Evaluating the Competency of Your Diabetic Foot Treatment Team: Essential Skill #2: Testing for Diabetic Peripheral Neuropathy in the Feet.

Evaluating the Competency of Your Diabetic Foot Treatment Team: Essential Skill #2: Testing for Diabetic Peripheral Neuropathy in the Feet.

In these discussions, we discuss each of the 7 essential skills that your diabetes treatment team must use in order to help you prevent an amputation related to your diabetes.

Today we will discuss essential skill number two.

2. Test for neuropathy to help determine the risk of ulceration and amputation.

In the simplest of terms, nerves are the wiring system of the body. They carry information from the outer reaches of the body (such as the hands and feet) all the way back to the brain where this information is processed. One thing that wires and nerves have in common is that they both transmit electrical signals. However, it is probably not a surprise that by comparison, electrical wiring system is significantly simpler than a nervous system.

There are a number of processes that happen within the body that can affect the function of nerves. In the diabetic patient in particular, this includes the way the body is using insulin, levels of blood sugar, levels of circulating lipids (or fats in the blood), blood supply to the nerves themselves, and energy metabolism with in the nerve cells that make up an individual nerve.

Although there are many different processes which can damage nerves, high circulating levels of blood sugar are likely the most damaging. In the United States, diabetic peripheral neuropathy (nerve damage in the feet related to high levels of blood sugar) is the most common type of sensory nerve damage.

Although the nervous system is very complex, checking for nerve damage can be remarkably simple. The most reliable test in order to evaluate whether or not a diabetic patient is at risk of developing neuropathic ulceration that might lead to hospitalization or amputation of the leg can be done in only a few minutes and at very low cost. Because of this, it is absolutely inexcusable that a doctor treating a diabetic would not evaluate the function of the nerves in the feet.

In addition to being low cost and simple to perform, there is one test that is the most useful of all exams in determining whether or not a patient is at risk of developing a problem that might lead to a diabetic foot amputation.

This test is called the Semme’s-Weinstein 5.07 monofilament test. In this test, a 5.07 mm diameter monofilament wire is used to apply precisely 10 grams of pressure to the skin of the diabetic foot in order to determine whether or not
the patient has what is known as “protective sensation”.

During this test, the doctor will ask you to close your eyes. He or she will then touch different parts of your feet with this monofilament asking you to say “right” or “left” whenever the doctor touches either of your feet.

If you can feel every area where the doctor touches your feet, you are at low risk of developing a diabetic foot ulceration that might lead to amputation.

If you do have some loss of sensation, the damage is usually at the ends of the longest nerves in the body. The longest nerves of course happen to go from the spinal cord all the way down the legs and out to the end of the toes. Because of this, the damage seems to appear in what doctors call a “stocking glove distribution pattern.” This means that the damage occurs starting the end of the toes and will usually stop in the same area on both feet as if one has rolled socks on to both feet at the same time.

For example, someone may have lost all of the sensation in the toes, but has all of the station present in the ball of the foot. This means that the patient is at risk of having an open sore develop in the toes but less likely in the midfoot or ball of the foot.

Because this can get worse over time, it provides a good baseline to determine if the diabetic foot problems are staying the same or getting worse.

The implications of this test are that if you have lost “protective sensation,” you are at high risk of starting to develop a blister and not being able to feel that there is a problem. The patients that have this sort of nerve damage will oftentimes step on foreign objects such as splinters, thumbtacks, or slivers of glass and never even noticed that anything has happened. It is this type of open sore that can rapidly develop into an infected diabetic ulceration and later lead to a diabetic foot amputations.

There are a number of other tests that can be used to evaluate the function of the nerves in the diabetic foot. Simply touching a specific type of vibrating tuning fork to the feet and ankles can get a great deal of information about early nerve damage that may be present but not yet concerning for the kind of damage that can lead to open sores.

Other screening tests that your doctor might use include checking hot/cold sensation, two-point discrimination, and evaluating light touch sensation. Nerve conduction velocity exams are more invasive tests and should be reserved for those with indications of problems such as tarsal tunnel syndrome.

