Diabetic Limb Loss Often Preventable

Ms. Severino, an elderly woman who was diagnosed with diabetes just a year ago, told her family doctor that her shoes fit her fine, and that there was no way they were the cause of her blister. In fact, the blister on the side of her foot didn’t even hurt, despite the fact that it was really quite red, and kind of swollen too. She had noticed it a few days ago, but hadn’t done anything about it, figuring it would get better on its own.

She ended up having an aggressive infection which required hospitalization and multiple surgeries, changing her life forever. The sad part is that it all could have been avoided. Proper education, and referral to a podiatrist, would have ensured that she had correctly fitting, specially designed shoes for diabetics. Just as important, she would have known to see her foot doctor as soon as a problem developed.

As is often the case, this individual was not aware that she could no longer experience pain accurately because of the changes to her nerves, a problem termed neuropathy. Almost always, it starts in the feet. Initially, the afflicted individual will notice nothing unusual, but it is a progressive process, so eventually they‘ll develop numbness, or perhaps their skin may feel “thick“. Alternatively, some report a tingling or a feeling of “pins and needles“. Others have a burning sensation, which can eventually become constant, and thus, significantly reduce their quality of life.

Nerve problems weren’t the only cause of the disfigurement that Ms Severino experienced. Diabetics also have severe problems with impaired blood flow. This means that their skin is fragile and thin, more likely to tear or “break down“, and not nearly as capable of healing in a timely fashion. Blood is the transport system for the body’s defense mechanisms, so if flow is insufficient, infections can spread faster, and cause more damage. Infections are a tremendous problem for diabetics.

The individual mentioned above suffered so much damage because of how quickly the infection spread. That’s the last part of the trilogy, of what is called “The Terrible Triad“, the three conditions that, together, cause so many problems to the feet and legs of diabetics. The three conditions are: problems fighting infection (known as Immunopathy), decreased blood flow (termed Vasculopathy), and the previously mentioned Neuropathy.

Ms Severino couldn’t really “feel“ how her shoes fit, so she ended up buying shoes that were too tight. Shoe pressure caused her skin to form a blister because it was weak from poor blood flow. She felt no pain so she didn’t do anything about it, and there was more damage than otherwise would have been expected since the infection spread so fast.

Unfortunately, diabetic neuropathy can develop even with good blood sugar control. If one has become afflicted, improving your blood sugar levels is highly recommended, but it won’t reverse the problem. Our understanding of this condition has improved greatly, and some exciting new treatments are being discovered. Yet, for many years, the only option for treating neuropathy was some type of pain relievers.

Several new medicines attempt to provide the body with the substance which, if present in sufficient quantities, seems to help the nerves of people with neuropathy work better. In essence, it’s a specialized form of a well known vitamin, one that we know is essential for proper nerve function.

Additionally, several new devices that have tremendously positive effects on neuropathy have recently been developed, via the production of a unique form of electrical stimulation. Not nearly enough studies have been done with them, but preliminary results have been very exciting.

If you suffer from diabetes, many experts agree, you should see a podiatrist. Perhaps you’ll only need a quick, once-a-year checkup, but in this case, ignorance is not bliss. See a specialist to see what your options are, and what is really going on. Many treatments are available for these kinds of problems, before they can become serious complications, all likely the result of the terrible triad.

The last thing I’ll say about this, as some excellent studies have revealed, is that 85% of all diabetic amputations are preventable! This is a startling number, one that can be reduced if we work together to get diabetics educated and evaluated. By saving feet, we will be saving lives!