In my last column I mentioned a woman with diabetes complications that led to the amputation of her arms and legs. It's a frightening turn of events that could happen to any of us with diabetes.
A dear reader in his 70s emailed me a little bit of information on his history and how he works to keep his blood sugar lower. Like me, he really is trying. And as it is with me, his is a constant battle.
He said he has read about amputations associated with diabetes, but wanted to know what leads to such drastic measures. The more I thought about it, the more I realized that I had questions too, especially since it could affect me and others I know personally.
Amputation is a scary topic. We could lose a limb, finger or toe, or even our life.
I reached out to the ever-helpful Dr. Peter A. Goulden at the University of Arkansas for Medical Sciences. He's an assistant professor of medicine and the director of the UAMS diabetes program.
I first asked what situations could lead a person with diabetes to need leg or foot amputation.
Goulden said three main factors can create the "at-risk foot" for these people.
First is the loss of sensation, or diabetic neuropathy. This happens when the sensory nerves in the foot become damaged over time, particularly if the diabetes has not been well controlled.
In some patients, he says, low vitamin B can contribute to such nerve damage. (So that's something to have checked by our doctor: Are we getting enough vitamin B?)
Secondly, reduced blood flow or peripheral vascular disease can contribute. Signs of peripheral vascular disease can include a change in the color of toes or aching in the calves after exertion.
According to information provided by the U.S. National Library of Medicine, peripheral vascular disease, also known as PVD or PAD (which I prefer), is a condition of the blood vessels that leads to a narrowing or hardening of the arteries that supply freshly oxygenated blood to the legs and feet. The narrowing of the vessels decreases that blood flow, which in turn can injure nerves and other tissues.
The vessels narrow when fatty material called plaque builds up on their walls -- somewhat like gunk collecting on the insides of a pipe. The channel through which blood can flow tightens, and the walls of the arteries become stiffer. This means they cannot widen or dilate to allow greater blood flow when it's needed -- for instance, when someone tries to run to catch a bus or keep up with a toddler.
As a result, when the muscles of your legs are working harder they cannot get enough blood and oxygen.
We are at higher risk for PAD if we have a history of:
• Abnormal cholesterol
• Diabetes
• Heart disease
• High blood pressure
• Smoking
• Kidney disease
• Stroke
FEND OFF PAD
There are steps people with diabetes can take to help prevent PAD (but always consult your doctor). We can:
• Balance exercise with rest. Over time, circulation may improve as new, small blood vessels form.
• Stop smoking. It narrows the arteries, decreases the blood's ability to carry oxygen and increases the risk of forming clots.
• Take care of our feet.
• Control our blood pressure.
• Reduce weight if we are overweight.
• Lower our cholesterol by eating a more careful diet.
• Monitor blood sugar levels.
For more information on this topic, go to nlm.nih.gov and search for "peripheral artery disease."
MONITOR ALL SORES
The third common trigger leading to amputation is an open wound or ulcer, typically on the foot. Healing may be delayed as infection is often "encouraged" by high glucose levels in the blood. The glucose feeds harmful bacteria. When wounds become infected, severe cases can progress to gangrene.
As a teen, I had the occasion to be a candy striper at the former Baptist Medical Center where there was a patient who had been in a motorcycle wreck. I was not privy to the details, but he had gangrene. I can still hear his moaning and wailing in my mind. The leg looked awful and eventually was amputated. I can only imagine what horrible things he experienced through it all.
Gangrene is basically the death of tissue in a part of the body. The body part loses its blood supply from things like a serious injury, blood vessel disease, diabetes, surgery or a suppressed immune system.
Treatment can include antibiotics, operation to remove dead tissue (sometimes several operations), operation to improve blood supply to the area, or amputation.
The key message, Goulden says, is to look at our feet every day and seek treatment if we develop a sore or ulcers. Early assessment can be key in reducing the risk of amputation.
So we need to look for signs of infection. They can include heat, redness and pain. However, for a person with neuropathy who might not have much feeling in the hands or feet, such a wound could be painless. And poor blood flow to the feet can increase the risk of rapid progression of foot problems. So an annual foot exam can really help.
TAKE IT SERIOUSLY
So what can we do to avoid the need for amputation?
Goulden says that constant vigilance is key. And quick action if we suspect a problem is important, too. Having an assessment with a podiatrist is also a good idea. Things like wearing the right shoes or making adjustments to ill-fitting footwear can make all the difference. A regular exam can also correct ingrown toenails, athlete's foot and calluses.
And for the patient with an ulcer or open wound, see the doctor. Appropriate care and antibiotic therapy can reduce the risk of infection.
Exercise can help as well, by increasing circulation and blood flow. Goulden says that for people with neuropathy, a stationary bike and swimming are good choices. And those activities are low impact, so just about anyone can do them even if we need a little help.
There are two things, he says, that are key to remember:
• Check with your health-care provider before starting an exercise routine.
• Check your blood glucose before and after any exercise routine.
I guess the bottom line is that if we don't want diabetes to cost us an arm or a leg, we need to practice due diligence with our bodies. As the song says, "the road is long with many a winding turn, that leads us to who knows where." And where we go is really, in the end, up to us.
Email me at:
rboggs@arkansasonline.com
ActiveStyle on 06/02/2014