Neuropathy in Diabetes and Foot Problems

If you have ever noticed that diabetics often have lost a foot or even a leg below the knee to their diabetes, you may have wondered how that happened. Although some time in the future I will go into a longer article discussing this topic in depth, I wanted for now to discuss how neuropathy can play a role in this complication. This is the second in a series of articles discussing complications of diabetes.

Diabetes is a disease process that is chronic. As it progresses the diabetic tends to lose both blood flow and nerve connections to the extremities of the body. With a diminished circulatory system, there is less natural ability to rally white blood cells to fight infections. But the real kicker for diabetes is the neuropathy, when it comes to diabetic foot problems.

If a diabetic has started to lose sensation to the toes or feet, then when there is a cut or sore, they may not notice it. That is why good diabetes care involves getting in the habit of always inspecting the feet for cuts and other injuries or abrasions that might get infected.

If the foot gets infected, and the infection is not treated swiftly, then it can progress, and the worse the progression has become, the less likely that vigorous attention from the podiatrist will be sufficient.

Eye Problems Diabetics Need to Monitor

Diabetes Mellitus Type 2 – Chronic Eye and Vision Complications

Type 2 diabetes could be hard to accept and acknowledge, and some of the complications can be particularly hard to bare. If the chronic Type 2 diabetic patient does not attend to their own self-care, one of the consequences could actually be blindness.  While total loss of vision only occurs in less than 2% of type 2 diabetics, nearly all of them will have some amount of retinopathy, and by 10 years, over half have developed it. Diabetes is one of the leading causes of preventable deaths nationally in America –  a country with more than its share of obesity.

It also takes a toll through  both emotional and physical stress, once the diabetic process starts to get the upper hand. More often than not, the warning signs of various complications like diabetic retinopathy are ignored, and the diabetic, who may not wish to think about the risks he faces, might be inclined to tune out these symptoms, such as blurry vision, and lack of focus. Sometimes there are no symptoms. Sometimes there is a lack of knowledge about the complications and risks from diabetes. Furthermore, the diabetic can mistakenly believe that insulin and/or other medications are sufficient to address their poor blood glucuse control, their Diabetes Eye Problems, and so may not own their part in the treatment.

The of loss of eye sight in adults diabetics is a serious and all too common problem, and diabetic retinopathy problems is a primary cause of that blindness. Other eye problems, like floaters and macular edema can be devastating. I myself have type 2 diabetes, and blurry vision led me to see my eye doctor. Even though I have some floaters, and atrocious night vision, he gave my retina a “clean bill of health.” At least for another year. As mentioned already, diabetics may not have any symptoms, or they may have the tell tale blurry vision, but an examination of the retina will clarify how much if any damage the retina has sustained.

For most diabetics,  even with a diagnosis of retinal problems, the treatment approach might initially be conservative, with an emphasis on controlling blood sugars, and cholesterol. Blood sugar needs to be kept in check, and big swings avoided; furthermore, hemoglobin a1c should be well below 7.0. But as the disease progresses, if the diabetes continues to worsen, then more intrusive interventions may be needed. Among the options then to address the eye problems would be laser surgery, and if that is not feasible, then other surgical procedures and even freezing the eye are options.

This is the first article in a series on complications in diabetes, to see the next, on diabetic foot problems, follow the link.

Droid Addiction

Add to the list of addictions that are so trendy, one new one  — and this one has spread like wildfire amongst the under-40 crowd. Anyone with a new smart phone — especially the recent generation of Droid smartphones, knows what I am talking about.  Try, just try to go without your phone for a week.

The key aspect of most addictions, including cigarettes, booze, drugs and other such obsessions, is not the chemical itself. These addictions are all maintained as much by the body’s spikes of neuroendocrines and endorphins than the external chemicals. When tension builds and then is sated and released, an exchange of internal chemicals in your body leaves you feeling good, pain-free, and somewhat relaxed, at least relative to the tension you usually carry.

Droid addicts are constantly stimulating themselves, and along with that stimulation likely comes a surge of endorphins and other things that make us feel pleasure and feel “jazzed.” Along with more sedate (by comparison) internet addictions, especially games  like Mafia Wars and Farmville, Droid/smartphone addictions keep us from spending time on things that can really matter. No time for nature. No time for others, or even to say (unless by text) how is your day.

So put down your Droid for a day, and discover what life is like out there, away from the little box. Ladies, if you are thinking of buying presents for him this christmas, consider something to do with the outdoors, or with a sport, rather than still yet another gadget that will just take him away from you. And guys, please go shoot some hoops!

