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B1.

Q. What is diabetes?
A.  Diabetes is a disease in which blood glucose levels are above normal. Glucose is a natural sugar produced by our bodies. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugar to build up in your blood. Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes is the sixth leading cause of death in the United States. For more information, see the National Diabetes Information Clearinghouse publication, Your Guide to Diabetes: Type 1 and Type 2.*

Excerpt from the FAQ Section of the CDC (Centers for Disease Control and Prevention) Article "National Center for Chronic Disease Prevention and Health Promotion Diabetes Public Health Resource"*
*By clicking on one of these links, you will be directed away from this website. Links are provided solely as a service to the readers of this article. Links do not constitute an endorsement of any organization by Cobbler's Corner or its staff, and none should be inferred. Cobbler's Corner is not responsible for the content of the individual organization Web pages found at any of these links.

 1.5 million new cases of diabetes were diagnosed in people aged 20 years or older in 2005.
 20.8 million people, or 7.0% of the population have diabetes. 14.6 million people have been diagnosed, 6.2 million people are undiagnosed. About 176,500 people aged 20 years or younger have diabetes. This represents 0.22% of all people in this age group. About one in every 400 to 600 children and adolescents has type 1 diabetes. Although type 2 diabetes can occur in youth, the nationally representative data that would be needed to monitor diabetes trends in youth by type are not available. Clinically-based reports and regional studies suggest that type 2 diabetes, although still rare, is being diagnosed more frequently in children and adolescents, particularly in American Indians, African Americans, and Hispanic/Latino Americans. 20.6 million or 9.6% of all people age 20 years or older have diabetes. 10.3 million or 20.9% of all people age 60 years or older have diabetes. 10.9 million or 10.5% of all men aged 20 years or older have diabetes. 9.7 million or 8.8% of all women aged 20 years or older have diabetes.

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Complications of diabetes in the United States

Heart disease and stroke. Heart disease and stroke account for about 65% of deaths in people with diabetes. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. The risk for stroke is 2 to 4 times higher among people with diabetes.

High blood pressure. About 73% of adults with diabetes have blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg) or use prescription medications for hypertension.Blindness. Diabetes is the leading cause of new cases of blindness among adults aged 20 74 years. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

Kidney disease. Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2002. In 2002, 44,400 people with diabetes began treatment for end-stage kidney disease in the United States and Puerto Rico. In 2002, a total of 153,730 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico.

Nervous system disease. About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation of pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems. Almost 30% of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling). Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations. About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation of pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems. Almost 30% of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling). Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.

Amputations. More than 60% of nontraumatic lower-limb amputations occur in people with diabetes. In 2002, about 82,000 nontraumatic lower-limb amputations were performed in people with diabetes.Dental disease. Periodontal (gum) disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes. Almost one-third of people with diabetes have severe periodontal disease with loss of attachment of the gums to the teeth measuring 5 millimeters or more.

Complications of pregnancy. Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5% to 10% of pregnancies and spontaneous abortions in 15% to 20% of pregnancies. Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child.Other complications. Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma. People with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.

Deaths among people with diabetes, United States, 2002

Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2002.
This ranking is based on the 73,249 death certificates in which diabetes was listed as the underlying cause of death. According to death certificate reports, diabetes contributed to a total of 224,092 deaths.
Diabetes is likely to be underreported as a cause of death. Studies have found that only about 35% to 40% of decedents with diabetes had it listed anywhere on the death certificate and only about 10% to 15% had it listed as the underlying cause of death.
Overall, the risk for death among people with diabetes is about twice that of people without diabetes of similar age.

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B4.
Q. What are the symptoms of diabetes?

People who think they might have diabetes must visit a physician for diagnosis. They might have SOME or NONE of the following symptoms:

• Frequent urination
• Excessive thirst
• Unexplained weight loss
• Extreme hunger
• Sudden vision changes
• Tingling or numbness in hands or feet
• Feeling very tired much of the time
• Very dry skin
• Sores that are slow to heal
• More infections than usual.

Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of insulin-dependent diabetes, now called type 1 diabetes.

Excerpt from the FAQ Section of the CDC (Centers for Disease Control and Prevention) Article
"National Center for Chronic Disease Prevention and Health Promotion Diabetes Public Health Resource"*

*By clicking on this link, you will be directed away from this website.Links are provided solely as a service to the readers of this article. Links do not constitute an endorsement of any organization by Cobbler's Corner or its staff, and none should be inferred. Cobbler's Corner is not responsible for the content of the individual organization Web pages found at any of these links.

