Will I Lose My Legs?
How diabetes impacts limbs
You may find it odd to hear, but a countless number of my diabetes patients have asked me if they will lose a leg.
They start the questioning by recalling a story about their dad’s sister’s brother or their next-door neighbor’s aunt. All these stories had one thing in common: A lower limb amputation.
Amputation is one of the most feared diabetes-related complications. I assume this is because it is so obvious, dramatic and it can significantly affect quality of life.
Having a mild heart attack or a cataract pales in comparison when dealing with a foot ulcer that won’t heal and looking down the barrel of an amputation. It’s confronting and it puts an otherwise often ‘hidden’ medical condition into the spotlight where it can’t be ignored.
Studies suggest that approximately 1% of all people with diabetes will have a lower limb amputation. It is estimated that a lower limb, or part of a lower limb is lost every 30 seconds as a result of diabetes. So how does one go from being newly diagnosed with diabetes to facing an amputation?
How does diabetes affect feet?
Diabetes is characterized by elevated blood glucose levels. When blood glucose levels are elevated, blood vessels are damaged, much like the damage that results from smoking, high blood pressure and high cholesterol. When blood vessels are damaged, they begin to narrow and therefore blood doesn’t flow as effectively as it should.
Toes are the body part that is furthest away from the heart. Oxygenated blood has to work its way through a maze, having a mighty long way to travel through a number of different arteries, to flow from the heart all the way down to the toes.
So, if there’s narrowing of blood vessels due to elevated blood glucose levels, this decreases the amount of oxygenated blood flow to the lower limbs. Reduced blood flow to the lower limbs is known as peripheral arterial disease. Symptoms of peripheral arterial disease (PAD) can include pain, cramping, burning or aching, discoloration, coolness of the legs and numbness or weakness. PAD prevents the tissues and skin from healing quickly and properly due to the lack of blood supply.
Going a step further, when blood vessels narrow and oxygenated blood flow to the nerves reduces, this can cause damage to the body’s nerves. Nerves are the things that send messages to and from the brain to other body parts. The nervous system enables us to breath, walk, talk, feel emotion, as well as feel discomfort and pain. When accidentally picking up a hot pan from the stove, it’s the nervous system that alerts us to drop it quickly, so we don’t get a serious burn.
When the nerves in the lower limbs become damaged through elevated blood glucose levels, sensation in our feet and legs can be altered, resulting in burning or tingling sensations, pain, cramps, numbness and a decreased ability to feel pain or temperature changes. This is known as peripheral neuropathy.
As you can imagine, when our feet don’t pick up pain and sensation effectively, we could accidentally stand on hot concrete and not notice our feet burning, we may sustain a cut on our foot and not feel it is there or we may even pick up a nice little toenail infection from our latest pedicure and not realize.
When a person with diabetes has PAD or peripheral neuropathy (or both!), a foot ulcer can result indicating diabetes-related foot disease. Ulceration can unfortunately, at times, lead to serious infections, resulting in amputation.
How to protect your feet
Now with all this depressing information, it is important to remember that there is a lot that can be done to prevent damage to blood vessels and nerves and reduce the risk of developing diabetes-related foot disease. Here’s a few tips to help keep feet healthy.
Look after your diabetes.
Aim to keep blood glucose levels in your target range. We know that damage to blood vessels and nerves is caused by blood glucose elevations, so keeping levels as close to ‘normal’ range as possible will reduce the risk of foot problems. Talk your doctor or diabetes healthcare professional about your current diabetes treatment and whether it is appropriate for you.
Look at your feet every day.
At the end of a long day when plonked in front of the TV watching Netflix, have a good look at your feet. If you can’t see them easily get a friend or family member to look at them or use a mirror. If you notice any changes or anything unusual make an appointment to see your doctor as soon as possible. It’s also a good idea to have a diabetes foot check conducted by your doctor or podiatrist at least once a year, just to keep an eye on the health of your feet.
Wear protective well-fitting shoes.
I know when it’s a hot summers day we all just want to rock our flip flops or fashion sandals. Wearing clean socks and well-fitting shoes that cover your toes will help protect your feet from any potential scraps or burns.
Wash and dry your feet well every day.
Let’s face it, even without diabetes no one likes stinky feet, so wash them with a gentle soap and dry them well, particularly between your toes. You can also moisturize your feet every day to reduce dryness — just don’t put moisturizer in between your toes.
Trim your toenails.
Keep your nails well-trimmed. If you can’t reach your toenails then seek regular assistance from your doctor or podiatrist.
Stop smoking.
Smoking contributes to the development of PAD, causing narrowing of our blood vessels, so quitting smoking will reduce the risk of developing foot problems.
Lose weight.
Being overweight as well as having high cholesterol can increase the risk of developing PAD and neuropathy. It also increases the risk of foot ulceration. Engaging in regular physical activity and eating a healthy diet can assist with weight loss, as well as improve blood glucose levels thus reducing the risk of blood vessel and nerve damage.
Remember, prevention is king
Whilst around 1% of people with diabetes will have an amputation, 99% of people with diabetes won’t. These are good statistics.
Showering your feet with the love and attention they deserve, whilst incorporating the tips above into your life will help to reduce your risk of diabetes-related foot problems.
There’s no time like the present to put your best foot forward!
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