Related to the numbness is a reduced ability to feel pain from excessive temperatures (both hot and cold). Because of this, diabetics are at greater risk of getting scalded from a hot bath or getting frostbite during the winter. Chronic numbness can prevent a diabetic from knowing when their foot is cut, blistered or otherwise injured. This phenomenon is very common in diabetics, and can result in the foot becoming infected. Sometimes, the neuropathy is so bad that the foot is infected for a long time before the person realizes it, and the infection can get deep into the tissue and even affect the bone. This can require a long course of IV antibiotics and can be potentially life-threating. Peripheral neuropathy symptoms, such as numbness, are usually worse at night while in bed.
Tingling and burning sensations usually begin on the bottom (soles) of the feet, although they can also progress up the legs. These strange sensations can sometimes mimic a fungal infection (Athlete’s foot) or an insect bite, although the diabetic foot is typically not as itchy. Peripheral neuropathy in the feet develops because there’s too much sugar (glucose) in the blood, which is toxic and destructive to small nerve fibers.
This type of diabetic-related foot complication can mimic or be misdiagnosed as a gout attack or severe inflammatory arthritis. The type of pain associated with this increased sensitivity is often described as electric in nature or burning pain.
Unlike regular muscle cramps where you can see the muscle twitch or contract, diabetic foot cramps aren’t always visible to the eye. Also unlike normal cramping, diabetic foot cramps and pains do not get better or go away with walking. Diabetes-related foot cramps and pain can sometimes mimic and be misdiagnosed as a stress fracture or Restless Leg Syndrome.
In conjunction to foot and ankle weakness, the nerves that give feedback to your brain for coordination and balance are also damaged, so walking quickly becomes a real difficult task among diabetics. The damage to nerves and weakness of ankle muscles/tendons also leads to reduced reflexes. As such, tapping the Achilles tendon in diabetics triggers only a weak response (twitch of the foot) at best.
Hammertoes can sometimes resolve themselves with time, but usually surgery is needed to correct them. A common deformity of the big toe often seen in diabetics is a bunion, which is caused when the big toe is constantly pushed towards the other toes. It’s particularly important for diabetics to wear shoes with lots of space for their toes in order to reduce the risk of deformities. Women, in particular, should never wear high-heels if they’re diabetic.
Visual signs of an infection include significant swelling, discoloration (red or bluish hues) and the leaking of whitish pus or other fluid from the wound. Infections usually start to smell bad as soon as the wound seeps pus and blood. Chronic diabetics also have reduced abilities to heal as their immune systems are weakened. Consequently, minor injuries linger for much longer, which increases the likelihood of infection. If a minor injury turns into a serious-looking open ulcer (like a large canker sore), medical attention is required immediately. It is recommended that diabetics check the bottom of their feet once a week or so and that their doctor performs a close inspection of their feet at all checkups.
Similar to the stocking-like distribution of diabetic foot symptoms, complications in the upper limbs progress in a glove-like pattern (from the hands and then up the arms). Diabetic-related symptoms in the hands can mimic or be misdiagnosed as carpal tunnel syndrome or Raynaud’s disease (arteries that narrow more than normal when exposed to cold temperatures). It’s much easier to check and be aware of your hands on a regular basis compared to your feet because your feet are often encased in socks and shoes.
Uncontrolled sweating (or complete lack of sweating) in the feet or other parts of the body is a sign of autonomic neuropathy. Widespread autonomic neuropathy eventually causes organ dysfunction, such as heart disease and kidney failure.
Diabetic retinopathy affects blood vessels in the eye’s retina and is the most common cause of vision loss among diabetics. In fact, adult diabetics are 2-5x more likely than those without diabetes to develop cataracts. Diabetic eye disease also increases the risk of developing cataracts (clouding of the lens) and glaucoma (increased pressure and damaged optic nerve).
