The holidays are over and Old Man Winter has settled in. Winter brings some challenges to our healthy lifestyles. Our activity levels have slowed and often our stress levels increase. For the diabetic, winter is definitely no party and can actually pose some dangers.

Among the many complications of diabetes, peripheral neuropathy can be complicated by cold weather. Peripheral neuropathy is a result of nerve damage that often causes numbness and pain in the hands and feet of diabetics, as well as in other areas of the body.

People generally describe the pain of peripheral neuropathy as a tingling or burning sensation and at the same time compare the loss of sensation to the feeling of wearing a thin stocking or glove. Itís the loss of sensation that is most troublesome.

When you canít feel your feet, youíre not as likely to notice any problems that may be going on. Diabetes causes changes in the skin of your foot. The problem is that the nerves that control the oil and moisture in the feet no longer work, which prevents sweating and can cause them to become very dry. The skin may peel and crack and if not watched carefully can develop ulcers (open sores) and become infected.

Ulcers occur most often on the ball of the foot or on the bottom of the big toe. Even though some ulcers do not hurt, every ulcer should be seen by your doctor right away. It may require a special shoe, brace or cast in order to protect it. Some severe ulcers may also require hyperbaric oxygen treatment (HBOT). Patients spend time in a special chamber in order to increase oxygen to tissues and speed healing.

Calluses can be a big issue with diabetes. They occur more often and build up faster on the feet of diabetics. Daily use of a pumice stone can help keep calluses under control. Note: It is best to use the pumice stone on wet skin, followed by a thin application of lotion. Over applying lotions or ointments can lead to a fungal infection. Do not attempt to cut calluses or corns yourself as this can lead to ulcers and infections. Let a podiatrist or your health care provider cut your calluses. The same goes for nail trimming.

Another complication working against diabetics is Peripheral Arterial Disease, which is a narrowing or blockage of blood vessels in the legs by fatty deposits. This causes poor blood circulation to feet and legs.

Poor circulation can make your feet feel cold. Youíll be tempted to warm them, but when you canít feel heat around your feet, it is easy to burn them with hot water, hot water bottles or heating pads. Iíve even had a patient whose feet, placed too closely to heating vents, were burned during a long-distance car trip.

The best way to help cold feet is to wear warm socks and sensible, well-fitting shoes.

There are some good techniques for managing this facet of diabetes during the winter:

8 First and foremost, inspect your feet regularly, at least twice a day.

ē Test your blood sugar regularly to keep your sugar levels under control. High blood glucose levels make it hard to fight infections.

ē Be particularly mindful of what you eat. People tend to consume more during the winter months for a variety of reasons.

ē Exercise. Even a little will keep you warmer and increase your bodyís ability to use insulin better.

ē Stay hydrated and use moisturizers. Both will help with problem dry skin.

When problems do come up, talk with your doctor. Early treatment will prevent infections from getting worse.

Dr. Scott W. Kujath, MD, FACS, is a vascular surgeon and Medical Director of the Center for Wound Care and Hyperbaric Medicine at St. Maryís Medical Center and can be reached at 816-655-5780.