Diabetes is a disease which leads to several complications over time. If it is properly managed at the outset, many debilitating or even life-threatening problems may be avoided in the long run. When nerve damage due to prolonged high blood sugar level becomes severe, the lower extremities may have to be amputated. Diabetic patients have an approximately 15 fold higher risk of amputation than non-diabetic patients.
Amputations Are of Two kinds
Minor amputations – the toes or feet are removed.
Major amputations – the area above or below the knee is removed.
Causes of Amputations Due to Diabetes
Ischemia is a term derived from Greek, which means an insufficient circulation of blood in the tissues. This causes a shortage of oxygen and glucose, leading to the death of the tissue. The signs of ischemia are numbness of the body part, mottling of the skin or uneven discoloration of the skin. If a diabetes patient suffers from a vascular disease resulting in poor blood flow, then amputation may become necessary during extensive ischemia.
Diabetic patients are more prone to developing infections. Lower extremity infections such as foot infections, osteomyelitis (infection of bone) in the ankle or foot, cellulitis (infection of connective tissue) and fasciitis (infection of skin and subcutaneous tissues) are commonly seen.
Foot infections may occur in the nail bed, at the bottom of calluses or in ulcers. Bacteremia (presence of bacteria in the blood) may worsen the situation. The microorganism Staphylococcus aureus is frequently seen in diabetes-related infections. When the infection becomes advanced, amputation is the only way to prevent it from spreading even further.
The presence of a high level of glucose in the blood for a long period of time causes injury to the blood vessels which cater to the nerves (vasa nervorum).
Reduced sensation makes it difficult for the patient to detect the early signs of ulcer and injury such as cuts and bruises. When such ulcers or cuts become infected, they are tougher to treat.
Faulty Wound Healing
Diabetes brings about lower immunity by impairing the action of polymorphonuclear leukocytes. These cells are responsible for destroying foreign agents in the body. Thus, an infected ulcer or sore in the body may take longer to heal, or may not respond to treatment at all. In such an event, amputation is the only remedy.
If minor cuts, bruises or cracks in the skin are not dealt with appropriately, they may progress to non-healing ulcers or sores and get infected. So, it is necessary to monitor the feet continuously for small changes in the skin.
The diabetic patient may not be able to feel any undue pressure on the foot caused by ill-fitting footwear or walking and running. This may give rise to neuropathic ulcers with little pain. Ulcers may also form below corns and calluses, especially if the patient tries to dress the wound by himself.
Severe blockage of blood flow to the lower extremities ultimately leads to gangrenous (dead) tissue. This is a life-threating condition and may occur all too often in poorly managed diabetes.
The thought of amputation rightly strikes a chord of fear in every patient’s heart. However, proper management of diabetes is the key to preventing it.