The Hidden Risk of Amputation for Diabetes Patients

Type 2 diabetes is a disease that affects more than 350 million people worldwide and is characterized primarily by insufficient production or inadequate use of insulin, that is, the hormone responsible for the cells to get glucose from the blood to produce energy. The result is an excess of glucose in the bloodstream, resulting in damage to multiple organisms in the body. In fact, and as recalled by specialists participating in the XXVII National Congress of the Spanish Society of Diabetes (SED) held last week in Bilbao (Vizcaya), diabetes is the paradigm of systemic diseases - that is, it affects organs of the whole body.

It is well known that diabetes correlates with an increased risk of developing cardiovascular and atherosclerotic disease, which accelerates its evolution, worsens its prognosis and multiplies the rate of early mortality of cardiovascular origin. The usual worsening of renal function in the person with diabetes is also assumed and the possible loss of vision is accepted and especially feared as a habitual consequence of this disease.

Throughout the body

Even today, there is a great deal of ignorance about the effects of diabetes on bone fragility, on the risk of developing neurodegenerative diseases, on the development or aggravation of gum health or in the development of foot ulcers that end in amputations.

Thus, the prevalence of diabetes is much higher in patients with depression - up to two times greater - or with schizophrenia - four times higher. And as regards dementia specifically, insulin deficit and decreased sensitivity to the hormone at the brain level may contribute to the pathophysiological process of Alzheimer's disease. The fact is that since neurons have a greater difficulty in using glucose, their capacity to produce energy is significantly reduced and, consequently, their survival is lower.

There’s more; diabetes is also associated with the accumulation of tau protein in neurons, one of the characteristic damages of Alzheimer’s disease. The result is that patients with diabetes have twice the risk of developing this type of dementia.

Feet at Risk

Diabetes is the leading cause of lower extremity amputations in the whole world. The reason is the so-called 'diabetic foot', that is, infection, ulceration or destruction of the deep tissues that, related to neurological alterations and peripheral vascular disease in the lower extremities, can affect patients in whom diabetes is not correctly treated.

It is surprising that this problem is not given enough attention and even the patient does not see it as a threat.

Therefore, and in addition to better training and coordination among health professionals, the patients should be made aware of this complication. And in this context, it is important to highlight three simple measures that would significantly reduce the impact of diabetic foot. Be careful in using antibiotics to cope with diabetic foot infections, as there is a certain overtreatment. It is also essential that the wound is cleaned with extreme care and rigor, examining the lesion daily, before using any dressing to cover the ulcer of the foot. And finally, it is necessary to carry out a vascular exploration, to make sure that the patient still has the ability to feel through their limbs.

There is a typical profile of people with diabetes who are at greater risk of foot related problems. For example, elderly patients and other ‘fragile patients’; people whose immune systems are compromised due to another disease. In these cases, the diabetic foot is only the tip of the iceberg, a disorder that hides a much broader and more complex pathology, associated with high morbidity and mortality.

Vigilance is the only solution

The only way to prevent this is to stay vigilant. Make sure you check your feet for any sore spots regularly. Also make sure you go to your doctor for checkups regularly. If you have diabetes, there is a chance that your nerve endings in your foot are not working properly, which can result in you not being able to feel the pain on a sore spot. Getting things checked by a doctor is the best possible solution.

Linh Le