How Nerve Damage Leads To Diabetic Foot Amputation

Published: 09th January 2009
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James found himself sitting in the podiatry office, having just been diagnosed with diabetes. The foot doctor asked him if he had ever known anyone to have an amputation. James responded, "Yes, I had an uncle that actually lost his lead to diabetes. But I really don't know any of the details of how that happened." Podiatrist responded, "Do you have any idea what can cause an invitation and someone with diabetes?" James said that he had no idea.



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. Next thing you know, your doctor is telling you that you have to start exercising, he's telling you what you can and cannot eat, and he is also telling you to have a heart attack. 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.



Diabetic nerve damage makes it very difficult for someone to tell if they're starting to develop a blister, cut, or even an infection. This can put them in a very high risk for developing serious 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 elevated levels of blood sugar can prevent the white blood cells from engulfing the bacterial cells. 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. If you start a walking program to help control your diabetes, but you have a little nerve damage, he may not be able to field blister starting to develop. If you keep walking the blister conversed. 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!





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Dr. Christopher Segler is an award winning diabetic foot specialist. After discovering that preventable amputations resulted from a failing health care system, it became his passion to teach strategies to stop diabetic amputation. If you have diabetes, you can learn more by requesting your FREE report "No Leg Left To Stand On: The Secrets Insurance Companies Don't Want You To Know About Diabetic Foot Amputation" at http://www.ineedmyfeet.com .

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