As I continue to fight the good fight against my first respiratory infection of the season, I will serve you a few portions of learnin' from the old blog. --PalMD
We've spoken a bit lately of the micro- and macrovascular complications of diabetes. Let's see what that means in real life. One of the most devastating complications of diabetes is amputation, which is often due to the microvascular complication of peripheral neuropathy. This can begin as a tingling, burning pain in the feet, but can lead to loss of sensation. Small injuries can rapidly become limb-threatening...(Warning: Yucky picture under the fold)
In 2002, over 80,000 amputations were done on diabetics. Prevention of diabetic foot disease and amputation is relatively simple and effective, with the ability to prevent one-half to two-thirds of amputations. Prevention includes yearly foot exams by a medical professional. This includes simple tests of sensation and blood flow, which requires no specialized equipment. If an abnormality is found, prompt referral to podiatrists for specialized foot care and footwear, and cessation of all smoking can help prevent amputation.
I recommend that all my diabetics check their feet daily, with a mirror if necessary, and call me promptly with any problems.
Preventing amputation is cheap, easy, and effective---and not always done. Stay alert.
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Having formerly worked in a clinical setting and done outpatient and inpatient DM counseling, you would be shocked by the number of diabetics who do not regularly check their feet or control their blood glucose.
I actually had a patient tell me a blood glucose of >400 mg/dL is "normal" for her so the standards don't apply ("they are for other people"). Her doctors told her the risks and I attempted counseling after a referral to no avail. This patient already experienced neuropathies associated with poorly controlled DM, and it's only a matter of time before this person will have to consider amputation (the patient already had ulcerations, but they wanted to let them "heal naturally"). Sometimes a case just like the picture you gave as an example still isn't enough to shock people into action.
I met a 75 year old lady in India who had an approx 1 inch wound in her foot which wouldn't heal due to bad circulation from diabetes. As a last resort before amputation her doctor sent her for one hour treatment sessions in a hyperbaric chamber for 30 days. By the time I met her she had been having treatment for 27 days and the wound had healed up to the point where just the skin needed to heal over the top of her foot. The oxygenation of the blood from the hyperbaric chamber had improved the blood circulation to the foot so that it healed.
My very favorite guitar player almost lost his foot, due to a tiny nick on his toe that was sustained during a gig we played. It couldn't have been more than a quarter inch scratch that wasn't terribly deep - within a couple weeks he was having a lot of pain just walking on it. Much of the damage was under the surface even then. It was ugly and gross on top, but it was only about an inch maybe - when they opened it up though, there was much more significant damage below the surface that looked a lot like bruising from the surface. The doctors told him that had he waited even a week, they probably would have had to take the foot.
Hella good motivation to maintain control over my weight. There is some history of diabetes in the family of my paternal genetic contributor. I'm not keen on going there - not keen at all.