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Risk factors are less well defined for type 1 diabetes than for type 2 diabetes, but autoimmune, genetic, and environmental factors are involved in developing this type of diabetes.

Gestational diabetes occurs more frequently in African Americans, Hispanic/Latino Americans, American Indians, and people with a family history of diabetes than in other groups. Obesity is also associated with higher risk. Women who have had gestational diabetes are at increased risk for later developing type 2 diabetes. In some studies, nearly 40% of women with a history of gestational diabetes developed diabetes in the future.

Other specific types of diabetes, which may account for 1% to 2% of all diagnosed cases, result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses.

Excerpt from the FAQ Section of the CDC (Centers for Disease Control and Prevention) Article
 "National Center for Chronic Disease Prevention and Health Promotion Diabetes Public Health Resource"*
*By clicking this link, you will be directed away from this website. Links are provided solely as a service to the readers of this article. Links do not constitute an endorsement of any organization by Cobbler's Corner or its staff, and none should be inferred. Cobbler's Corner is not responsible for the content of the individual organization Web pages found at any of these links.

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A. The causes of type 1 diabetes appear to be much different than those for type 2 diabetes, though the exact mechanisms for developing both diseases are unknown. The appearance of type 1 diabetes is suspected to follow exposure to an "environmental trigger," such as an unidentified virus, stimulating an immune attack against the beta cells of the pancreas (that produce insulin) in some genetically predisposed people.

For more information about the immune system, visit these pages from The National Institute of Health’s (NIH) National Institute of Allergy and Infectious Diseases Web site:

• The Immune System*
• Understanding Autoimmune Diseases*

For more information on genetics and disease, visit:

• Genetics Home Reference*
• NIH’s Human Genetics and Medical Research* online exhibit
• The Centers for Disease Control and Prevention’s (CDC)Office of Genomics and Disease Prevention*
• National Center for Biotechnology Information’s Human Genome Resources page*

Excerpt from the FAQ Section of the CDC (Centers for Disease Control and Prevention) Article
"National Center for Chronic Disease Prevention and Health Promotion Diabetes Public Health Resource"*
*By clicking on any of these links, you will be directed away from this website. Links are provided solely as a service to the readers of this article. Links do not constitute an endorsement of any organization by Cobbler's Corner or its staff, and none should be inferred. Cobbler's Corner is not responsible for the content of the individual organization Web pages found at any of these links.

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B9.
Q. Can diabetes be prevented?

A. A number of studies have shown that regular physical activity can significantly reduce the risk of developing type 2 diabetes. Type 2 diabetes also appears to be associated with obesity.

 Researchers are making progress in identifying the exact genetics and "triggers" that predispose some individuals to develop type 1 diabetes, but prevention remains elusive.

 See Preventing Diabetes* in the FAQ section of the CDC article "National Center for Chronic Disease Prevention and Health Promotion Diabetes Public Health Resource" for more information.

Excerpt from the FAQ Section of the CDC (Centers for Disease Control and Prevention) Article
"National Center for Chronic Disease Prevention and Health Promotion Diabetes Public Health Resource"*
*By clicking on either of these links, you will be directed away from this website. Links are provided solely as a service to the readers of this article. Links do not constitute an endorsement of any organization by Cobbler's Corner or its staff, and none should be inferred. Cobbler's Corner is not responsible for the content of the individual organization Web pages found at any of these links.

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A. In response to the growing health burden of diabetes, the diabetes community has three choices: prevent diabetes; cure diabetes; and improve the quality of care of people with diabetes to prevent devastating complications. All three approaches are actively being pursued by the US Department of Health and Human Services.

Both the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) are involved in prevention activities. The NIH is involved in research to cure both type 1 and type 2 diabetes, especially type 1. CDC focuses most of its programs on being sure that the proven science is put into daily practice for people with diabetes. The basic idea is that if all the important research and science are not applied meaningfully in the daily lives of people with diabetes, then the research is, in essence, wasted.

Several approaches to "cure" diabetes are being pursued:

• Pancreas transplantation
• Islet cell transplantation (islet cells produce insulin)
• Artificial pancreas development
• Genetic manipulation (fat or muscle cells that don’t normally make insulin have a human insulin gene inserted — then these "pseudo" islet cells are transplanted into people with type 1 diabetes).

Each of these approaches still has a lot of challenges, such as preventing immune rejection; finding an adequate number of insulin cells; keeping cells alive; and others. But progress is being made in all areas.

