As a child, Josephine Decresenzo watched her mother lose toes to diabetes. Her family had little money to be able to afford the proper footwear and custom insoles she required. Now, as a 71-year-old living with the same disease, Decresenzo ensures she takes the necessary measures to prevent these health complications.
“If it wasn’t for the Medicare, I wouldn’t have been able to afford this,” the Selden resident said about the pedorthic services she receives.
Decresenzo benefits from the Diabetic Therapeutic Shoe Program. Diabetics with Medicare as their primary insurance are entitled to one pair of diabetic footwear each year, whether it be custom-molded or over the counter, as well as up to three pairs of custom insoles. Medicare covers 80 percent of the cost.
According to the Centers for Disease Control and Prevention’s “National Diabetes Statistics Report, 2017” there are 30.3 million Americans, almost a tenth of the population, living with diabetes. This number reflects the nearly 23.4 million diagnosed and 7.2 million undiagnosed patients who have the disease.
Foot ulceration, non-healing or poorly healing sores or wounds, is a serious concern for these individuals.
“If shoes are rubbing against a diabetic’s toes or their forefoot deformities, it can ulcerate,” certified pedorthist Phil Celestino said. He specializes in the design, manufacture and modification of footwear, to alleviate problems caused by disease, congenital condition or injury. Long Island Comfort Shoes and Pedorthic Services, his business, partakes in the Diabetic Therapeutic Shoe Program. Decresenzo is one of his patients.
“They’re more prone to getting an infection,” Celestino said. “We have to be very careful with these patients when they come in to make sure they are properly fitted.”
Nearly 50 percent of people with diabetes suffer from mild to severe forms of peripheral neuropathy, a type of nerve damage that affects a person’s feet, legs and sometimes hands and arms. High blood glucose levels, or high blood sugar, and high levels of fats, such as triglycerides, in the blood cause damage to a diabetic’s nervous system over time.
Symptoms can range from pain and numbness, to loss of feeling entirely in the appendage. When diabetics are unable to detect cuts or a sores, their wounds can become infected. In addition to ulceration, complications can include gangrene, when an infection causes tissue death or, in some serious cases, like Decresenzo’s mother, removal of lower extremities such as toes.
Diabetics often have poor circulation — lack of blood flow to the area makes it harder for infections to heal.
“When he gets a cut or anything, it takes forever to heal,” Jesica Varnis said about her 12-year-old son who has Type 1 diabetes. “One time at school, he had fallen down a small flight of stairs and cut his leg. Where it would have taken any other kid one or two weeks to heal, it took him at least two months.”
Previously a third grade teacher in the Comsewogue school district, Varnis quit her job to take care of her son when he was diagnosed four years ago. Every night she wakes up to do bi-hourly checks of his blood sugar to make sure he is healthy. Taking care of her son is “a full-time job,” Varnis said.
The most common types of diabetes are Type 1, Type 2 and gestational. Type 1, a disease most commonly diagnosed in young people, is when a person produces little to no insulin. Type 2 is a condition that makes a person insulin resistant, which means their body doesn’t respond properly to the hormone. Gestational occurs when a pregnant woman experiences increased blood sugar levels.
Type 2 is the most common form — it makes up more than 90 percent of cases in the United States. It is often more common for those who are middle-aged, especially if they are overweight.
Both Type 1 and Type 2 diabetes are on the rise in the United States, according to a study conducted by the CDC. In 1958, there were 1.58 million diagnosed cases, compared to the 23.4 million today.
“I have seen many newly diagnosed diabetics in [this area],” Robert Parant, a research information volunteer for the Long Island chapter of JDRF, said.
The grassroots fundraising and advocacy group is the leading global organization funding Type 1 diabetes research. The organization’s mission is to lower the number of individuals getting diagnosed each year. It has raised 2 billion dollars for the cause.
“[Having diabetes] is 24/7/365 no days off and no cure,” Parant said. He has been managing his Type 1 diabetes for the past 46 years — his inspiration for becoming a volunteer for JDRF. The organization’s motto is “turn Type 1 into type none.”
Diabetes requires constant maintenance.
Whether Type 1 or Type 2, diabetics need to monitor their insulin, a hormone produced by the pancreas that regulates glucose levels in the blood. Normal blood sugar levels teeter between 100 to 150 milligrams of sugar per deciliter of blood, but for diabetics, these numbers can dangerously sink or rise.
“Diabetes puts a daily burden on life,” Ryan Lessman, a 21-year-old with Type 1 diabetes, said. “Whether it’s having to pull the car over while driving, because my blood sugar is low and I need a snack, or having to skip a night with friends, due to my high blood sugar making me feel nauseous and achy, it’s a consistent inconvenience.”
Diabetics are able to take steps to prevent foot complications. Examining their feet daily, cleaning and dressing wounds as they occur, and the use of supportive shoes and socks all lower a diabetic’s risk of complications.
“With regular maintenance and awareness, diabetics can lower the likelihood of infection,” Celestino said. “The issue is that so many don’t know that this is an issue. Foot care is crucial to their health.”