Women's Health Wednesday - The Diabetic Foot: Dr. Saylee Tulpule Shares Everything You Need to Know
In the spirit of the launch of The Shoe Project, today’s Women’s Health Wednesday will be our first Foot Health article, in our mission to educate communities on proper foot health and protection. We are excited to kick off with Dr. Saylee Tulpule, a D.C based podiatrist who has passionately educates the community on important foot related topics through television appearances, guest lectures, and more. She shares her expertise on The Diabetic Foot (Diabetic Mellitus), one of the world’s most common diseases, affecting over 422 million people. Dr. Tulpule provides essential information on symptoms, treatments, testing, and answers the common questions.
One of the most common worldwide diseases is Diabetes Mellitus. According to the World Health Organization, it is estimated that an average of 422 million people around the world are affected by this chronic disease (https://www.who.int/health-topics/diabetes#tab=tab_1). Let's review the etiology, symptoms, and treatment protocol to better understand the disease process.
What is diabetes mellitus? It is the body's inability to effectively control blood glucose levels through the hormone insulin. There are two types of diabetes: Type II Diabetes Mellitus, which is the most common, and Type I Diabetes, also known as Insulin Dependent Diabetes Mellitus. For Type II Diabetes Mellitus, the body becomes resistant to insulin or is not able to produce enough insulin to regulate blood sugar levels. For Type I Diabetes Mellitus, the pancreas does not produce enough insulin, thereby causing a spike in blood sugar levels.
Symptoms of diabetes mellitus are systemic: they affect the entire body, from eyes to feet. Common symptoms are difficulty seeing, constant urination, increased thirst, numbness in hands or feet, and increased weight. Possible long term complications are vision loss, kidney failure, neuropathy, increased risk of heart attack or stroke, and limb amputation. In the field of podiatry, one of the more common manifestations is peripheral neuropathy. Peripheral neuropathy is the loss of sensation to the hands or feet due to elevated sugar levels. Over time, damage occurs to nerves and patients experience symptoms of numbness, sharp, shooting, or burning pain. With diminished sensation, a diabetic patient is more susceptible to developing open wounds, ulcers, and burns. It is estimated that 60-70% of diabetic patients will experience some form of peripheral neuropathy (https://my.clevelandclinic.org/health/diseases).
The diagnosis of diabetes mellitus is made with a fasting plasma/blood glucose test and hemoglobin A1c levels (HgA1c) levels are measured. HgA1c is a marker for the average sugar level in one's bloodstream over a two to three month period. Diabetes Mellitus is defined by the American Diabetes Association if the HgA1c level is greater than or equal to 6.5%. (diabetes.org). Once the diagnosis of diabetes mellitus is established, a comprehensive treatment protocol will be implemented with the goal to bring sugar levels into a controlled range.
The treatment for diabetes mellitus, whether Type I or Type II, involves a multi-disciplinary approach with a medical team that most likely consists of internists, endocrinologists, neurologists, cardiologists, vascular surgeons, physical therapists, nutritionists, and podiatrists. Common treatment guidelines will involve dietary management and an emphasis on increasing physical activity. Both are excellent methods to reduce sugar levels while promoting heart health. Insulin therapy or oral medication will also be administered based on Type I or Type II diagnoses of Diabetes Mellitus.
To summarize, diabetes mellitus is a progressive disease that involves a multi-disciplinary approach to improve the quality of life and health for those fighting the disease.
From the perspective of a podiatrist - Diabetic foot care involves a comprehensive foot and ankle exam which focuses on four main pedal components: vascular, dermatological, neurological, and musculoskeletal. A podiatrist will perform a thorough clinical exam involving these four components and will also order radiographs or other diagnostic studies based on clinical findings.
A vascular exam consists of palpating pulses and identifying any signs of peripheral arterial disease, such as lack of digital hair, temperature gradient changes, and skin mottling. A dermatological exam consists of inspecting nails, hair, lesions (such as moles), or any open wounds or cuts. A neurological exam consists of checking vibratory sensation, reflexes, and using a monofilament to assess for protective sensation. This can help determine early signs of diabetic peripheral neuropathy A musculoskeletal exam will assess for muscle strength, bone deformities, joint range of motion, and biomechanical issues (such as flat feet or an imbalanced gait).
Based on any abnormal results, treatment involves but is not limited to:
1) eliminating barefoot walking, especially with signs of neuropathy
2) shoe modification: wearing indoor house sandals/slippers and outdoor shoes with cushion, support, depth
3) checking feet daily for any skin or nail changes and visible cuts or open sores
4) reviewing proper forms of exercise and diet
5) using a functional foot or ankle-foot orthotic to provide biomechanical support
6) physical therapy to improve joint range of motion and muscle strength
7) regular podiatric care: trimming nails and shaving down painful calluses
Thank you Saylee for sharing your insights with us! We are excited to have you in our global women’s network!
Bio: Dr. Saylee Tulpule is a 2007 graduate of The California School of Podiatric Medicine at Samuel Merritt University in Oakland, California. She then completed a three year surgical residency, while serving as Chief Resident, at the Long Beach Memorial Surgical and Medical Podiatric Residency program in Long Beach, California. She eventually moved to the DC Metro area in 2010 with her husband.
Dr. Saylee Tulpule has been practicing podiatry in DC and Maryland since 2010. Her primary interests include general podiatric medicine, sports medicine, and biomechanics. Her approach to successful patient management involves educating her patients, providing them evidence based medicine, and maintaining an honest approach to patient care.
She also enjoys educating the community regarding podiatric medicine by participating in health fairs and giving lectures. Her efforts to raise social awareness regarding foot health include World Bank/IMF lectures, articles for the Huffington Post, Prevention magazine, and other news/magazine outlets, government sponsored health lectures, tv appearances, and participating with the American Podiatric Medical Association's Marketing committee.
During her leisure time, she enjoys spending time with friends, her husband and two adorable children, cooking, and traveling!
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