AJMAN // For the country's many diabetics, losing a toe - or an entire foot - is a real danger, but experts say it does not have to be every diabetic's destiny.
Although a quarter of diabetics will develop a foot ulcer and one in five of those will require an amputation, that number can be brought down with a little education and some changes of habit.
"Everyone with diabetes thinks they're going to get an amputation," said Dr Timothy Fisher, a consultant podiatric surgeon at Sheikh Khalifa Hospital's Rashid Centre for Diabetes and Research in Ajman. "But I don't see nearly as many wounds or foot ulcers here as I did in the US."
Dr Fisher joined the hospital's diabetes centre in August to address a complication of diabetes that often goes overlooked in the region. "The disease is new here and the country's younger population have not yet lived with diabetes for the 10, 20 and 30 years that precede complications such as kidney disease, blindness and of course, neuropathy [nerve damage]," he said.
About two-thirds of diabetics suffer this irreversible nerve damage. It usually begins with a numbness in the feet, as the nerves furthest away from the central part of the body are attacked and killed. The patient loses "the gift of pain", so they can step on glass and not feel it. This leads to wounds that go unnoticed, which can become dangerously infected.
While the number of people in the UAE with diabetes is worryingly high - it has the second-highest prevalence of the disease in the world - the relatively young population means that "this is the time for us to go in and teach people what to look for in order to prevent amputations later in life", according to Dr Fisher.
Teaching patients to be alert for numbness and tingling, to avoid walking barefoot and to see a foot specialist at least once a year should prevent foot complications, he said.
Gulnaz Tariq, a charge nurse at Sheikh Khalifa Medical City in the capital, said sandals were at least partly to blame. She tells her patients to invest in medical shoes with a special sole to offset pressure. "We have 100 per cent improper footwear in this part of the region, especially for diabetics."
Patients are also taught to cut their toenails straight to avoid ingrown nails, and to dry feet properly after ablutions to avoid fungal infection.
Ms Tariq makes sure every diabetic in the hospital gets his or her feet checked - 518 were screened between April and August this year. Of those, 473 suffered ulcers on their feet, 354 had calluses - which can develop into ulcers - and 267 suffered nerve damage, while 41 had already had an amputation. Of the 518, none owned medical footwear.
Dr Fisher welcomed the move towards specialised centres, saying they were "crucial for a country with such a high incidence of diabetes".
The number of diabetes-related amputations in the UAE is not known, but Dr Fisher said he had seen too many since he had arrived. Half of those amputees will die within five years. That, he said, "is more than the mortality rate of breast cancer or colorectal cancer".