|June 13 2013
People’s feet vulnerable to the effects of diabetes
By B.L. Azure
Dr. G. Gregg Neibauer, D.P.M./Podiatrist, sees patients in the St. Ignatius THHS Clinic the first Tuesday of each month and the Ronan THHS Clinic the first Thursday of each month to take care of the foot health needs of THHS eligible clientele. (B.L. Azure photo)
ST. IGNATIUS — They say the eyes are the windows to the soul. On the same note people’s feet are often the windows to the potential of diabetes or increasing problems with diabetes. Diabetes, in particular type 2 diabetes, can be a stealthy and aggressive grim reaper of American Indians. Diabetes is also a problem in the non-Indian community and in Montana the mortality rate from age-adjusted diabetes for non-Indians is 23 per 100,000.
For American Indians in Montana the mortality rate is three times higher — 69 per 100,000. American Indians account for approximately seven percent of Montana’s population but account for approximately 25 percent of reported cases of prevalent diabetes annually.
There is also a lot of damaging collateral effects of diabetes, including: kidney disease, cardiovascular disease, skin ulcers, infections, amputations and eye problems.
In an attempt to keep on top of a folks with type 2 diabetes, the Tribal Health and Human Services Department’s Diabetes Prevention program contracted the services of Dr. G. Gregg Neibauer, D.P.M./Podiatrist, in 2009. The Missoula-based podiatrist sees patients twice a month. He is at the St. Ignatius THHS Clinic the first Tuesday of each month and at the Ronan THHS Clinic the first Thursday of each month.
“What I am here for is to treat patients with diabetes that have problems with their feet,” Neibauer said, adding that diabetes can negatively affect nerves causing decreased blood flow, especially to the areas far from the heart like feet and lower legs. “Sores in the lower extremities don’t heal well because of decreased blood flow. That can eventually lead to amputations.’
Neibauer said that in his private practice most of the patients he sees have type II diabetes. “Type 2 is prevalent all across society and is increasing here in America,” he said. Much of the problems with diabetes are caused or exacerbated by poor diet choices and sedentary lifestyles.
“The foot is a very complex piece of the human anatomy,” Neibauer said. “The feet, our foundation, affect the whole body including impacts on our psyche. People usually ignore foot pain because they feel that the pain is normal. It’s not normal. There is a reason for the pain.”
Often the pain is structurally related, i.e. arches, bunions, hammer toes, etc. Other times it is disease related with diabetes being a prime example.
Of course not all foot problems are the result of diabetes however. Neibauer said they are a good indicator of it and that he is always looking at the potential of diabetes when examining his patients’ feet.
“There are symptoms that can indicate that diabetes is present,” he said. “I don’t make the diabetes call that’s for the health care providers but I am always on the look out for it and strongly advise people with indications to see their doctor.”
Brenda Bodnar, THHS Diabetes program manager, said that since Neibauer came aboard his patient schedule has been very busy.
What is diabetes?
Diabetes means your blood sugar is too high. Your blood always has some sugar in it because your body needs sugar for energy to keep you going. But too much sugar in the blood is not good for your health.
What is pre-diabetes?
Pre-diabetes means your blood sugar levels are higher than normal but not high enough for diabetes.
People with pre-diabetes are at higher risk for developing type 2 diabetes and heart disease.
People can reduce the risk of getting diabetes and perhaps even return blood sugar levels to normal with a small amount of weight loss through healthy eating and increased physical activity.
What is type 2 diabetes??
People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. Eventually, the body also cannot make enough insulin. This leads to high blood sugar. Over time, high blood sugar can lead to serious problems with your eyes, heart, kidneys and nerves. ??Type 2 diabetes is the most common type in American Indian and Alaska Native people. This type of diabetes can occur at any age, even in children.
What are the signs of type 2 diabetes?
Signs can be severe, very mild or none at all, depending on how high blood sugars have become.
Look for these signs:
• Increased thirst
• Increased hunger
• Fatigue (feeling very tired most of the time)
• Increased urination
• Unexplained weight loss
• Blurred vision
A blood test to check your blood sugar will show if you have pre-diabetes or diabetes.
What factors increase my risk for getting pre-diabetes and type 2 diabetes?
• Being physically inactive
• Having a parent, brother, or sister with diabetes
• Having had the kind of diabetes which can happen during pregnancy
• Being overweight
Can type 2 diabetes be managed?
Yes. Taking care of your diabetes every day will help keep your blood sugar in a healthy range and help prevent health problems that diabetes can cause over the years.
Where can I get help with pre-diabetes and diabetes?
Your health care team (doctor, nurse, diabetes educator, dietitian, psychologist, fitness coach, social worker) can help you.
Talk with them about diabetes. They can help you create a physical activity and healthy eating plan that will work for you. Many people also need medication to treat diabetes.
Get help from others. Talk with your family and friends and ask for support.
“Fifty-nine percent of our (diabetes) vulnerable service population has had a foot exam in the past year and that’s good,” Bodnar said. “The problem with that turnout though is 41 percent of our service population don’t get an exam but they do come in when they start having problems with their feet. Because feet are the furthest extremity from the heart they often are the negatively affected first because of the restricted blood flow caused by diabetes. Too much sugar in the blood is a sign of vascular disease.”
Diabetes program nurse Nancy Grant, LPN, said it is paramount for people to get their feet checked by appropriate medical personnel at least once a year. Grant said prevention is always the easiest and safest route when dealing with the potential of diabetes. To that end the Diabetes program’s monitoring of people’s feet health and education on prevention and management of diabetes amputations have been very low on the Flathead Reservation.
“We thoroughly check for signs of diabetes in a person’s feet,” Grant said and recommended that people, especially the elderly and people at risk for diabetes check their feet daily and look for blisters, cuts, scratches, red and black spots, ingrown toenails ulcers and dryness. She also emphasized that a proper fitting and well-constructed footwear (shoes and socks) is important to maintaining good feet health.
“Tribal Health is doing a great job of addressing diabetes,” Neibauer said. “The Tribal Health nurses are my — pun not intended — my foot soldiers out there on the front lines. I depend on them very much. They alert their patients of problems and the alert me or suggest their patients see me. Diabetes is a national problem and the nurse-patient relationship here is very important in prevention and treatment.”
Neibauer sees patients two days a month at THHS clinics. He is in St. Ignatius the first Tuesday of the month and Ronan the first Thursday of the month.
• To schedule with Dr. Neibauer, contact Tribal Health at 845-3525.
• For more information on the THHS Diabetes program, contact Brenda Bodnar at 745-3525, ext. 5020, or Nancy Grant at 75-3525, ext. 5028.