Excerpt from the FAQ Section of the CDC (Centers for Disease Control and Prevention) Article
"National Center for Chronic Disease Prevention and Health Promotion Diabetes Public Health Resource"*
*By clicking on this link, you will be directed away from this website. Links are provided solely as a service to the readers of this article. Links do not constitute an endorsement of any organization by Cobbler's Corner or its staff, and none should be inferred. Cobbler's Corner is not responsible for the content of the individual organization Web pages found at any of these links.

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A. People who have diabetes often develop neuropathy (nerve damage), in their feet. Nerve damage can lead to loss of sensation or feeling in the feet, leaving a person unable to feel pain, cold or heat. The longer a person has diabetes, the greater the potential of developing foot problems.
 When a person has diabetes, this gradual loss of feeling inthe feet interferes with their ability to determine whether their shoes or orthotics fit well and are performing properly. Their shoes may be too short, too narrow, or not deep enough to accommodate their feet. Shoes can be tied too loosely, Causing the heel to slip, or allowing the foot to slide forward, hitting the end of the shoe. Shoes can be tied too tight, interfering with circulation. Any of these problems can go unnoticed and result in blisters, calluses, ulcers or, worse, amputation. Properly fitted shoes and foot orthotics help protect a person's feet and improve their ability to walk.
 A Certified Pedorthist, working along with a person's doctor, is able to alleviate foot problems by properly fitting special diabetic shoes and foot orthotics, and then making specific modifications to the shoes and orthotics. By doing so, we are able to address any potential problems before they become serious. We also do follow-up care to assure the shoes and orthotics perform in the best way possible.

Make sure yor footwear, instead of being part of the problem, is part of the healthy solution!

For more information about our Pedorthic Facility, retail store, shoe repair facility, or orthotic lab, or to learn more about the Medicare Shoe Bill or how we can you get on the road to healthy feet, please stop in or call.
Follow this link for our hours, location and phone no.

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A. Federal Government Organizations:

The CDC’s National Diabetes Fact Sheet*

The National Diabetes Information Clearinghouse*

MedlinePlus’s Diabetes Tutorial*

Department of Veterans Affairs - Internet http://www.va.gov/diabetes/*

Health Resources and Services Administration - Internet http://www.hrsa.gov/*

Indian Health Service
Diabetes Program
5300 Homestead Road NE, Albuquerque, NM 87110
505/248-4182 - Internet http://www.ihs.gov/MedicalPrograms/Diabetes/index.asp*

National Diabetes Education Program - Internet http://www.cdc.gov/diabetes/ndep/index.htm*

The NDEP is a nationwide initiative of the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). It is an inclusive, partnership-based program involving many diverse public and private sector partner organizations. The goal of the program is to reduce the morbidity and mortality of diabetes and its complications. For more information on NDEP, call toll free 1-800-438-5383.

National Institute of Diabetes and Digestive and Kidney Diseases
1 Information Way, Bethesda, MD 20892-3560
800/GET LEVEL (800/438-5383) or 301/654-3327 - Internet http://www.niddk.nih.gov/*

National Eye Institute (NEI)
Bldg. 31, Room 6A32
31 Center Drive, MSC 2510
Bethesda, MD 20892-2510
301/496-5248 or 800/869-2020 (to order materials); 301/402-1065 (fax) - Internet http://www.nei.nih.gov/*

Office of Minority Health Resource Center
US Department of Health and Human Services
P.O. Box 37337, Washington, DC 20013-7337
800/444-MHRC (444-6472) - Internet http://www.omhrc.gov/

Non -Federal Government Organizations:

American Association of Diabetes Educators
100 West Monroe, 4th Floor, Chicago, IL 60603-1901
800/338-3633 for names of diabetes educators; 312/424-2426 to order publications - Internet http://www.aadenet.org/*

American Diabetes Association
1701 North Beauregard Street
Alexandria VA 22311
Telephone 703-549-1500
1-800-ADA-ORDER to order publications toll free; 1-800-342-2383 (800-DIABETES) for diabetes information - Internet http://www.diabetes.org/*

American Dietetic Association
National Center for Nutrition and Dietetics
216 West Jackson Boulevard, Suite 800, Chicago, IL 60606-6995
800/366-1655 Consumer Nutrition Hotline (Spanish speaker available); 800/745-0775 - Internet http://www.eatright.org/*

American Heart Association National Center
7272 Greenville Avenue, Dallas, TX 75231
214/373-6300 - Internet http://www.americanheart.org/*

