Lance’s Dad and I have a reoccuring nightmare.
It has nothing to do with his love of Sci Fi flicks, or from disecting dead redback spiders.
Our nightmare is far, far worse than anything you get to see in an art department or in a special effects trailer on location of a horror movie.
It’s real.
It could affect our son.
We see live human evidence of it almost everytime we visit the Diabetes Outpatients Ward.
Severe Diabetic Foot Ulceration (photo taken before amputation.)
(Sorry…I had to start with the worst image first to keep your interest.)
This is such an overlooked issue, yet possibly the most sinister long term side effect of Diabetes.
Peripheral Neuropathy and Amputation.
Lance’s Dad and I both have our own fears for our son as he grows into an adult living with Type 1 Diabetes.
However this is one nightmare that we both share.
You see, our Happy Little Vegemite HATES shoes. Even as a baby, we have a photo of him, on his bouncer with his foot in in mouth trying to tear off his sock. If he had his way, he would roam the streets barefoot and fancyfree.
Lance has a shoe closet that would rival a Beckham offspring. He has different styles and funky coloured Nikes, Pumas, Filas. Canvas laceups, uggs, crocs, Spiderman light-up-when-you-walk sandals, thongs….you name it..he has it.
Last year, I presented a speech at an awards presentation. There, in the front row, was Lance, struggling, red faced and on the verge of a panic attack, trying to remove his offending footwear. (”They were suffocating my feet!!”) At the very best, sandals, uggs, and thongs are still high tolerance shoes for him.
I understand where this fear of being constricted comes from.
On Diagnosis Day, whilst drifting in and out of consciousness and in the firm grip of deadly DKA, Lance had to have a drip inserted into his hand. Except they put it in on a crooked angle. So they had to do it again. (His tiny body may have been lacking in insulin, but he certainly proved that he could crank up his adrenalin!!) His little legs were pinned down to an examination table to stop him from thrashing. His arms were held down, two doctors on each side, so that they could get a blood sample from other arm. His head was even held back by two nurses, to prevent any further chaos due to his furious determination to be released. His azure blue eyes penetrated mine, his face awash with confusion. I will never recover from that look of abandon, that, despite his hysteria, was clear for all to see. His mother who had lovingly held him and protected him for his first year on Earth, had suddenly handed him over to total strangers to hurt him and take away his freedom. Little did he know that I had no choice-these people saved his life.
(These memories are so painful, I had to stop typing momentarily and snuggle up beside my son, my ear pressed to his back, random tears soaking up in his sweet smelling pyjamas. I can still put my hand in his, and he will entwine his fingers with mine, even in the midst of slumber. I will fight to set you free from this my love.)
As a result of this, Lance still has issues with being being held too tightly, seatbelts and wearing restrictive clothing. Shoes are number one on the list of “Let me OUUUUUUUUUUT!”
The point of this story is that I often find Lance outside, frolicking wildly with his dog, with his feet bare. He will agree to come inside and put some form of protective footwear on, but only when asked.
He will climb the fence, and later come hobbling inside, tearfully acknowledging the splinters that he has newly aquired from chatting to My Neigbour. Even whilst I squeeze, remove and apply alcohol wipes to the affected area, it’s STILL not enough for him to remember for next time.
Today, I was absolutely exasperated when I discovered Lance teetering on the edge of the fence again, chatting to his friends who ride by daily. Shoeless.
After his recent discovery of long term complications, I told him to follow me to the PC. I googled “foot ulcers diabetes” and clicked on images. We both remained silent as we observed the gaping, festering holes in feet, toes barely hanging on by a thread, bones visible through the erosion of skin. We looked at each other knowingly. His eyes were like saucers, his mouth was slightly agasp. He gulped, and said to me, “These are adults’ feet. Look at my feet, Mum! I don’t have any holes in them! I’m careful! I know how to be responsible!”
However after he left the room, ten minutes later, I witnessed a scene that allowed me to exhale a sigh of relief. He was sitting on the sofa, climbing into a pair of socks, and strapping on his sandals. He then proceded to go outside. I hated showing him those images…Definitely a case of being “cruel” to be kind….
“People with diabetes are at risk of developing ulcerations and infections within their feet, which have the potential to require an amputation of the foot or leg. In fact, the most common reason a person with diabetes will require hospitalisation is for a foot complication. Even trivial or minor injuries to the foot have the potential to become very serious and threaten a limb.”
Despite Lance’s disdain for shoes, he has learnt to become very aware of good feet health whilst inside the home. He will always report the tiniest graze, or removal of top layer skin so that I can treat it immediately with antiseptic and cover it. (I have learnt that it’s beneficial to make extra fuss over feet injuries, I have even resorted to bandaging an area to psychologically entice Lance into understanding that feet injuries are something to be taken seriously, and that his feet are a very important priority when it comes to his overall wellbeing.)
I have had several debates with parents of other children who have Type 1 Diabetes about introducing feet care to them at an early age. Some have agreed and considered it to be a good preventive measure, others have seen it as just another burden to take on, and that their child was “too young” to worry about a procedure such as amputation.
Two years ago, I made an appointment at a podiatrist that specialised in Diabetic complications. Soon after, Lance had his first consultation with him, as I was concerned about a toenail that had been cut by a well meaning relative. (It was a little too “close” to the edge for my liking…) He also had a thorough examination of both feet, and had his toenails cut correctly.( I asked if he could demonstrate correct nail cutting techniques step-by-step, so that I could continue doing it the same way at home.) He commended me for bringing Lance to be examined, noting that if Diabetes Educators drove home the point of commencing meticulous feet care immediately after diagnosis, that so many tragic amputations in young adults living with Diabetes could be avoided.
Our podiatrist is on our health care team list-we see him annually.
His general advice for parents with children who have Type 1 Diabetes:
Examine your childs feet daily; on top, on the sole, between the toes and on the heel. Look for any cuts, blisters, grazes, discolouring or fungal infections.
Teach your child to dry in between their toes after showering, and have appropriate protective footwear at public pools/showers to avoid adding tinea or other fungal infections to the list of diabetic complications.
It may sound pedantic, and over the top, but a general rule of “shoes outside and socks inside” is doing your child the biggest favour.
Never treat corns, callouses or severe cuts yourself-ALWAYS SEEK MEDICAL ADVICE.
Non smoker, diabetic for 25 yearDiab insuline dependent for 13 years.
Left foot partial amputn 3 m25 years, insuline dnjjjjjjjj
” Diabetic ulcers are the most common foot injuries leading to lower extremity amputation. Family physicians have a pivotal role in the prevention or early diagnosis of diabetic foot complications. Management of the diabetic foot requires a thorough knowledge of the major risk factors for amputation, frequent routine evaluation and meticulous preventive maintenance.”
Visit Diabetes Australia or go to their website to investigate their advice on caring for your feet. They also have online stores in each state; Diabetes Australia Queensland (DAQ) have extensive orthotic merchandise as well as socks and feetcare products.
Looking after your child’s feet now can protect them from peripheral neuropathy in later life. Good feet care, good feetwear, and good control of glycaemic levels is helping your child to become aware that an important part of having Type 1 Diabetes means being responsible for looking after your feet.
If your child does have a serious foot injury, treat it as an Emergency. Tell the ambulance or the hospital staff immediately that your child has Type 1 Diabetes. Extra care will be taken to ensure that the best possible chance of complete healing will occur.
The current motto of the week in our house?
We love NEAT SWEET FEET. 
