Amputation and Diabetes – what you need to know
Updated: Apr 7, 2020
Amputation for Diabetes – what you need to know
We have heard more about diabetes in the past couple of years than ever before. We have heard how it’s a worldwide epidemic which is costing an inconceivable amount of money in terms of health care, lost earnings and loss of life.
We have also been made more aware of one of the complications of diabetes which results now in 169 amputations/week in England (Diabetes UK). This is a shocking statistic and one which is difficult to get your head around.
We may have heard this figure but do we actually understand why this is happening?
Below is a simple guide to diabetes and the potential risk of lower limb amputations. Hopefully it will make it clear why anyone with diabetes, whether newly diagnosed or someone who has had it for years, needs to be so vigilant with their feet.
Diabetes
First let us outline what diabetes actually is – it’s a disease where the body either cannot produce insulin, use it properly or both.
Insulin is a hormone which allows the body to absorb blood sugar into the cells where it is needed for energy.
There are 2 main types of diabetes (there are others but these 2 are the most common)
Type 1 diabetes is an autoimmune disease which usually starts in childhood. The immune system attacks the insulin producing cells in the pancreas stopping it from producing insulin. Insulin needs to injected daily for life as the pancreas will never produce insulin again.
At present there is no cure for Type 1 diabetes.
Type 2 diabetes develops in adults but sadly in the last 10 years increasing numbers of children are now developing Type 2.
This disease develops when cells become resistant to insulin. Cells can develop resistance to insulin as a response to excess fatty tissue. The result is no blood sugar can be absorbed into the cells for energy. Chances of developing Type 2 are increased by factors such as being overweight, lack of exercise, family history, getting older or being diagnosed with pre-diabetes.
Type 2 can sometimes be reversed if drastic changes in the patient’s diet and lifestyle are made and adhered to.
Symptoms of diabetes:-
Thirst
Frequent urination
Tiredness
Weight loss
Blurry vision
Slow healing wounds
People with Diabetes have a greater risk of:-
Developing Heart Disease
Having a stroke or heart attack
Kidney Failure
Eye problems e.g. cataracts, retinopathy
Gum Disease
Gastroparesis which is delayed stomach emptying
Foot problems and amputations
Diabetes complications related to amputation -
Peripheral artery disease
1 in 3 people with diabetes have peripheral artery disease. This is when the blood vessels are damaged, specifically they narrow due to a build-up of fatty deposits or plaque on the cell walls. One cause of this condition is high blood sugar levels.
This damage develops slowly over time so people don’t necessarily know they have it. This disease usually affects the blood supply to the lower limbs and ultimately can cause pain and swelling in the legs as well as cramping and numbness.
More importantly, as this damage affects the amount of blood flow to the lower limbs, it can affect the rate of repair to any injuries as well so increasing infection risk.
In severe cases infection can lead to gangrene which is dead tissue as no blood is getting to the affected area. Amputation is then required to preserve the rest of the body.
2. Neuropathy is nerve damage and in people with diabetes this nerve damage affects the legs and feet.
In basic terms – if someone is suffering from neuropathy they will not feel the sensation of pain so will not be aware if they have cut their foot, stood on something sharp or developed a blister on their toe. As the person is unaware of this injury they will not have it treated, potentially allowing it to escalate to an ulcer, then infection and possible amputation.
Symptoms of peripheral neuropathy in the feet and legs include:
Numbness, tingling or pins and needles, shooting pains, diminished reflexes in the ankle, foot problems such as infection, ulcers, and pain
Who is at risk of amputation?
People with uncontrolled diabetes who still have high blood sugars are at a higher risk of amputation.
Complications of diabetes make the legs and feet vulnerable to sores or infection and tissue damage.
Those that have both peripheral artery disease and neuropathy have a greater risk of amputation as there is already nerve and blood vessel damage. This damage makes healing of any sores, ulcers or tissue damage much more difficult as the blood flow is restricted from the infected areas so unable to help the healing process. That is assuming you know there is a problem to start with; suffering from neuropathy removes that ability to ‘feel’ there is a problem.
Sometimes amputation is the only way to preserve the rest of the patient’s body if the infection has taken hold. Removing the infected area can save the patient’s life by stopping the infection spreading.
There are now 169 of these lower limb amputations every week in England at present due to diabetic complications.
Preventing amputation
Of those 169 amputations per week, 80 % are preventable.
How?
By taking responsibility for your health and foot health.
- Monitoring blood glucose levels can help keep them within a healthy range.
- Achieving a healthy weight and maintaining it, and adopting a healthy eating plan. Regular exercise which is appropriate for your own body. (consult Doctor if unsure what is appropriate).
- Being aware of early symptoms of neuropathy. Early detection can help preserve foot
health.
- Daily foot check after washing and drying - establish a daily foot check as soon as you are diagnosed. It can be likened to cleaning your teeth twice a day which becomes a habit so changes to teeth and gums are detected straight away. It should be the same for your feet. Daily checks allow you to become familiar with the soles of your feet when they are healthy. This makes it easier to spot a change, which if looked at by a foot health professional straight away, may minimise the risk of something serious developing.
- Wearing properly fitted footwear and diabetic socks.
Surgery and life after an amputation
Unfortunately, in too many cases amputation is the only option left – if the toe or foot cannot be saved it is then necessary to remove the dead tissue to stop the infection spreading and risk the life of the patient.
Surgery involves cutting away dead tissue; this could be a toe, toes, foot or lower limb amputation up to the knee.
Sadly, if you have already had one amputation, the chances of you needing another amputation are much higher.
Rehabilitation after surgery depends on the extent of surgery and the patient’s medical history. Some will be able to have reconstructive surgery to allow prosthetics to be used. Some patients will not be able to use prosthetics.
Whatever the result of surgery, the life has been saved for now, but that life has changed. This not only affects the individual but also the family. If the amputee is the bread winner of the family, their ability to go out and provide for their family is affected – certainly in the short term but potentially for the long term.
Hopefully this has helped to explain why foot health is so important if you have diabetes and why it is especially important to take responsibility for your foot health to reduce the chances of having an amputation.
If you want to read the full article written by Caroline Leopold, which this is based on, look at the MNT website - here is the link: