How Diabetes Can Damage Your Body Parts And Lead To Amputation

Sunita Desai, 68-year-old, has kept her nose to grindstone both as a school principal and a mother of four. It was only after retirement that she got some time for herself. One day, while strolling in a park, a little nick on her left foot pricked. She thought it would go away with time, but it just got bigger, from sore to abscess to ulcer. Within two years, it festered to the extent that the foot had to be amputated. “I was always worried about my heart due to my high blood sugar level. But it affected my foot instead,” she says.

Ms Desai is not the first one. Every 30 seconds a lower limb is lost due to diabetes worldwide. According to the Vascular Society of India, about one lakh leg amputations occur every year in India due to diabetes-related problems. Out of the 62 million diabetics in the country, 25 per cent develop ulcers, sores and life-threatening infections on their feet at some point during their lifetime. A lot of things can go wrong with diabetes, but more than a kidney transplant, stroke, nerve damage, loss of vision or heart attack, what puts you in the hospital most often is a foot infection. It's largely under-reported and yet one of the most serious complications of the disease.

Some of the signs and symptoms that a person should look out for and consult a doctor include swelling in the feet, blisters, an ulcer that lasts more than a week, a bad odour from a wound and a sore that does not quickly begin to heal.

The root cause of diabetic amputation

Sometimes diabetes can lead to peripheral artery disease (PAD). When a person is suffering from PAD, blood vessels narrow and reduce blood flow to the legs and feet. This may cause nerve damage which is known as peripheral neuropathy. It could prevent you from feeling pain. The patient may not realize they have a wound or ulcer on the feet as they cannot feel pain. Unknowingly, they may continue putting pressure on the affected area, which can cause it to grow and become infected.

Reduced blood flow can delay wound healing and can make the body less effective at fighting infection. As a result, the wound may not heal. Tissue damage or death (gangrene) may occur, and any existing infection may spread to the bone. If the infection cannot be controlled or the damage is irreparable, amputation may be necessary.

For diabetic foot ulcers, walking barefoot is considered a serious risk factor. In The Journal of Diabetic Foot, a 2013 study showed that the percentage of high-grade foot ulcers was significant in those who walked barefoot or wore ill-fitting shoes, with 84 per cent stepping accidentally on hard or sharp objects. Indians are known to sit cross-legged. Pressure on feet for too long often leads to nerve damage. Toe rings cut off oxygen and blood supply. This leads to heat, sweat and fungal infection setting deep inside the foot.

Potential ways to avoid amputation

It’s important to keep in mind that early intervention and treatment of PAD is the most effective way to potentially avoid amputation. Waiting too long to seek treatment can severely limit your options. If the patient is concerned about having surgery to treat PAD, they should ask the doctor about less invasive alternatives. There are several minimally invasive peripheral artery disease treatment options you can look into, including procedures such as atherectomy or angioplasty and stenting.

Several lifestyle factors can help a person manage their blood sugar levels, such as - reducing stress, following a well-balanced diet plan that a nutritionist has helped create, doing regular exercise, taking medications and insulin according to a doctor's recommendations. Another important preventive step is to take good care of the feet, which a person can do by examining the feet regularly for cuts, bruises, blisters and scrapes.

In rural areas, patients with diabetic neuropathy are more prone to foot ulcers than those who live in urban areas - the main predisposing factor is barefoot walking, which can result in injury to the feet. In India, among diabetic patients, there is poor awareness regarding the need for foot care. Strategies such as foot care education and intensive management are helpful in preventing newer problems and surgery in diabetic foot disease. Population in rural areas have lower educational status, therefore more intensive methods for awareness are required. Do not forget, there is no such thing as a harmless cut on your feet when you have diabetes.

Dr Digvijay Sharma

Guest Author The author is Principal Consultant Vascular & Endovascular Surgery, Max Hospitals.