When you have diabetes, there’s a greater chance that you’ll one day require an amputation, especially of a foot or a toe.
Although it’s not a pleasant thought, doctors say it’s better to stay well-informed about your risk and take preventive steps now.
[See: Got Diabetes? Why You Must Protect Your Feet.]
Around 60 percent of lower-limb amputations that are not caused by trauma among people age 20 or older occur in people with diabetes, according to the American Diabetes Association. A total of 73,000 nontraumatic lower-limb amputations were performed in adults with diabetes in 2010, the association also reports. The risk for amputation is there whether you have Type 1 or Type 2 diabetes.
There are now fewer amputations of upper and lower limbs, but there’s an increase in amputations of toes or partial toes, according to 2013 research published in the journal Foot & Ankle International.
The increased risk of needing an amputation when you have diabetes has a few causes.
First, many diabetics experience what’s called peripheral neuropathy. That means poor blood sugar control over time can lead to pain, tingling or lack of feeling in your hands and feet — but especially your feet, says Dr. Deena Adimoolam, an endocrinologist and assistant professor of diabetes, endocrinology and bone disease at the Icahn School of Medicine at Mount Sinai in New York. You may step on something sharp but not feel it. Without proper monitoring, that injury could lead to an untreated infection (a foot sore is also called a foot ulcer). If the infection becomes bad enough because it’s not treated, it could require amputation.
About 0.65 percent of patients under age 44 experience foot ulcers; that risk increases to 1.3 percent in those age 75 and older, according to a 2014 study in the Journal of Vascular Surgery. The numbers may seem small, but when ulcers occur, they can turn serious without treatment.
[Read: The 411 on Diabetic Foot Ulcers.]
Additionally, people with diabetes are at a greater risk of peripheral artery disease, which is a clogging of the arteries. (Atherosclerosis is another term for this.) When you have clogged arteries, it’s harder for blood to circulate in your body. In turn, that makes it harder for things like foot ulcers to heal. “The ulcer is not getting enough blood supply,” says Dr. David Klonoff, a clinical professor of medicine at University of California–San Francisco and medical director of the Diabetes Research Institute at the Mills-Peninsula Medical Center in San Mateo, California.
“We need doctors to help [patients] get better control of blood sugar and prevent atherosclerosis,” says Dr. Todd Berland, a vascular surgeon and assistant professor of surgery at NYU Langone Medical Center in New York.
On top of all that, some of the factors associated an increased risk for amputation are also more common in people with diabetes. This includes having a high blood pressure, high cholesterol levels and a history of smoking.
Reducing Your Risk for an Amputation
If you’re diabetic, what can you do to reduce the chances of needing an amputation?
“Prevention, prevention, prevention,” says Dr. Richard A. Frieden, medical director of the Amputation Specialty Program at Mount Sinai Hospital in New York. One major step in that is better blood sugar control. However, that’s not the only thing you need to do, Frieden warns.
[Read: 8 Complications of Diabetes.]
— Quit smoking. “Smoking is the probably the No. 1 way to prevent atherosclerosis,” Berland says. It’s easier said than done, but smoking slows your body’s healing time and increases the risk for amputations. Klonoff tells the story of a group of doctors pondering if they had any patient who had needed an amputation but who was not a smoker. “No one raised their hands,” he says. Seek help if you have trouble quitting.
— Inspect and wash your feet every day. Check for signs of injury or problems that require further attention.
— Wear clean, dry socks. In fact, Klonoff recommends wearing white socks because if you have a foot injury that causes bleeding, it will be easier to spot.
— Don’t walk barefoot. “If you have neuropathy, you won’t feel it if you step on glass,” Adimoolam says. “Always wear footwear to prevent this.”
— Shake out your shoes every day, Frieden advises. This helps you make sure that a pebble or something similar hasn’t lodged in your shoe and irritated your feet.
— See a podiatrist regularly. Your podiatrist can help check the condition of your feet, cut your toenails properly, recommend proper-fitting footwear and treat any signs of foot ulcers.
— Be aware of your increased risk for peripheral artery disease when you have diabetes. Symptoms of peripheral artery disease in the legs includes weakness, cramping, a pain when walking and, in men, even erectile dysfunction, Adimoolam says. Talk to your doctor if you have these symptoms, and he or she can refer you to a specialist for further screening and treatment. If you have high cholesterol, make sure you get it checked regularly, and take any recommended medications and other steps to lower it, Berland advises.
— If you aren’t diagnosed with diabetes but think you’re at risk, get screened. “The majority of folks who come in [for amputations] are in their 60s,” Frieden says. He would like to see more people get screened for diabetes in their 40s and 50s so they can begin treatment earlier and avoid prolonged blood sugar levels that are out of control.
— Consider high-tech tools. There are now socks available with temperature sensors, and if one foot gets 5 to 6 degrees warmer than the other foot, or if you put more pressure on one foot than the other, it will let you know, Klonoff says. Those changes could indicate an injury. There are other innovations to help those with neuropathy to track foot irregularities they otherwise can’t feel, he adds.
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Why Diabetes Can Lead to Amputation originally appeared on usnews.com
