Diabetes Management

Facts About Diabetes

For the year ended 30 June 2009, there were 520 major lower limb amputations in New Zealand, of which 212 were listed by the Ministry of Health as caused by diabetes (41%). Of these, 21% were for Maori and 5% were for Pacific Island people.

How Can I Save My Other Leg?

If your amputation was related to poor circulation and/or diabetes, the other leg remains at high risk for loss. The chief problem for a person with diabetes is often the loss of protective sensation in the foot. There are several basic things you can do to compensate for this:

1. Never walk barefoot: Carpeted and even bare floors at home may conceal hazards like needles or bits of glass that can produce injuries that go unnoticed until a limb-threatening abscess forms.
2. Examine your foot daily: Look for evidence of injury or redness indicating areas of excess pressure or friction. If your eyesight has been affected by diabetes, have a family member or friend help you with this.
3. Obtain properly fitted shoes: See an orthotist for custom-molded shoes if needed, especially if you have prominent foot bones or a history of foot ulcers.
4. Shake out your shoes: Before putting them on, dislodge any objects like pebbles to prevent ulcers.

If a foot ulcer occurs, treatment must be prompt and effective to avoid limb-threatening infection. A foot abscess in someone with diabetes is a dire emergency requiring prompt, wide surgical drainage to save as much of the foot as possible. Unfortunately, many people with diabetes, because of denial related to the loss of protective sensation in the foot, fail to seek help for initially minor infections for days or weeks until it may become impossible to save the foot.

Another major action that people with diabetes can take to reduce the chance of a second amputation is keeping their blood sugar levels under tight control. Constant high blood sugar levels lead directly to blindness, kidney failure and loss of foot sensation ending in amputation. High sugar levels also interfere with white blood cell functions, impairing the body’s ability to ward off infection.

In your zeal to take the best possible care of your remaining foot, do not forget your residual limb and its partner, your prosthesis. At the interface where they meet, the residual limb may endure hundreds to thousands of weight-bearing and sliding forces during the usual day of walking. Because the lack of protective sensation in people with diabetes may extend into the residual limb, a daily skin check for any redness indicating friction or excessive pressure is required. These or any other problems not immediately solved by sock adjustments should send you promptly to your prosthetist for evaluation. If skin ulceration has occurred, you should immediately stop walking on your prosthesis and seek medical advice. Continued use of the prosthesis can turn an inconvenience of a few days into weeks of healing or even revision surgery.

These suggested precautions provide a blueprint for maintaining your other foot indefinitely by stopping the vicious cycle of events leading to amputation. The first step, however, is to accept the fact that no-one should care more about your foot than you. If you can also overcome the human tendency to deny the possibility of a second amputation, you are halfway to your goal of preventing it, despite the statistics. The time to get serious about it is now.