How Diabetes Affects Your Feet Can Prevent an Amputation

Shouldn't every diabetic know the details so that amputations could be prevented?

With each and every new patient with diabetes, they either fully comprehend the risks of diabetes to their feet (very rare) or they have no clue (very common). With every one of these folks I feel that the one goal is to get them to understand that diabetic foot problems are optional.

Diabetes can be a tough disease to deal with. Your doctor starts telling you what to eat, telling you to exercise, lecturing about heart attacks. Then you are at home learning about blood sugar monitoring, taking medicine, pricking your finger every day. People will say, "Now I gotta think about my feet too? Seems like such a hassle."

And it is.

But the good news in all of this is that everything bad that can happen to you because of diabetes is preventable. Everything. All it takes is a little learning, a little lifestyle change, and little daily effort. The goal is to get you to understand the basics of how diabetes can affect your feet...so you can do something about it.

When you have diabetes you have three main problems, all working together and conspiring against you, that can lead to a diabetic foot amputation. It involves your nerves, blood flow and immune system.

When your blood sugar is high, there is a chemical reaction that directly damages the ends of the longest nerves in your body. The longest ones start in your back (where they exit the spine) and head all the way down to the toes in one long piece. Because the ends get damaged first, any nerve damage starts in the toes and gradually creeps up the foot toward the ankles.

It is always damaged at the same level in both feet. For example, if you have nerve damage (neuropathy) at the ball of the foot, the nerve damage is only in the toes. In this case the arches and heels might be fine.

Neuropathy makes it hard for you to tell if you are getting a blister or an open sore, and puts you at risk for problems. It is deceptive because you might be able to feel other things like the position of your feet, shoes and socks squeezing, but not a blister, cut or sore.

The second problem is the circulation or blood flow in the feet and legs. The arteries get clogged faster when you have diabetes. If you take two people who are identical, except one is diabetic, the one who is diabetic is four times more likely to have a heart attack. That is because of the increased rate of clogging up those arteries through the process called atherosclerosis. But this process happens everywhere, not just the heart. The blood vessels to the legs get plugged up too. Then, when you get a sore it takes longer to heal. It is also harder for your infection fighting white blood cells to get down there.

The last problem is your immune system. When your blood sugar is high, the white blood cells (called macrophages) have a hard to time fighting off those nasty bacteria. The white macrophages find bacteria through a process called chemotaxis. It is like following a trail of chemicals to its source. This is not very effective when the blood sugar is elevated. In effect, the macrophages are lost in the dark, simply bumping around, hoping stumble into some bacteria to kill. Very inefficient and not very effective.

Once they do find the bacteria they have a bigger problem. The high blood sugar prevents them from eating the bacteria. The process where the white blood cells engulf the bacteria (called phagocytosis) is essentially disabled. So they bump up against they bacteria, but can't do anything. Imagine a great white shark with his mouth wired shut trying to eat a smaller fish for dinner. Because of all of this, the immune system is ineffective, the bacteria continue to grow and the infection quickly gets out of hand.

So a diabetic amputation goes something like this. You get a little nerve damage, can't feel a blister starting when you are walking at the mall, and it pops. Just like that, you have an open sore. Your blood flow is a little sluggish and it takes a long time to heal. Then it gets infected while it is trying to heal. If your blood sugar is high, all of those sharks are wandering around in the dark, mouths wired shut, and the infection spreads.

If it spreads enough, one of the foot bones gets infected. And a bone infection is the kiss of death for the diabetic foot. The only reliable way to heal a bone infection in an adult diabetic is to remove the infected bone. And that is where the amputation begins.

The moral of the story is watch your blood sugar, and your nerve damage will never get any worse. If you walk 30 minutes a day, fives days a week, your blood flow will never get any worse. If you have any nerve damage, you need close monitoring by a diabetic foot expert. If you ever get any open sore, blister or ingrown toenail it is an emergency...no joke. Get that foot checked out or it might get chopped off!