"It is not about money. No amount of money will give back my limb" said a 65 years old woman with diabetes (name withheld on request) who underwent limb amputation at the Gandhi Memorial & Associated Hospitals (GM & AH). She couldn't have been right in conveying the message in the lead up to the World Diabetes Day, 14 November 2008, to prevent many diabetes-related complications that are extremely devastating. "Diabetes ups the risk for heart disease and stroke" said Dr Rishi Sethi, who works with Department of Cardiology at CSM Medical University. "This increased risk to stroke and heart diseases can be lowered by keeping blood glucose (also called blood sugar), blood pressure, and blood cholesterol close to the recommended levels. Reaching your targets also can help prevent narrowing or blockage of the blood vessels in your legs, a condition called peripheral arterial disease" advises Dr Sethi. "People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness - loss of feeling - in the hands, arms, feet, and legs" informed Professor (Dr) Rama Kant, who heads the diabetic foot unit at CSM Medical University (formerly King George's Medical College) in Lucknow, India. "Another major diabetes-related complication is related to kidneys. People with diabetes are prone to develop a serious condition in which the kidneys fail to rid the body of wastes. Kidney failure is the final stage of chronic kidney disease (CKD)" explains Prof Kant. "Will you be surprised to learn that diabetes is the most common cause of kidney failure, accounting for nearly 44 percent of new cases" says Prof Kant. "Even when diabetes is controlled, the disease can lead to CKD and kidney failure" adds Prof Kant. However the diabetes-related complication which had devastated the life of the 65 years old woman in GM & AH (who is quoted above), is diabetic foot. "The foot of the patient with long-standing diabetes is often the site of neuropathic and vascular growth which poses a considerable threat, not only to the lower limb but also to the life of the patient" warns Prof Kant. Relatively diabetic foot is one of the leading causes resulting in long hospital stays for people with diabetes. It demands much care and attention by both the patient and healthcare personnel. Two major problems which predispose the patients with diabetes to amputation are the development of neuropathy due to uncontrolled diabetes over several years while result in damage to the nerves in the feet leading to the loss of sensation. They also develop certain high pressure points under the feet which result in the formation of callus which later turns in to an ulcer. In addition cigarette smoking will lead to nerve damage and reduced blood flow in the feet. With increasing age, people with diabetes may develop diminished sensation and decreased peripheral circulation in the feet, and thus are at a heightened risk of developing foot infections. Prof Kant lists some ways people with diabetes can take care of their feet: 1. Keep feet clean – wash them regularly. 2. Use only lukewarm water – no hot water, heating pads, hot water bottles, iodine or alcohol. 3. Keep the feet dry – especially between toes-use unscented lotion or cream to keep skin soft. 4. Use only medicines recommended by your doctor 5. Cut toe nails straight across, not deep into the corners to help avoid ingrown toe nails. 6. Never use razors, knives or corn caps to remove corns. 7. Wear shoes or slippers at all times -never walk bare foot even at home. 8. Wear good fitting shoes/slippers - not tight or worn-out ones. Boots should be used only for short periods. 9. Check your feet daily and see your doctor immediately about foot problems. "Diabetes costs a lot to the people, much more than money" says Prof Kant. According to Diabetes Atlas published by the International Diabetes Federation (IDF), there were an estimated 40 million people with diabetes in India in 2007 and this number is predicted to rise to almost 70 million people by the year 2025. The countries with the largest number of people with diabetes will be India, China and USA by 2025. It is estimated that every fifth person with diabetes will be an Indian. Due to these sheer numbers, the economic burden due to diabetes in India is amongst the highest in the world. International Diabetes Federation (IDF) is striving to raise awareness about diabetes, and advocate for standard treatment facilities globally. With few weeks to go for this year's World Diabetes Day, 14 November 2008, which in India, is also observed as Children's Day to commemorate the birth anniversary of India's first Prime Minister Jawahar Lal Nehru who was known for his affection towards children, let us hope that the awareness related to diabetes can be upped phenomenally.