Even if there is nerve damage, the open sores that result primarily from existing nerve damage are still mostly preventable. It just requires a little extra vigilance on the part of the patient and the doctor.

If there is only one screening test is performed your doctor evaluating your risk of foot problems that could lead to an amputation, it is the SWMF 5.07 test. For this reason, you must make sure that your diabetic foot doctor checks your feet initially to determine your risk of developing the sort of problems.

Only then will you know whether or not you are at imminent risk of and amputation.


Dr. Christopher Segler is an author, inventor and award winning diabetic foot surgeon. After discovering how diabetic leg amputations resulted from inadequate patient education, it became his passion to teach strategies to stop diabetic amputation. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

One Fourth of Diabetic Amputees Wish They Saw a Podiatrist Sooner

A 2008 study conducted by an an independent research firm for the American Podiatric Medical Association found 25 percent of 600 diabetics who were surveyed and had suffered an amputation related to their diabetes said they should have seen a diabetic foot specialist like a podiatrist. Thirty percent of amputees believed that watching closer and heeding known early warning signs, such as “hot spots” and diabetic foot ulcers, might have prompted them to visit their doctor before things worsened.

In total, 75 percent of the survey participants were type-2 diabetic. The remaining 25 percent were considered at high risk for developing the disease, sometime called "per-diabetic" or "bordeline." The study results showed also found that Hispanics were the least likely ethnic group to be tested for diabetes, compared to African-American and Caucasians. Surveye participants said the reason for not getting tested for diabetes was primarily due to normal blood sugar levels or not having noticeable symptoms.

“This survey shows just how immensely important it is for those diagnosed with diabetes, and those at risk, to have their feet examined by a physician during their annual checkup” the APMA president said. “Regardless of one’s ethnic background, taking a proactive approach to your health in asking your physician to check your feet can save both your limbs and your life.”


Dr. Christopher Segler believes diabetic amputations are preventable. He teaches strategies that help his clients avoid amputation. He is also and award-winning diabetic foot surgeon, inventor and author. If you have diabetes, you can learn how to avoid amputation by more by requesting your FREE reportt “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

National Health Service Increases Funding for Diabetic Foot Programs Related to Podiatry

Children with diabetes in certain areas of the United Kingdom will be getting extra financial support.

The National Health Service has recognized the critical nature of funding diabetic programs for children. His most recent funding will help to pay for pediatric diabetic nurses as well as psychological support for children with type 1 diabetes. It is known that type 1 diabetes in children is linked with high levels of depression as well as eating disorders.

In addition to counselors who specialize in diabetes related to children and pregnancy, extra podiatrists have been added as well. For many years podiatrists in the United Kingdom have been recognized as critically important to preventing complications lead amputation. They have recognized that intensive monitoring by foot and ankle specialists, particularly podiatry, lead to early interventions and help to provide rapid treatment for diabetic foot ulcerations and open sores that can lead to amputation.

It has long been known that open sores in diabetic patients can rapidly become infected and lead to gangrene. Is also known that bone infections known as osteomyelitis are typically preceded by diabetic foot ulcers.

The hope of the additional funding is that diabetic patients will taking off of waiting lists and will be able to be evaluated sooner.

In addition to funding for type 1 diabetic patients, there’s a great need to assist with those with type 2 diabetes. Type 2 diabetes is becoming increasingly common. This rising type 2 diabetes, directly correlates with the increase in obesity within any given population.

At present, approximately 10% of the entire National Health Service annual budget is spent on treating diabetic foot ulcers, open sores on the feet, diabetic foot infections, and other diabetic foot complications.

Is well known that by having patient work closely with their primary care doctors and podiatrists, it is easier to keep diabetes under control and prevent diabetic foot amputations. It is also important to make sure that they podiatrist is closely involved one of diabetic patient begins a new program of exercise to help control the persons blood sugar.

Diabetes is not have to lead to amputation. With good blood sugar control, proper diet and exercise, diabetic patients can hope to lead a healthy and active life.



