Why do diabetics lose limbs?

Do Diabetics lose limbs?

I see a ton of diabetic patients in my office and sometimes they come with diabetic foot ulcers sometimes they come to see me the first time with the missing limbs and that really really makes me sad and I want the awareness to go up and today I’m going to talk to you about why diabetics sometimes lose limbs and how to prevent that.

How do limb amputations develop?

Let's discuss the vascular system and the neurological system. Diabetes is a vascular disease so when your blood sugars (high HbA1c) go up and when you're insulin resistant, these things will definitely create pressure in your blood vessels and you will start getting narrowing of your blood vessel.

Especially the arteries and the most affected blood vessels in diabetes are the small arteries which are the ones that go to your hands or your feet. Kidneys also do have very small arteries.

Diabetic neuropathy is the main reason for diabetic foot ulcers

What happens is when these blood vessels start getting clogged up, the nerve cells that are getting nourished through those blood vessels or arteries also start dying. So, it’s a combination of multiple factors. Due to the nerve damage diabetics start losing the sensation under their feet.

The main problem is they sometimes walk around barefoot. They step on things and they don’t realize. Think about it, it’s your foot which is not the cleanest place on your body. So, if there is a break on your skin eventually it gets infected. When a diabetic has an opening on the skin it’s like opening your doors to the enemy.

Then the bacteria will sneak in if you’re you’re totally clean and protecting your feet. Because skin bacteria that are living on your skin on a normal basis can sneak into the system Through the break on your skin. In addition to that, due to the high blood sugars, those bacteria will thrive.

This situation will eventually create an infection. Infection if not treated correctly can turn into a diabetic foot ulcer and possibly losing a limb via amputation. The real problem is you may not be even aware of  The diabetic foot ulcer until it gets really bad because you don’t even feel it in most cases. That is one of the main reasons why diabetics lose the limbs.

Self-examination of the feet is very important for diabetics

DIABETIC FOOT ULCER STAGES

Since most diabetics do not have a good sensation under the feet, you have to be really careful and check the bottom of your feet a couple of times a week. A lot of people expect only doctors to do their foot exams but in reality, you can get a foot infection tomorrow right after you see the doctor.

So it's not necessarily the doctor, you have to be your own doctor and make sure you check your feet all the time and check the bottom of your feet to make sure nothing is there. If you cannot reach out to the bottom of your feet you can use the mirror. Neuropathy may lead to infection. 

The infection gets deeper and deeper and then sometimes it eventually reaches the bone.  When the infection gets so deep it becomes hard to heal. So, we sometimes give antibiotics and wait for it to heal.  If it is not healing there are some other treatments that can be done when there's dead tissue. Typically this is where the infection lives.

There is no way for that infection to go away because it is an area that the blood vessels or body's healing mechanisms cannot reach out. Then that tissue starts decomposing and starts affecting the tissue that is next to it. That is when the real problem starts.

If it reaches the bone that becomes a real problem because then it is almost impossible to get that infection out.  Along with accompanying high blood sugars that feed the infection and the body's weak immune system bacteria Becomes more difficult to leave your body.

At that point, it is hard to defeat the bacteria. Unfortunately when we cannot salvage the tissue that is infected amputation may be necessary to prevent infecting further tissue and this can lead to diabetics losing the limb typically the toes, midfoot, or below the knee depending on the severity of the infection.

The important role of the vascular system in diabetic foot ulcer healing and prevention of losing limbs

Vascular problems in diabetes

Think your main arteries like a city's main arteries. If they are jammed up, the ambulance is not going to get there on time.  So, as a result, diabetics with vascular problems sometimes need to see vascular doctors to open up their arteries.

Vascular problems are even more prevalent in diabetics who have uncontrolled blood sugars and the ones who smoke. Unfortunately, small arteries may not even be accessible by vascular surgeons. Those small tiny arteries that are typically clogged up due to diabetes.

As a result sometimes to save the rest of the tissue doctors will end up amputating the limb totally to avoid spreading that infection. So, the bottom line that's why diabetics lose limbs. Again, if you are aware of the problems that you have neuropathy and/or vascular problems, when you have an infection acting early will help you salvage or save the limb.

However, if you're not aware of it, if you sleep on it, if you ignore your infection, or if you're late, because of all the factors we have discussed it may be way too late for you to save the limb.

Summary

Remember diabetic wound care management is teamwork. Make sure that if you have a primary care doctor giving you an antibiotic and your infection is not getting better you must contact your podiatrist.

If you don’t have one get one immediately go to Er. Sometimes hospitals will have wound care centers that employ the podiatrist doctors or orthopedic doctor dealing with those wound infections. Diabetic foot ulcers should very carefully be observed until it heals up to prevent loss of limbs for diabetics.

Sometimes doctors will consult vascular surgeons to help open up the arteries. Also your podiatrist, your endocrinologist, your vascular surgeon even sometimes infectious disease specialist and wound care nurses will work together to get rid of that infection to save the limb.

AHMET ERGIN, MD, FACE, CDCES, ECNU ENDOCRINOLOGIST 2260 Palm Beach Lakes Blvd. Ste 212 Unit #7 West Palm Beach, Florida