TORONTO -- More that 2,000 foot amputations took place in Canada in 2011-12 due to complications of diabetes, according to a new report on wounds in the Canadian health-care context.
Amplifying that already evident tragedy is the fact that many of those amputations could have been avoided, with good blood sugar control and careful foot care, said Dr. Jan Hux, chief scientific adviser for the Canadian Diabetes Association.
People suffering from both forms of the disease -- Type 1 and Type 2 -- are at higher risk of having to undergo an amputation because of a one-two punch diabetes throws.
The disease damages the small blood vessels that feed the nerves in the extremities, particularly the feet. That leads to a loss of sensation, which leaves diabetics with neuropathy (the term for the condition), unable to sense small cuts, blisters or abrasions on their feet. As a result, they may continue to wear a shoe that is rubbing, or won't know to clean and treat a cut or blister.
Once wounds form, they are slow to heal. Hux explained that the damage to the blood vessels prevents white blood cells from getting to the source of infection to clean up wounds and start the healing process. It even impairs flow of antibiotics to the site of the wound, if those medications are needed.
Depending on how far the damage has progressed, people can need to undergo a substantial amputation merely because what would be a small wound on someone else will not heal.
"If the injury is just in a toe, surely they could just do an amputation of the toe? But the very thing that prevents your own body from healing the wound in the toe would prevent it from healing the incision once you've done the surgery," Hux said.
"And so if the blood vessels aren't good in the foot and the blood vessels aren't good at the ankle and the blood vessels aren't good at the calf, you may end up with an above-the-knee amputation for a wound on the toe because that's how far the surgeon has to go to get tissue that has a sufficiently good blood supply that it will be able to heal after the surgery."
Diabetes care: Diabetes foot self-care
Most people only become aware that they have diabetes, after they develop major complications. These complications generally affect the eyes, heart, blood vessels, kidneys, nerves, teeth and gums. However, one of the most dreadful health complications that diabetes can cause is the diabetic foot.
Diabetic foot usually occurs as a consequence of diabetic neuropathy, which means damage to the nerves because of uncontrolled blood sugars. According to the World Health Organization, almost 27 per cent of diabetics develop periphery neuropathy and more than 50 per cent of those develop foot ulcers, gangrene and amputation resulting in a high mortality rate.
With increasing blood sugar levels, the blood circulation in the legs and feet may deteriorate and the nerves may become less sensitive leading to diabetic foot. This occurs due to neuropathy, peripheral vascular disease and infections. Nerve damage or diabetic neuropathy results in loss of sensation in the feet and makes diabetics more prone to other foot infections. There is also a diminution in sweat and oil gland functionality that lubricates the skin of the foot. As a result, the foot loses its natural ability to moisturise the overlying skin and becomes dry. These factors can lead to abnormal pressure on the skin, bones and joints of the foot during walking and can lead to a breakdown of the skin on the foot. Since there is no pain, most patients do not realise the gravity of the situation and tend to ignore minor injuries like a shoe bite. Peripheral Vascular disease, on the other hand, contributes to ulcerations and leads to delayed healing of those ulcers. Also, the diabetic foot can get infected and if the infection spreads down to the bone, it can lead to an amputation of the affected limb.
Symptoms of diabetic foot:
-A tingling or burning feeling in the toes and foot
-Numbness or loss of sensation in the foot
-Acute or piercing pain
-Serious foot problems such as ulcers, deformities in foot
-Difficulty in walking
Self care for diabetics:
-The foot should be cleaned thoroughly and then moisturised with skin cream at least twice a day in order to avoid dryness.
-Lukewarm water and soap should be used for cleaning the feet.
-One should check his/her feet everyday to look for any major or minor traumas. -There should not be any pressure marks or cracks between the spaces of the toes, redness or swelling around nails.
-One should wear comfortable and sturdy shoes, which are not too tight or loose to avoid shoe bites or pressure ulcers. The best socks to wear are woolen or cotton socks.
-Toe nails should be trimmed with nail clippers after washing the feet.
One should quit smoking as it damages the blood vessels and leads to poor blood circulation.
-One should avoid immersing the foot in hot water.
-One should not self-treat blisters occurring due to tight footwear. If there is blood or pus in the blister, a doctor should be consulted immediately.
-A proper control on blood sugar levels should be maintained by eating a balanced diet and taking prescribed medications.
There are some treatments that slow the progression of the disease, relieve pain and prevent complications. Most people need a combination of medications to relieve the pain. Some antidepressants (like amitriptyline, imipramine and duloxetine) can be given to diabetics to give them relief from pain. However, their prolonged use can have side effects like constipation, drowsiness and headaches. Nerve supplements such as methylcobal and gamma linolenic acid (GLA) as well as certain other medications can also be prescribed by the doctor.
Diabetic foot, if not treated on time, can lead to amputations. Although, there is no cure for diabetic neuropathy, most of the amputations can be prevented with timely treatment and proper education.
Study Finds Antipsychotics Triple Diabetes Risk
A new study suggests that medications often prescribed to individuals with developmental disabilities are associated with a significantly heightened risk for diabetes.
Researchers found that young people taking atypical antipsychotics like Risperdal, Seroquel, Abilify and Zyprexa were three times more likely to develop type 2 diabetes within the first year of using the drugs as compared to those taking other psychiatric medications.
The finding, published this month in the journal JAMA Psychiatry, is based on a review of medical records from 1996 through 2007 for individuals ages 6 to 24 enrolled in Tennessee’s Medicaid program. Nearly 29,000 of those studied were prescribed antipsychotics while the remaining 14,400 were taking other types of psychiatric drugs.
Beyond the threefold increase observed in the first year of taking antipsychotics, the study found that the risk for diabetes increased with cumulative dosages and persisted for at least a year after stopping the medications.
Doctors should carefully consider alternatives to antipsychotic medications and ensure that they are keeping tabs on kids who do take the drugs, said Wayne Ray, a professor of preventive medicine at Vanderbilt University and senior author of the study.
“Children should be monitored carefully for metabolic effects predisposing them to diabetes, and use of the drug should be at the lowest possible dose for the shortest possible time,” he said