Dr. Christopher Segler is an award winning diabetic foot surgeon, author and inventor. He is the founder of a groundbreaking private consulting firm that specializes in diabetic amputation prevention. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Is Diabetes a Handicap?

Although diabetes is a serious disease, it should only be considered a handicap when it limits the activities that allow you to enjoy life. One obvious way this can happen is through an amputation or blindness. But it doesn’t have to be this way.

Although we know that diabetes can lead to heart disease, stroke, blindness and open sores on the feet that lead to amputation or death, this is largely preventable.

Research shows that regular exercise and a healthy diet are two ways that can help people prevent diabetes, or even to alter the course of a person’s disease if they do already do have diabetes.

One of the very best ways to make sure the diabetes does not become a handicap is with exercise. We know that when a patient has diabetes, diet and exercise can significantly change the way your body uses insulin and help fight the disease. In fact, we know that after 45 minutes of aerobic exercise, such as running, a diabetic patient’s, insulin sensitivity may increase for up to 48 hours. This is extremely beneficial for type 2 diabetics.

Exercise not only changes the way that your body uses insulin, but it can reduce problems associated with cholesterol, blood pressure, risk of a heart attack or stroke and obesity. We know that when a diabetic patient will lose 15 to 20 pounds, it improves insulin levels from anywhere to 30 to 50%. This results in much better blood sugar control that can prevent many of the complications from diabetes that we worry about.

In United States diabetes is the fifth deadliest disease. We actually think it might be much worse than this because people who do have diabetes might die from other complications including heart attack, stroke or complications of an amputation with gangrene related to a diabetic foot sore.

Whether you are a type 1 or type 2 diabetic patient, exercise can provide a tremendous benefit. You just have to be careful and make sure that you manage your blood sugar correctly.

Oral hypoglycemic medicines ( pills to keep your blood sugar down) may also have a significant impact on your blood sugar when you exercise. For example, sulfonylureas (glipizide, glyburide, etc.) and meglitinides (prandin, starlix, etc.) may require dosing adjustments in order to prevent hypoglycemia (low blood sugar) during exercise. Metformin (glucophage) and thiazolinediones (actos and avandia) are less likely to cause hypoglycemia when you exercise. However if you are taking any of these medicines it is important to talk to your endocrinologist or primary care physician to make sure that you don’t get into trouble.

You should also make sure that you get checked by a podiatrist to make sure that you do not have any problems with your feet, such as diabetic peripheral neuropathy ( loss of feeling) that can put your risk of developing the kind of open sore that can lead to an amputation. An annual diabetic foot exam with a podiatrist is a good way to make sure that you are not at risk of an amputation.

And amputation is one sure way they diabetes can become a handicap. Once a leg is amputated, it’s very difficult to move around the home. Even something as simple as turning on a ceiling fan can become a major challenge. We also know that there are a number of risks associated with having an amputation. About half of all patients who have an amputation on one foot will have any vacation on the other leg within five years.

We also know that diabetic patients who have indications on both feet will most often die within five years.

In spite of all this gloom and doom, there is hope for diabetes. There are a number of available technologies which can significantly reduce the risk of amputation of diabetes. This requires intensive intervention from a specialist in diabetic limb preservation. Unfortunately, not covered by insurance, but is essential to making sure that in amputation is prevented.

Although it can be frustrating when you find out you have diabetes, it does not have to be a negative life altering situation. They can be a very positive thing because many of these people will start a new exercise routine, lose weight, and develop a healthy lifestyle that includes athletic activities that they might find intensely enjoyable.

For many of these people, what started out as a bad thing turns into a way to begin to enjoy life. So if you have been diagnosed with diabetes, don’t worry, it doesn’t have to become a handicap.

Dr. Christopher Segler believes diabetic amputations are preventable. He teaches strategies that help his clients avoid amputation. He is also and award-winning diabetic foot surgeon, inventor and author. If you have diabetes, you can learn how to avoid amputation by more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://ineedmyfeet.com.