Home Health Glenn Ellis Ellis: Diabetes and Amputation

Ellis: Diabetes and Amputation

By Glenn Ellis

If you have diabetes, you’re at higher risk for many related health problems, including foot or leg amputation. That’s when you have surgery to remove a limb or a digit like a toe or finger.

Diabetes is a chronic (long-lasting) health condition that affects how your body turns food into energy. Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream. When your blood sugar goes up, it signals your pancreas to release insulin. Insulin acts like a key to let the blood sugar into your body’s cells for use as energy. With type 1 diabetes, your body does not make insulin. About 90 percent of people with diabetes have type 2.

In the U.S. 30.3 million adults have diabetes, and one in four of them doesn’t know they have it. African American adults are 80 percent more likely than non-Hispanic white adults to have been diagnosed with diabetes.

In the United States, 84.1 million adults – more than one in three – have pre-diabetes. What’s more, 90 percent of them don’t know they have it. With pre-diabetes, blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes.

Diabetes is the seventh leading cause of death in the United States, and is the No. 1 cause of kidney failure, lower-limb amputations, and adult blindness.

In people with diabetes, a trifecta of trouble can set the stage for amputations: Numbness in the feet due to diabetic neuropathy (nerve damage) can make people less aware of injuries and foot ulcers. These ulcers may fail to heal, which can in turn lead to serious infections.

About 15 percent of all diabetics will develop a foot ulcer at some point and up to 24 percent of people with a foot ulcer need an amputation. You’re at extra-high risk if you’re black, Hispanic, or Native American. These minority populations are (at least) two to three times more likely to have diabetes than non-Hispanic whites, and their rates of amputations are higher.

High blood sugar levels caused by diabetes can damage the nerves and blood vessels in your body. That includes the ones in your feet and legs. If your nerves are damaged, you might not feel pain or other symptoms of ulcers or infections. That raises your risk of serious infection or gangrene, which refers to the death of your tissue. In some severe cases, the only way doctors can treat the infection or gangrene is to amputate, or remove, the area that’s affected.

If you’re wondering about diabetic foot amputation statistics, be warned: these statistics may seem discouraging. But keep in mind that information can be empowering, and these stats emphasize the importance of seeking medical care for foot ulcers as soon as you notice them.

A foot ulcer is the initial event in more than 85 percent of major amputations that are performed on people with diabetes. Throughout the world, it’s estimated that every 30 seconds one leg is amputated due to diabetes. In urban America, among black men in particular, the rate of amputation of a limb is at least three times higher than in white men! It is important to understand that I said limb, the rate for toes and feet is probably even higher!

A foot ulcer (or sore) is the initial event in more than 85 percent of major amputations that are performed on people with diabetes. Every year, about 1-4 percent of people with diabetes develop a new foot ulcer. Between 10-15 percent of diabetic foot ulcers do not heal. Of those diabetic foot ulcers that do not heal, 25 percent will require amputation.

Even after amputation, it’s important to follow your diabetes treatment plan. People who’ve had one amputation have a higher risk of having another. Eating healthy foods, exercising regularly, controlling your blood sugar level and avoiding tobacco can help you prevent additional diabetes complications.

The single most important thing that a person with diabetes can do to prevent a problem is to look at their feet every day, just as they comb their hair or brush their teeth. Hopefully this knowledge will remind you to take care of your feet if you have diabetes.

Although there’s no cure for type 2 diabetes, studies show it’s possible for some people to reverse it. Through diet changes and weight loss, you may be able to reach and hold normal blood sugar levels without medication. This doesn’t mean you’re completely cured. Type 2 diabetes is an ongoing disease.

According to Dr. Ronald Renzi, a podiatrist who specializes in amputation prevention care, the circulation to the feet of a diabetic is critical to being monitored.

There are ways to prevent diabetes. See your doctor regularly and pay close attention to your feet.

As Dr, Renzi would say, “Save your Souls”!


Glenn Ellis, is Research Bioethics Fellow at Harvard Medical School and author of Which Doctor?, and Information is the Best Medicine. Listen to Glenn, on radio in Birmingham or V94.9, Sundays at 7:50pm, or visit: www.glennellis.com