Published in: on November 5, 2010 at 11:01 pm  Comments (1)  
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DSM-5 revisions

While I am on the topic of the DSM process, it may be of interest to some readers that the American Psychiatric Association has posted some of its proposed changes to the old DSM-IVTR edition on this revision site. Until some time in April (no not April Fools) they are leaving the changes out for view, and supposedly comments. I will be commenting here from time to time; I haven’t decided if I will comment there, as I am no longer sure I want to invest any more time in that system, which refuses to make the kinds of changes that McHugh advocates (see the previous post). Today I will touch on eating disorders, and how they have been insidiously degraded, by the new changes. Again these are my personal opinions, and not a professional treatise.

Eating Disorders

In the new field guide, they propose to make it easier to spot this disorder, because the occasional binge-purger will now qualify, making it more like a personality disorder than an illness. Will the weekend binge drinker, who now purges the bar food up most Saturday nights, qualify? By numbers they certainly will, So now there will be more money for psychiatry, and more diagnostic muddle for serious researchers.

Another change in DSM-5, in Eating Disorders, which will similarly muddle any diagnostic clarity, is combining the subtypes. In DSM-IIIR, when I was on the Ad Hoc Panel there, they combined useful subtypes of Conduct Disorder, when most of us argued for more refined distinctions. The result then was a diagnosis too broad to be of much use or interest to serious researchers. The same thing likely goes with this, I am curious what other clinicians and researchers think.

Instead, we should be sharpening the clarity beyond the “field guide” approach, to look at variables that might some day shed a light on this disorder. Tension regulation. Co-morbid addictions. Family patterns.  Adjustment. This list goes on..DSM doesn’t want you to have to think.

Published in: on November 4, 2010 at 7:38 pm  Leave a Comment  
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Diagnosis or Field Guide- How Useful Is the DSM Process

As someone who worked on the DSM-IIIR version of Psychiatry’s diagnostic bible, I may not be entitled to it, but certainly have some personal opinions about how the diagnostic system has evolved. I was provoked to write this post by a recent presentation at an MUSC psychiatry grand rounds by Paul McHugh one of the deans of psychiatry, and a Professor at Johns Hopkins University.

When I worked on that earlier version, my primary contribution was as a member of the committee who forged many of our current conceptualizations of the childhood-specific psychiatric disorders. The committee was comprised largely of respected academicians, and our decisions were informed by some of the latest research. In that climate, we were all hopeful that this process, as it evolved, would bring our research into closer contact with the real problems we addressed.

However, as Dr McHugh points out, the DSM has been rather unsuccessful, as a research catlyst and has contributed little to our progress in the field. (It has, however, through its royalties, been a goldmine for the professional organziation). The likely reason it has not been useful in research is that it is a simplistic “field guide” which requires no more than a hobbyist’s understanding to be used be used by amateurs and professionals alike. The kinds of in depth, thoughtful training that once characterized psychiatry and psychology, has given way to crib sheet learning.

When I studied personality in my graduate psychology class, we had to read and understand 38 books. Now its less rigorous. From all of the last ten interviews I conducted for psychology jobs — with newly minted psychologists — only one was able to actually discuss what personality was, and most did not even have a clue, muchless 38 books-full of knowledge.

Diagnosis needs to move in a more useful and less superficial direction I believe we can have reliable diagnoses that are also useful. Let’s move to that playing field, and score a few touchdowns.

Published in: on November 3, 2010 at 7:34 pm  Leave a Comment  
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Majority Leader Shumer?

If the Democrats do hold the senate, but Reid loses his bid for reelection, there will be a new leader of the Democrats. While anyone new would likely mean a PR improvement for the Democrats, the two likely contenders are Dick Durbin of Illinois, and Chuck Shumer of New York.

According to Chris  Smith of the New York magazine, both men have begun the maneuvering, albeit subtly. But if he gets it, Shumer, who is, if anything, a tough player, will have a very different style than the meek Harry Reid. If Obama is in the mood for compromising even further, he may find that Shumer has a more realistic read on his Republican colleagues, who have no intention of cooperating.

While we can almost count on gridlock for the next two years, Shumer would lend some spice to the family feud we now call the U.S. government. Durbin, on the other hand, will likely be even more accommodating than Reid has been, and he will certainly do what ever his fellow Illinoisan, Obama, asks of him.

Published in: on November 2, 2010 at 10:51 pm  Leave a Comment  
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