There is one more reason to quit smoking, especially if you are diabetic and already grappling with high blood glucose levels. Researchers have pointed out that smokers face a higher risk of getting afflicted with gangrene infections and diabetic foot ulcers (DFUs). This holds true for most people living with serious diabetic conditions, the adverse vascular interactions of nicotine considerably slowing down the healing process of foot ulcers in smokers.
What is diabetic foot gangrene?
According to experts, diabetic gangrene — the localised death and decomposition of body tissue — is the most common problem in people with diabetes. It happens when the blood flow to the feet gets disrupted due to the damage of blood vessels and nerves — a lesser sensation, in effect.
In such cases, a person may not feel any prick or cut to his feet — further leading to infections. Sometimes the wound may be hard or even impossible to heal.
Veteran diabetologist Dr V Mohan, who heads the Dr Mohan’s Diabetes Specialities Centre as the chairman and chief of diabetology, said he has come across several cases of people walking around with a nail in their shoes for an entire day without realising the injury it was causing to the foot. “[The foot] had been pierced many times but the person was unaware until it was really hurt [and] inflicted serious injury — to a potential level of an infection,” said Dr Mohan, emphasizing the importance of people with diabetes taking as much care of their feet as of their face.
No smoking
Gangrene typically affects the toes, fingers and limbs. People with this condition should seek immediate medical help since urgent care is required to remove the dead tissue and prevent bacteria from spreading through the bloodstream. If left untreated, gangrene due to diabetes in foot can lead to a life-threatening infection — the reason doctors insist on good foot-care practices among people with diabetes.
“When there is a lesser blood circulation or even a total absence of blood circulation, an injury inflicted on that part will not get healed,” said Dr Mohan. “Loose-fitting, comfortable footwear designed for people with diabetes, a routine practice of examining your foot to see any colour changes, increase or decrease in temperatures of the foot are all important.
“Smoking is a strict no-no here as it’s one of the commonest causes of gangrene. Smoking increases the chances of gangrene several fold. But I know people who have been seeing me for the past three or four decades and still doing well without foot problems. From cases at my own centre, I can say that it’s possible to have a long and healthy life despite diabetes if you take basic precautions.”
Smoking and nicotine intake reduces the oxygen-carrying capacity of blood vessels. In addition, the production of carboxyhemoglobin (due to the combination of carbon monoxide and hemoglobin) also affects the oxygen distribution through blood in the body. If the oxygen-carrying capacity of the blood is adversely affected it would lead to an oxygen shortage in the body to carry out bodily functions, including the healing of DFUs.
How to reduce chances of diabetes-related foot problems?
Seasoned diabetologists insist on going back to the basics, taking extra care of the feet, regular monitoring of the blood glucose levels, enough physical activity and a good healthy diet.
Foot problems are common in people with diabetes. This can happen over time when high blood sugar levels damage the nerves and blood vessels in the feet. This is also called diabetic neuropathy — numbness, tingling, pain or a loss of feeling in the feet in experiential terms. Or imagine you can see your legs with your eyes but cannot feel or sense them — neither can you stand up and walk nor do you know when your feet are hurt.
Dr Vijay Viswanathan, head and chief diabetologist of MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre in Chennai, said he has been seeing an average of at least 10 cases a day of people with diabetic neuropathy who have loss of sensation in their feet. “They walk barefoot inside their homes, in temples, etc, and get blisters, which they ignore as they do not have the pain sensation,” he said. “This soon becomes infected and turns into gangrene.”
Dr Viswanathan, who has conducted several research studies and works in diabetic foot care and TB among diabetes, said the solution is to diagnose the loss of sensation and follow the medical advice of not walking barefoot even inside their house. “We have been manufacturing footwear and special socks for people with neuropathy,” he said. “These footwear and socks help to prevent injuries in the feet of people with neuropathy.”
If diabetes is no longer a rich man’s disease in India, the cost burden of DFU is also a matter of concern. While a 2000 study by the Prof M Viswanathan Diabetes Research Centre said the total median expenditure incurred by diabetic people with foot complications was Rs 15,450, a recent study said, “DFU in India, which bears one of the highest prevalence of diabetes and gangrene related complications, costs around 1,960 USD [nearly Rs 1.5 lakh].” Besides, the study says, an average Indian patient needs 5.7 years of their income to completely treat a DFU.
In 2019, India had an estimated 77 million adults with diabetes, according to the International Diabetes Federation’s Diabetes Atlas (9th edition). And projections say the figures are likely to touch 101 million by 2030, and 134 million by 2045.
