All you need to know about amputation for diabetes

Amputation is preventable or it can be delayed. People with neuropathy, peripheral artery disease, or both can take steps to preserve their health

how-to-talk-to-your-doctorPeople with diabetes have high blood sugar, which can lead to serious complications if untreated.

Two serious complications are nerve damage and peripheral artery disease. These can lead to the need for amputation below the knee.

Diabetes overview

Diabetes mellitus, commonly known as diabetes, refers to a group of metabolic diseases where the body cannot produce insulin, use insulin properly, or both.

Insulin is a hormone that helps the body to absorb blood sugar into the cells. In the cells, it is used for energy.

The main types of diabetes are type 1 diabetes and type 2 diabetes. Another type, gestational diabetes, develops only during pregnancy. This type puts women at a higher risk of developing type 2 diabetes in the future.

Type 1 diabetes

Type 1 diabetes is an autoimmune disease where the immune system mistakenly destroys insulin-producing cells in the pancreas. People with type 1 diabetes can no longer produce insulin.

Treatment is usually through insulin injections. There is no known way to prevent type 1 diabetes.

Type 2 diabetes

Type 2 diabetes is the most common form of diabetes. It develops when the body’s cells become resistant to insulin. This means the cells cannot get enough blood sugar needed for energy.

Obesity is believed to be the greatest risk factor for type 2 diabetes. Cells develop insulin resistance in response to excess fatty tissue. Other risk factors include family history, lack of exercise, and a history of prediabetes or gestational diabetes.

Type 2 diabetes can sometimes be reversed or slowed with lifestyle changes.

Gestational diabetes

Gestational diabetes is a form of type 2 diabetes that starts during pregnancy. It usually stops once the baby is delivered. Around 9 per cent of all pregnant women develop gestational diabetes.

Symptoms of diabetes

Many of the symptoms of type 1 and type 2 diabetes are the same. The most common symptoms are excessive thirst and frequent urination. Other symptoms common to both type 1 and type 2 diabetes are:

  • Intense hunger
  • Tiredness
  • Weight loss
  • Slow-healing wounds
  • Blurry vision

Anyone experiencing any of the above symptoms should seek a health provider. Diabetes is diagnosed mainly through testing blood sugar levels.

Complications

Diabetes is a serious disease, and it can affect nearly every part of the body. People with diabetes have a greater risk of heart disease and stroke. People with diabetes are two times more likely to have a heart attack or stroke than people without the disease.

Here are some other complications of diabetes:

  • Kidney problems leading to kidney failure
  • Eye problems such as cataracts or glaucoma
  • Digestive disorders such as gastroparesis, which is delayed stomach emptying
  • Gum disease

Diabetes complications related to amputation

Peripheral artery disease

Peripheral artery disease occurs when the blood vessels become narrow. The narrowing occurs because the walls of the arteries have fatty deposits or plaque on them. People who have plaques in their arteries have atherosclerosis. This narrowing can lead to blocked arteries, which is peripheral artery disease.

Peripheral artery disease is more common among people with diabetes. About 1 in 3 people with diabetes have peripheral artery disease. Often people do not know they have peripheral artery disease because there are no symptoms.

When symptoms occur, they may include pain and swelling in the lower leg, and pain or cramping while walking, called claudication.

Peripheral artery disease usually affects the arteries taking blood to the legs, but can affect arteries going to the other parts of the body.

The reduced blood flow to the legs and feet can cause problems in the legs. The blocked blood flow can cause pain, numbness, and might make a person more susceptible to infection in the affected limb.

If the blockage is severe, an infection can lead to gangrene. This means that some tissue has died. Advanced cases of peripheral artery disease can lead to amputation

Neuropathy (nerve damage)

High blood sugar can damage the nerves, leading to neuropathy. Diabetic neuropathy most often affects the legs and feet.

A person with nerve damage in the foot can have an injury without feeling it.

An injury or wound that is not treated could lead to serious problems, including amputation.

Symptoms of peripheral neuropathy include:

  • Numbness
  • Pain
  • Tingling or sharp pains
  • Weakness
  • Loss of coordination
  • Diminished reflexes in the ankle
  • Foot problems such as infection, ulcers, and pain

 

Who is at risk for amputation?

People with uncontrolled diabetes, high blood sugar, and high blood pressure are at greater risk of needing to have their toe, foot, or leg amputated. This is because poor blood sugar control is more likely to lead to complications.

The complications of diabetes, including neuropathy and peripheral artery disease, increase the risk of further problems and the need for an amputation.

The complications of diabetes make the legs and feet vulnerable to skin sores, or ulcers, infection, and tissue damage.

Often, people have peripheral artery disease and neuropathy. This makes the problem worse. These conditions can worsen quickly, and they are difficult to treat.

Sometimes, amputation is recommended to preserve the body and save the patient’s life.

Between 12 and 15 people in every 100,000 each year will have an amputation due to peripheral artery disease.

Most of these people have diabetes. The reason for amputation is to remove infected or dead tissue caused by lack of blood flow to heal the area.

Preventing amputation

Amputation is preventable or it can be delayed. People with neuropathy, peripheral artery disease, or both can take steps to preserve their health. Ensuring that the feet are properly cared for is recommended for people with diabetes.

The following steps are important:

  1. Monitoring blood glucose levels can help to make sure they stay within a healthy range. People with type 1 diabetes may need to use a glucose meter on a regular basis. People with type 1 and type 2 diabetes may need A1C blood tests to see how their blood glucose has been over the past 3 months.

  2. Maintaining a healthy weight and adopting a nutritious meal plan is critical, especially for people with type 2 diabetes

  3. Engaging in regular physical activity and exercise is important. The American Diabetes Association recommends 30 minutes of moderate exercise 5 days per week or a total of 150 minutes. Some physical activities are not safe for people with nerve damage.

  4. Monitoring for symptoms of diabetic neuropathy, and consulting a doctor if symptoms appear. Early detection and treatment can preserve limb health.

  5. Taking good care of the feet and checking them daily for wounds or problems such as coldness or heat. This is important, as the person might not feel pain.

  6. Protecting feet with good shoes and socks that fit properly is important. Patients should be careful when washing and drying the feet.

Surgery and life after an amputation

Amputation becomes necessary when there is a serious health threat or major infection, such as gangrene.

Surgery involves cutting away dead tissue and repairing damaged arteries. It may be used to restore blood flow.

Complications of amputation surgery are similar to those of other types of surgery. They include complications with anaesthesia, infection, nerve and blood vessel damage, bleeding, or blood clots.

Recovery depends on a range of factors. Each person’s surgery and rehabilitation will be different. Patients are advised to discuss their situation with specialists who understand peripheral artery disease and neuropathy.

Reconstructive surgery may be done to make it easier to use a prosthetic. There are a variety of prosthetics available, and Medicare or other insurance can cover them.

Resources that explain surgery and recovery include a detailed patient guide by Johns Hopkins School of Medicine.

There are support groups available such as the Amputee Coalition.

Source: Medical News Daily