Patients with advanced diabetic nephropathy or end-
stage renal failure have an increased propensity to develop necrosis. Most have anaemia, neuropathy (which may be aggravated by uraemia) and arterial calcification. In addition, the atherosclerotic process is accelerated. The reasons for this propensity of diabetic renal patients to develop necrosis are not entirely clear.
Necrosis can occur in diabetic renal patients with palpable pulses in the absence of severe peripheral arterial disease and in the absence of infection. An apparently small and trivial trauma such as a small split in dry skin (Fig. 6.9) or a tight nail sulcus will frequently lead to necrosis which then spreads (Fig. 6.10). Necrotic lesions often become rapidly infected in diabetic patients with renal failure.
Traumatic injuries are very common in diabetic patients in end-stage renal failure (Fig. 6.11): this may be because the soft tissues of the foot are more easily damaged in end-stage renal failure, or because patients with the heavy burden of managing to cope with diabetes and renal problems become more careless about looking after their feet.
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All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.