Diabetes: Lower Limb Amputation, Neuropathy and PAD - Advanced Physical Medicine
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Diabetes: Lower Limb Amputation, Neuropathy and PAD

We've spoken before about the problem of diabetes in America, and briefly about the complications that can occur throughout the body when the disease is not well managed. Unfortunately having diabetes raises a persons risk factor when it comes to a number of other conditions. Trouble with skin and lower limbs are just two on a list of many, but they are two complications that need to be paid attention to. High blood sugar levels lower circulation and causes nerve damage that if not monitored, will lead to amputation.

According to the CDC, more than half non-traumatic lower limb amputations in the US are due to diabetes.

The statistics sound extreme, and the numbers have been going down some, but they emphasize the benefits of monitoring blood sugar levels and the harm that has been done to others by ignoring them. There are two main complications that will contribute to eventual loss of toe, foot or lower limb.

Reduced Circulation:

Cuts and other injuries in the body need the oxygen and nutrients that blood carries to assist in restoring and healing problematic areas. When high blood glucose decreases circulation to the lower limbs, any physical injury is inhibited in its healing process, leaving it open to serious infection. In some cases of neglect, the infection reaches the bone and becomes gangrene.

Neuropathy:File:Ulcers, fissures, and erosions.svg

Diabetes is one of the most common causes of neuropathy. Though raised glucose levels can damage nerve fibers throughout the body, the numbness and pain tend to be more prominently felt in the lower legs and feet. With the loss of feeling, often times cuts or injuries can go unnoticed and become infected or ulcerated, a condition in which the skin and soft tissues break down, easily. It is estimated that 15% of diabetic individuals will have diabetic foot ulcer problems in their lifetime. Medical professionals believe this number to be unrealistically low, due to diabetics not reporting foot issues.

What is the likelihood of infections effecting the lower limbs?

Unfortunately, the risk of infection is higher not only because poor circulation stunts a body's healing capabilities, but also because diabetics are also prone to a variety of skin conditions. High blood sugar can lead to conditions including:

  • Carbuncles (deep infections of the skin and soft tissues beneath)
  • Boils
  • Rashes
  • Foliculitis
  • Infections around the nail
  • Bullosis Diabeticorum: blisters on the back of fingers, hands, toes,  feet and sometimes legs and forearms.
  • Digital Sclerosis: tight thick skin on the back of the hand, and sometimes toes and forehead that causes joints to stiffen and become immovable.
  • Eruptive Xanthomatosis: yellow pea-like enlargements of the skin on the back of hands, feet, arms, leg and buttocks. More prevalent in men with type 1 diabetes and high cholesterol.
  • Charcot Foot: a food deformity that least to a loss of sensation during which an undetected broken bone will cause soft tissue destruction.

When combined with neuropathy, a diabetic skin condition on the legs or feet can easily be overlooked and fester into infection. At the point at which antibiotics and debridement, the removal of affected or necrotic tissues, stop being effective,  it becomes necessary to amputate in order to prevent the infection from spreading and damaging adjacent areas of the body.

Peripheral Arterial Disease:

File:Peripheral Arterial Disease.gifDiabetes also increases the likelihood of Peripheral Arterial Disease (PAD), which occurs when blood vessels in the legs are narrowed or blocked by fatty deposits, decreasing blood flow to the legs and feet. This condition puts a diabetic at even a higher risk of heart attack and stroke.

What connects diabetes and PAD?

Diabetics and those with impaired glucose regulation, test with high levels of C-reactive protein (CRP).

C-reactive protein (CRP): a protein found in the blood that appears when swelling is present somewhere in the body. It is often tested for after surgery or treatment for infections.

Elevated levels of CRP, which diabetics test high for, are strongly associate with the development of PAD. For one in three diabetics over 50, the reduced circulation due to high blood glucose, will lead to Peripheral Artery Disease (PAD). Other factors of the condition include smoking, high blood pressure and cholesterol, obesity, sedentary lifestyle and a history of heart disease.

If injury due to unnoticed effected tissue or the development of PAD because of high CRP levels lead to amputation, not only can it be an incredibly painful process, it also requires up to 8 weeks to properly heal. After that, extensive physical therapy and lifestyle adjustments are in order.

How can this be prevented?

The best way to prevent the possibility of amputation in the future is to take care of yourself. Keeping close watch on your diabetes by monitoring sugar levels regularly, adjusting to a more consciously healthy lifestyle and paying attention to even small injuries on your lower limbs will go a long way.

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