How uncontrolled diabetes can lead to nerve damage and limb amputation

Diabetes is a metabolic disorder, typically characterized by hyperglycemia or high levels of blood sugar or glucose. The term hyperglycemia refers to a condition in which the blood glucose is greater than 125 mg/dL (milligrams per deciliter) after 8 hours of fasting. This condition is prevalent in people who suffer from either Type 1 or Type 2 diabetes, where there is defective insulin secretion, impaired insulin action, or both.

• In Type 1 Diabetes, the person’s body may not be producing enough insulin.
  
  
• In Type 2 Diabetes, the person’s body may have enough insulin, but it is not being used as effectively as it should be.

The insulin deficiency and resultant increase in glucose in the person’s blood can result in several complications in the person’s system – particularly in the nerves, blood vessels, kidneys, heart, vision and limbs.

These long-term complications develop gradually, so patients may not notice them at first. However, by the time they receive the attention they need, the complications may be disabling or even life-threatening.

Nerve damage due to diabetes and its debilitating effects

Diabetic neuropathy or nerve damage is one of the most common complications caused by excess sugar in the blood. In many diabetics, the extra sugar injures the walls of the fine capillaries that carry blood and nourish the nerves that are present in the limbs.

Symptoms relating to the onset of this complication begin with tingling, numbness, burning, or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.

If untreated, this could lead to poor blood flow and loss of feeling in the affected limbs. This increases the risk of sores, blisters, and serious infections, which take time to heal. Unfortunately, this nonhealing ulcer can cause gangrene or death of bone and body tissue due to a lack of blood flow and may require surgical removal (amputation) of a toe, foot, or even the whole leg.

According to data from the Vascular Society of India, about 1 lakh leg amputations occur every year due to diabetes-related problems.

Prevention is the answer

The good news is that this dire complication can be prevented with proper diabetes management and careful foot care. Studies conducted internationally reveal that proper diabetes care has brought down limb amputation by more than 50 percent in the past 20 years.

Some of the first steps towards proper diabetes care include following a healthy diet, regular exercise, blood sugar monitoring, and adherence to a prescribed medication.

In addition, it demands that high-risk persons follow a proper foot care regimen.

Prevent ulcers on the feet

Pay careful attention to your feet, every day. Check your feet regularly for sores, calluses, blisters, bruises, cuts, cracks, redness, or swelling. If you need help in doing this, ask for help from a family member.

Wash your feet in tepid water before going to bed. Use a pumice stone or dead skin remover to remove dead skin tissue and calluses. Pat your feet dry with a clean towel, especially between the toes. Then massage your feet gently with cream or hydrating lotion and keep them soft.

Warts, corns, and cracked or flaky skin must be treated immediately to avoid bacteria from infecting your feet. However, this is best done under medical supervision, so do approach your GP or foot specialist (podiatrist) for the removal of any lesions on the foot.

It is very important to wear comfortable, well-fitting footwear to protect your feet at all times, even indoors. Footwear must always provide support and cushioning for the heel, arch, and ball of the foot.  Tight-fitting shoes and high heels or pointed shoes tend to crowd your toes and cause discomfort.

Socks, when worn, must always be made of breathable fabric such as cotton. Nylon or synthetic materials are a definite no no! Avoid socks which have tight elastic bands because these will reduce the circulation of blood and give rise to irritation, soreness and further complications.

Schedule regular foot examination at least once a year or your doctor if you have any of the following conditions on your foot

• Blisters
• Redness
• Swelling
• A foul odour
• Athlete's foot
• Constant pain
• Ingrown toenails
• Plantar warts on the sole
• An open sore or bleeding
• A sore that takes time to heal
• An ulcer bigger than 2 centimeters
• Darkening or discoloration of the skin
• Burning sensation in one area of the foot
• An ulcer that lasts longer than one to two weeks
• An ulcer so deep that the bone underneath is visible

Your doctor will inspect your foot to diagnose the problem and prescribe appropriate treatment.

When amputation is recommended

Quite often, untreated foot ulcers lead to the death of the surrounding bone and tissue. To prevent this from spreading further, doctors recommend surgical removal of the infected area. The treatment includes the removal of dead tissue or debris, keeping the wound clean, and promoting healing. After amputation, it may take four to six weeks for the wound to heal completely.

Even after one amputation, it's important to follow a strict diabetes treatment plan, because there is always the risk of a similar complication in any of the healthy limbs.

Diabetes reversal programs that promote eating healthy foods, non-sedentary activities, regular exercise, controlling blood sugar levels, and avoiding tobacco can help in preventing diabetes-related complications.

Start your "Diabetes Reversal" journey by participating in our Discover Reversal Session.  It is the introductory session of our annual diabetes reversal program which we call a Holistic Transformation Program conducted by Dr. Pramod Tripathi himself. Enroll in the upcoming online session now, to learn how you can also reverse your Diabetes.