Home Health Glenn Ellis Ellis: Diabetes and amputation

Ellis: Diabetes and amputation

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By Glenn Ellis

Black Americans on Medicare are three times more likely than other patients to lose a leg to amputation because of complications with diabetes and peripheral arterial disease, according to a 2014 study. In almost all cases, when comparing black and nonblack patients, the lowest-risk black patients had a higher risk of amputation than nearly all nonblack patients.

So you see, diabetes in blacks is no joke, and we shouldn’t take it lightly.

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.

Diabetes remains the seventh leading cause of death in the United States in 2015, with 79,535 death certificates listing it as the underlying cause of death, and a total of 252,806 death certificates listing diabetes as an underlying or contributing cause of death. However, diabetes may still be underreported as a cause of death. Studies have found that only about 35 percent to 40 percent of people with diabetes who died had diabetes listed anywhere on the death certificate and about 10 percent to 15 percent had it listed as the underlying cause of death.

Of the 30.3 million adults with diabetes, 23.1 million were diagnosed, and 7.2 million were undiagnosed. That means there are millions of people walking around with diabetes and don’t even know it.

Type 2 Diabetes

In fact, studies have shown that exercise and a healthy diet can prevent the development of type 2 diabetes in people with pre-diabetes — a condition that often develops prior to full-blown type 2 diabetes. Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves. Nerve disease caused by type 2 diabetes is the leading cause of amputation of feet, toes, legs, hands and arms among diabetes sufferers. Collectively, the disorders which cause these amputations are called diabetic neuropathies.

Type 2 diabetes foot problems are the most frequent reasons for hospitalization of people with type 2 diabetes. But many diabetes-linked hospitalizations and amputations could be prevented by better management of diabetes via increased insulin sensitivity and the reversal of the imbalance of blood glucose and insulin called Insulin Resistance. The earlier that action is taken to maximize insulin sensitivity, the greater the chance of avoiding the need for amputation.

People with diabetes can, over time, develop damage to nerves throughout the body. Neuropathies lead to numbness and sometimes pain and weakness in the hands, arms, feet, and legs. Problems may also occur in other areas, including the digestive tract, heart, and sex organs.

In some cases, diabetes can lead to peripheral artery disease (PAD). PAD causes your blood vessels to narrow and reduces blood flow to your legs and feet. It may also cause nerve damage, known as peripheral neuropathy. This could prevent you from feeling pain.

If you can’t feel pain, you may not realize you have a wound or ulcer on your feet. You may continue putting pressure on the affected area, which can cause it to grow and become infected.

Reduced blood flow can slow wound healing. It can also make your body less effective at fighting infection. As a result, your wound may not heal. Tissue damage or death (gangrene) may occur, and any existing infection may spread to your bones.

If the infection cannot be stopped or the damage is irreparable, amputation may be necessary. The most common amputations in people with diabetes are the toes, feet, and lower legs.

Persons with diabetes can develop nerve problems at any time. But the longer a person has diabetes, the greater the risk. An estimated 50 percent of people with diabetes have some form of neuropathy, though not all those with neuropathy have symptoms. The highest rates of neuropathy are among people who have had the disease for at least 25 years.

Diabetic Neuropathy

Diabetic neuropathy also is more common in people who have problems controlling their blood sugar, in people with high levels of blood fat and blood pressure, in overweight people and in those over the age of 40. The most common type of neuropathy is peripheral neuropathy – also called distal symmetric neuropathy – which affects the arms and legs.

This type of neuropathy damages nerves in the upper and lower extremities. The feet and legs are likely to be affected before the hands and arms. Many people with diabetes have signs of neuropathy upon examination but have no symptoms at all.

Symptoms of peripheral neuropathy may include: numbness or insensitivity to pain or temperature, a tingling, burning or prickling sensation, sharp pains or cramps extreme sensitivity to touch. These symptoms are often worse at night.

Peripheral neuropathy may also cause signs such as muscle weakness and loss of reflexes, especially at the ankle, leading to changes in gait (the way someone walks).

There is some encouraging news: In 2010, 73,000 American adults who have diabetes and are over age 20 had amputations. That may sound like a lot, but amputations account for only a small percentage of the over 29 million people in the United States with diabetes. Better diabetes management and foot care has caused lower limb amputations to be reduced by half over the last 20 years.

With ongoing diabetes management, foot care, and wound care, many people with diabetes can limit their risk of amputation or prevent it entirely.

The best way to prevent amputation and other severe diabetes complications is to manage your blood sugar. Because of the link between obesity and type 2 diabetes, you can do a great deal to reduce your chance of developing the disease by slimming down if you are overweight. This is especially true if diabetes runs in your family.

Remember, I’m not a doctor. I just sound like one.

Take good care of yourself and live the best life possible!

The information included in this column is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice.

Glenn Ellis is a health columnist and radio commentator who lectures, nationally and internationally on health related topics. Listen to Glenn, on radio in Birmingham or V94.9, Sundays at 7:50pm, or visit: www.glennellis.com.