after the name indicates a doctor of podiatric medicine) twice a year to help with foot care, as most are trained to treat foot conditions caused by diabetes, such as wounds, infections, peripheral neuropathy, and ulcers.
Should a person with diabetes be aware of athlete’s foot?
Yes, a person with diabetes should be aware of problems associated with athlete’s foot, also called tenea pedis.
It is considered to be a skin fungus, with the common name of ringworm (although it is not caused by a worm, and it does not involve a worm in any way).
Many times it is associated with dogs and cats and can be very contagious, whether from human or animal.
The symptoms of this skin fungus are scaling, itchy, flaky skin.
It is usually associated with the toes, but it can extend to the bottoms of the feet.
It thrives when the feet are hot and sweaty, especially if a person wears nonbreathable instead of breathable shoes and socks.
It can also spread in public places; for example, it can be found on the floors of saunas, swimming pools, locker rooms, shower stalls, and washrooms, or places that are associated with humidity and people walking barefoot.
Athlete’s foot is considered to be common in people with diabetes.
It can usually be prevented by daily washing and drying of the feet, wearing sandals in public places such as swimming pools, and by wearing breathable shoes and socks.
Although it is often diagnosed as just flaky skin, the problem for people with diabetes is not only the possibility of eventual infection in the area but also a secondary bacterial infection called cellulitis.
This noncontagious infection occurs most often because of poor circulation in the extremities and weakened immune systems associated with diabetes, causing redness, swelling, and tenderness in the infected area.
Antibiotics and anti-fungal creams or ointments are often prescribed, but if the cellulitis is not treated in time, it can lead to serious infections in the foot and lower limbs and, in the most extreme cases, to amputation.
Even a common and relatively minor affliction such as athelete’s foot can turn serious for a diabetic, who can develop serious infections.
DIABETES, HAIR, AND NAILS
How many hairs are on the human body, and where are most located?
On the average human body, there are approximately five million hairs. Males have a few hundred thousand more hairs than women. In males and females, hormones are responsible for the development of such hairy regions as the scalp, the axillary (armpit), and pubic areas, and, in addition in men, on the chest. Overall, the various types of hair grow all over the human body except for the soles of the feet, palms of the hand, eyelids, and lips.