American Optometric Association
1505 Prince Street, Alexandria, VA 22314
800/262-3947 or 703/739-9200 - Internet http://www.aoanet.org/*

American Podiatric Medical Association
9312 Old Georgetown Road
Bethesda, MD 20814
301/571-9200 or 800/ASK-APMA; 301/530-2752 (fax) - Internet http://www.apma.org/*

International Diabetic Athletes Association
1647-B West Bethany Home Road, Phoenix, AZ 85015
800/898-IDAA or 602/433-2113; 602/433-9331 (fax)

Juvenile Diabetes Research Foundation
The Diabetes Research Foundation
120 Wall Street, 19th Floor, New York, NY 10005-4001
800/JDF-CURE or 800/223-1138; 212/785-9595 (fax) - Internet http://www.jdrf.org/*

Medical Eye Care for the Nation's Disadvantaged Senior Citizens
The Foundation of the American Academy of Ophthalmology
P.O. Box 429098, San Francisco, CA 94142-9098
800/222-EYES (222-3937)

National Diabetes Information Clearinghouse
1 Information Way, Bethesda MD 20892-3560
301/654-3327 (phone); 301/907-8906 (fax) - ndic@aerie.com (e-mail) - Internet http://diabetes.niddk.nih.gov/index.htm*

Excerpt from the FAQ Section of the CDC (Centers for Disease Control and Prevention) Article
"National Center for Chronic Disease Prevention and Health Promotion Diabetes Public Health Resource"*
*By clicking on any of these links, you will be directed away from this page. Links are provided solely as a service to the readers of this article. Links do not constitute an endorsement of any organization by Cobbler's Corner or its staff, and none should be inferred. Cobbler's Corner is not responsible for the content of the individual organization Web pages found at any of these links.

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Section C: Diabetic Footwear 

C1.
Q. Why does a person with diabetes need special footwear?

A. Diabetes frequently results in neuropathy, or nerve damage, in the feet. Nerve damage can lead to loss of feeling in the feet, leaving a person unable to feel pain, heat or cold. You could have a tack or stone in your shoe and walk on it all day without knowing it is there. Always check the inside of your shoes for foreign objects before putting them on.
 When a person has diabetes, the gradual loss of feeling in the feet lessens the ability to judge whether shoes and/or orthotics fit and function properly. Friction or rubbing may go unnoticed and worsen into a blister, a break in the skin, or an ulcer. Circulation can also be hindered if shoes are tied too tight. On the other hand, the feet may have too much movement in the shoes if they are tied too loosely, allowing the feet to slide forward in the shoe, resulting in the toes hitting the end of the shoes. All this can be going on inside the shoe of a diabetic person and they may never feel any discomfort, resulting in serious foot and medical problems.
 Shoes and foot orthotics not only protect the feet; they improve the function of the feet. Foot problems can lead to stress on other parts of the body. Since the feet, legs, knees, hips and back all work together, proper footwear can enhance a person's ability to physically perform.

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C2.
Q. What should a diabetic look for in a shoe?

A.

1. Look for an extra depth shoe with an insole that extends from heel-to-toe and provides at least 3/16" of additional depth when removed. This space will accomodate a custom orthotic if needed.
2. The insole, in addition to being removable, should be made of a material that is soft, yet firm enough to hold an impression during use. It should also be comprised of three layers of material and be able to mold to a person's foot. These inserts are designed to spread the person's weight over the entire mold and to help redistribute weight away from areas of excessive foot pressure.
3. The depth shoe should be made of soft and supple leather, or another suitable material of equal quality.
4. The shoe should have a lining made of leather or similar material to provide a smooth, non-irritating surface to protect the foot.
5. The tongue of the shoe should be padded to improve fit and comfort.
6. The shoe must have a lace or Velcro® closure.
7. The sole of the shoe should be as wide as the entire upper part of the shoe and the central portion of the sole should be wide enough to provide additional support to the arch area of the foot. The sole's design will give it a wedge-like appearance so that the entire sole strikes the surface of the ground during walking, thus increasing stability. The sole should also be made of a lightweight material, thus reducing fatigue and enhancing comfort when walking.

There are now a number of manufacturers who provide suitable shoes for diabetics. At Cobbler's Corner, we have a wide selection of Medicare approved shoes for diabetics. Please stop in or call.
This link will take you to our contact information.

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A. Here are 10 tips for buying shoes which are properly fitted for a diabetic.

