On average, two diabetics a month have a portion of their leg or foot cut off in Bermuda.

It's a statistic that can be lowered if diabetics are more assertive and proactive with their health. Local podiatrists are on the frontline in helping to reduce the rate of lower limb amputations.

"Podiatry in Bermuda is of very high quality and we are the first line of defence against further complications like ulceration and amputation," said Dr. Neil Moncrieff of Bermuda Podiatry Centre.

"Good treatment of the diabetic foot is very important but we have to remember there is a big saving in preventative care and much of our work involves preventive measures and advice.

"It has been scientifically proven that podiatric care saves limbs, lives and money," he said. Despite this, he said it has been difficult to persuade local insurance companies of the importance of podiatric coverage.

At Bermuda Podiatry Centre, Dr. Moncrieff said he sees an average of 60 diabetic patients each month — 90 percent of whom have foot problems.

"Many are common like blisters, callus, corns, warts, fissures, fungal infections, paronychia (a type of nail disease), ingrown toenails.

These problems also occur in the general population and none are directly related to diabetes. But all these are potentially dangerous for the diabetic patient, and to prevent development into something more they must seek podiatric care," he said.

Dr. Moncrieff said one of the main causes of foot loss in the world is "bathroom surgery". This is used to describe diabetics cutting nails poorly or using a razor blade or penknife on their hard skin or corns.

Diabetics are more prone to this because the disease often results in loss of sensation in the foot (see related story).

It's important to note that all diabetics are risk of developing serious foot problems. "We see more women than men with diabetes in our practice," said Dr. Moncrieff.

"Usually they are over 40 years old. This does not mean there is a difference in the rate of diabetes between sexes but a reluctance of men to come forward for care. This is improving."

Most diabetic patients seen at the Bermuda Podiatry Centre have a family history of the disease and there is a tendency for them to be overweight as well.

The weight can pose an added problem, as proper diet and exercise are the best methods for controlling the disease.

"Diabetics walk less and exercise less. But we prescribe walking as therapy which puts them at risk of developing ulcers as there are increases in peak plantar pressures (pressure on the sole of the foot), so we have to be careful," he said.