Reviewed by Brunilda Nazario on June 12, 2012
C. Ronald Kahn, MD - President / Director, Joslin Diabetes Center; Mary K Iacocca Professor of Medicine, Harvard Medical School. His discoveries in insulin signals/receptors revolutionized diabetes research.
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C. Ronald Kahn, M.D. President and Director, Joslin Diabetes Center: One of the first things that many physicians who see a lot of diabetics do is, they tell their patients, the minute they walk into the room, take off your shoes. Cause I need to examine your feet. And the reason is that people with diabetes, especially long standing diabetes, have two problems that affect their feet. One is they may develop neuropathy, that is a loss of sensation in their feet and they're susceptible to injury of their foot. And the other is that they have blood vessel damage. Both the small blood vessels and the large blood vessels going to the legs can be impaired. And this means that if they damage their foot and get an ulcer for example, it won't heal normally because they don't have a normal blood supply.
C. Ronald Kahn, M.D. President and Director, Joslin Diabetes Center: So, the problem with people with diabetes have is that not only can they do this but they aren't necessarily aware of it because they don't have a normal sensation, they may not feel the pressure of a tight shoe the damage from stubbing a toe or doing some other kind of injury.
C. Ronald Kahn, M.D. President and Director, Joslin Diabetes Center: And so examining feet is not only something the doctor should do, it's something a person with diabetes should do themselves. We always recommend to individuals with diabetes, especially those who have vascular insufficiency and who have some degree of neuropathy that every day they take off their shoes at least one extra time of the day. They look at their feet, they take off their socks. They be sure that there's no sores or other pressure spots. If they do get pressure spots they should change shoes to a different fitting shoe, because moving the pressure around can help or changing to a better fitting shoe can help.
C. Ronald Kahn, M.D. President and Director, Joslin Diabetes Center: This is a big problem. There are about 100,000 people per year having amputations due to diabetes. And that's a lot of people. This could be reduced probably by more than half if people had paid better attention to their feet. And it's something your doctor can do once a month, once every three months, once every six months when they see you. But a person with diabetes can do it every day or even more than every day and should be doing it that frequently.