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es just found out that he has diabetes. He came into my office yesterday because he was told he needed a diabetic foot check. I asked James if he had ever known anyone who had a diabetic amputation,Coach Factory Outlet. He said that yes, an uncle of his had lost a leg and then died many years ago,Coach Outlet. I asked him what happened. He started mumbling about an open sore or some kind of infection,http://www.coachoutletdesk.com, but he didn’t know any details. He had no real understanding of what transpired. He also said he didn’t understand what diabetes had to do with feet and amputations,Coach Bags.
Shouldn’t every diabetic know the details so that amputations could be prevented?
With each and every new patient with diabetes, they either fully comprehend the risks of diabetes to their feet (very rare) or they have no clue (very common). With every one of these folks I feel that the one goal is to get them to understand that diabetic foot problems are optional.
Diabetes can be a tough disease to deal with. Your doctor starts telling you what to eat, telling you to exercise, lecturing about heart attacks. Then you are at home learning about blood sugar monitoring, taking medicine, pricking your finger every day. People will say, “Now I gotta think about my feet too? Seems like such a hassle.”
And it is.
But the good news in all of this is that everything bad that can happen to you because of diabetes is preventable. Everything. All it takes is a little learning, a little lifestyle change, and little daily effort. The goal is to get you to understand the basics of how diabetes can affect your you can do something about it.
When you have diabetes you have three main problems, all working together and conspiring against you, that can lead to a diabetic foot amputation. It involves your nerves, blood flow and immune system.
When your blood sugar is high, there is a chemical reaction that directly damages the ends of the longest nerves in your body. The longest ones start in your back (where they exit the spine) and head all the way down to the toes in one long piece. Because the ends get damaged first, any nerve damage starts in the toes and gradually creeps up the foot toward the ankles.
It is always damaged at the same level in both feet. For example, if you have nerve damage (neuropathy) at the ball of the foot, the nerve damage is only in the toes. In this case the arches and heels might be fine.
Neuropathy makes it hard for you to tell if you are getting a blister or an open sore, and puts you at risk for problems. It is deceptive because you might be able to feel other things like the position of your feet, shoes and socks squeezing, but not a blister, cut or sore.
The second problem is the circulation or blood flow in the feet and legs. The arteries get clogged faster when you have diabetes. If you take two people who are identical, except one is diabetic, the one who is diabetic is four times more likely to have a heart attack. That is because of the increased rate of clogging up those arteries through the process called atherosclerosis. But this process happens everywhere, not just the heart. The blood vessels to the legs get plugged up too. Then, when you get a sore it takes longer to heal. It is also harder for your infection fighting white blood cells to get down there.
The last problem is your immune system. When your blood sugar is high, the white blood cells (called macrophages) have a hard to time fighting off those nasty bacteria. The white macrophages find bacteria through a process called chemotaxis. It is much like the white blood cells are following a trail of chemicals to the bacterial source. This is not very effective when the blood sugar is elevated. In effect, the macrophages are lost in the dark, simply bumping around, hoping stumble into some bacteria to kill. Very inefficient and not very effective.
Once they do find the bacteria they have a bigger problem. The elevated levels of blood sugar can pr
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