1) HAVE BOTH FEET MEASURED EVERY TIME YOU PURCHASE A PAIR OF SHOES.
Over the course of your lifetime, your feet will change in both size and shape. For many people, one foot is slightly longer and/or wider than the other, so fit the largest foot first. Go to a shoe store that measures both feet and wear the type of socks you will wear with the shoes.

2) SELECT SHOES THAT MATCH THE SHAPE OF YOUR FEET.
The shoe should follow the natural outline of your foot. Make sure the shape of the shoe matches the shape of your foot.

3) SHOES SHOULD BE AS WIDE AS YOUR FEET AND LONGER.
When shoes contact the ground during walking or running, feet elongate. Allow adequate space (3/8" to 3/4") at the end of the shoe for your longest toe. Judge shoes by how they fit on your feet. Don't select shoes that feel too tight, too loose, or irritates any part of your foot. If a shoe feels too snug or too loose at the try- on stage, it is NOT a good fit, and may cause foot pain and problems later on.

4) MAKE SURE THE WIDEST PART OF YOUR FOOT (the "ball") FITS COMFORTABLY INTO THE WIDEST PART OF THE SHOE.
This match permits shoes to bend where your feet flex, giving you a more functional and more comfortable fit.

5) THE TOE BOX (the covering around the toe area) SHOULD BE ROUND, HIGH AND SHAPED LIKE YOUR FOOT.
You should be able to freely move your toes inside the shoe; if you CANNOT wiggle your toes inside your shoes this is NOT a good fit. Toe room is essential for a healthy foot, especially for the diabetic.

6) HEELS SHOULD FIT COMFORTABLY IN THE SHOES.
Don't buy shoes that are too small just to avoid heel slippage.
If your foot has excessive slippage in the heel of your shoe, try a different shoe or ask your shoe fitter to make some minor adjustments. Selecting shoes that have a combination last (shoes that are made wide at the "ball" and narrow at the "heel") can eliminate this problem.

7) INSERTS OR ORTHOTICS AFFECT THE WAY A SHOE FITS.
Shoe inserts or foot orthotics will take up shoe space intended for your foot. If you require inserts or orthotics, you will need a roomier shoe; otherwise, the inserts CANNOT function properly arid your shoes WILL NOT fit right. Purchase shoes that are designed to accommodate an insert or orthotic. There are many shoe styles from major manufacturers available that are designed with extra depth and/or removable insoles for this purpose

8) CHOOSE SHOES APPROPRIATE TO THE ACTIVITY AND THE AMOUNT OF TIME YOU WILL SPEND PERFORMING THE ACTIVITY.
Feet change shape and size during the day and under different conditions: after exercise, in warm weather, with weight gain, or from sitting or standing. When shoe shopping, remember that your feet are generally larger after an activity than preceding it, so buy accordingly, perhaps even timing shoe shopping immediately after the activity.

9) WALK IN THE SHOES TO MAKE SURE THEY FEEL COMFORTABLE.
Walk around the store. Shoes affect the health of our feet and also our emotional well being. If our feet hurt, we are NOT happy.

10) SHOP A STORE THAT OFFERS FULL SERVICE.
A store that measures both feet (length, width, depth, and shape of foot) and that evaluates worn shoes, checking for wear patterns, correct sizing and appropriateness of the shoe style is your best choice for finding a shoe that suits you. Always remember, a store which leaves you on your own to select and measure shoes does not care about your feet. Select a store that has a staff trained in proper shoe fitting, measuring, and most important, in recognizing foot problems and their causes. Avoid stores that try to make a few sizes and styles work for every foot. Not only is this impossible, it can prove dangerous to a diabetic or to others with foot problems.

OUR MANY FOOTWEAR STYLES COME IN SIZES RANGING FROM 4 TO 20
AND IN WIDTHS RANGING FROM 4A (AAAA) TO 9E (EEEEEEEEE)!

At Cobbler's Corner, A Certified Pedorthist oversees all fitting, custom footwear, custom orthotics and shoe modifications. Your comfort and satisfaction are very important to us. A shoe's fit is as personal as the sound of a person's voice. Whether a foot condition is temporary or permanent, shoes and other footwear devices can be part of the treatment plan. For people with diabetes, arthritis, or other foot problems, the right footwear can mean the difference between being able to WATCH and being able to PARTICIPATE!

Make sure your footwear, instead of being part of the problem,
is part of the healthy solution!

Please stop by or call today so we can start you on the road to happier, healthier feet. Just follow this link to view our Location, Phone No. and Contact Information.

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