Diabetes gives me cold feet... how can I keep them warm?
Ask Dr Ellie THE GP WHO’S ALWAYS HERE FOR YOU
dmg media (UK)
I AM 85 and have type 2 diabetes. I’ve suffered with cold feet for years, which get worse during winter. I’ve tried bathing my feet in hot water, massages and emulsifying creams, but nothing seems to work. Can you help? HAVING cold feet is often linked to problems with the circulation of blood. And poor circulation can be part and parcel of living with type 2 diabetes. It is also a common complaint in old age. In diabetes, high blood sugar levels can damage the smaller blood vessels in the feet and toes, limiting blood flow to the area and leaving the feet cold. The skin is also at risk of damage, as it is unable to heal without good blood supply. Using a rich moisturising cream is a good idea to prevent breakages in the skin. Annual foot checks – at diabetes clinics or GP surgeries – are vital. Speak to the GP if this isn’t occurring. The team can also use a test called an ABPI to check the blood supply from the arteries in the feet. This indicates the extent of the damage to the blood vessels. Circulation will be at its best if diabetes is well controlled. This means taking the optimal medication and having frequent blood tests. Keep cholesterol low and blood pressure at normal levels to avoid damaging the arteries further. Regular exercise is also crucial as this enhances circulation – studies suggest it can improve circulation and the health of the blood vessels by 20 per cent. Regular bursts of relatively intensive aerobic exercise are more beneficial than prolonged episodes every so often. In the meantime, it may be worthwhile investing in a pair of diabetes socks, which are specifically designed to keep the feet warm and dry while slightly improving blood flow in the area. I OFTEN suffer unexplained hives – I expect they are stress-related. In the past few weeks, I’ve noticed that the tips of my fingers have become red and swollen. They are painful to the touch. Are the two problems linked, and is there anything that can be done? I am a 44-year-old female. HIVES, also called urticaria, appear as an itchy, blotchy rash. Usually, the problem is triggered by contact with things you might be allergic to, such as food or pollen. It can also happen in certain temperatures. For instance, some people get coldrelated hives from the wind, while others have a heat-related problem that might crop up after eating spicy food. Hives often appear with other symptoms such as swelling of the hands, feet and face. When this happens, doctors call it angioedema. The hives and the swelling can feel like burning. Headaches, joint pains and swellings are not uncommon. It is not always clear what triggers patients’ symptoms, but it is a sign the immune system is in overdrive – specifically, that mast cells are overactive. These cells release the chemical histamine, which is responsible for the rash and swelling. Sometimes, hives are linked to an autoimmune condition in which the body reacts to its own cells. These sorts of conditions, such as rheumatoid arthritis, can also cause joint swellings and swollen fingers, so it is important that this combination of symptoms is investigated by a GP. Hives should be treated with daily antihistamines. Sometimes, a doctor may advise taking a more frequent dose. Other medications include steroids and a drug called montelukast, but this is a short-term solution. In some severe cases, specialist rheumatologists can prescribe potent immunosuppressants. Stress-related hives can be particularly troublesome. It results in a vicious cycle: the physical problem brings on stress, which makes the hives worse. Any stress-relieving activity, such as exercise or relaxation methods, will help to break the cycle. I CAN’T sleep because I have continuous breathing problems. Every night I have to get up for half an hour, have a hot drink to help me breathe, then go back to bed. My GP prescribed various nasal drops, to no effect. A consultant has confirmed that my nasal passages are clear. Is there anything you can suggest? I’m 84. WHEN someone has problems breathing at night, doctors usually suggest they take part in a special sleep investigation. This involves monitoring breathing, oxygen levels and the heartbeat throughout the night. A GP can refer patients for this test, which usually takes place in a hospital sleep clinic. Difficulty breathing at night could be a problem called obstructive sleep apnoea. Usually with this condition, parts of the airways, such as the windpipe, constrict when you’re asleep, but it can also happen when the nasal passages or sinuses are blocked. This can’t always be seen when a patient is examined. When you lie horizontally at night, the nasal passages may swell with fluid or become inflamed. You won’t necessarily get the same problem during the day, standing upright. An easy way to see if this is the case is to try sleeping propped up with a pillow. It may also be worth trying a nasal dilator – these are soft, plastic devices that sit in the nose at night and increase the airflow. If the sleep study reveals sleep apnoea, it means you actually stop breathing overnight. Patients will be offered a treatment known as CPAP – a pressurised face mask that keeps the airways open at night, stopping them collapsing. Although the device looks quite frightening and can take time to get used to, many patients find it to be life-changing.