DIABETIC EDUCATION SAVES LIVES
Modern American medical care has a well-deserved reputation for failing to emphasize preventive care, especially when it comes diabetic foot problems and subsequent amputations. Too many Americans endure this fate, and most were preventable. Many will have a positive family history for heart disease and/or diabetes. Lifestyle is also a factor, including excessive use of alcohol and cigarettes. Because of the damage to blood vessels, many diabetics will also have heart disease.
But in the presence of neuropathy, a developing problem will cause no pain. The first sign may be some swelling of the foot or drainage in socks. The nerve changes that often accompany high blood sugars will allow someone to experience no pain while they have some skin injury. A sore can develop between the toes which should cause pain. But if the nerves in the feet have been poisoned by high blood sugar, the sufferer won’t be alerted to the problem. If the individual isn’t inspecting their feet, they won’t know.
When Jack began to feel feverish, he went to the emergency room of his small, local hospital. The physician’s assistant working at the time prescribed an antibiotic, but wasn’t sure what to make of the situation. The pills made him feel a little better, but not much. By the time the chills were really in effect, he knew something was very wrong. A trip to the nearest tertiary care center elicited the worst possible news, a surgeon was recommending an amputation.
Jack had developed neuropathy, preventing him from experiencing the pain he should have had from the simple corn between his toes. With time, and sweat, pressure from poorly fitting shoes, and reduced skin health from diabetic small blood vessel disease, an opening in the skin resulted, allowing all those bad bugs into a deep compartment of his foot. This would normally be a painful process but the nerve changes prevented that. Neuropathy is a sneaky, gradually developing condition. Most of the people with neuropathy don’t even know they have it.
The experts had difficulty controlling the infection. The antibiotics chosen initially didn’t do the job and the doctors said the infection had been present too long; the foot had to go. He healed okay from the amputation but was never able to successfully use the prosthetic, the fake leg. His activity levels plummeted and soon he rarely got out of the wheelchair. His heart disease finally led to his demise. This isn’t a rarity, a minority of the diabetics who lose a leg are able to use a prosthetic and maintain more normal activity.
This fate befalls too many people with diabetes. Frequently, these people are never educated about the troublesome complications associated with this common malady. These problems result from the combination of diseased skin nerves, blood vessel disease, and an impaired immune system. Those of us in the field of diabetic foot medicine call this the “Terrible Triad” of diabetes. As it was for our protagonist Jack, it can be a recipe for disaster.
As a culture, as a society, we need to better understand the chain of events leading to these debilitating developments. One answer to so many of these lost limbs is education. We need to better teach those who have been diagnosed with high blood sugar about these changes and how to protect themselves (whether or not they have officially crossed into the territory that is a diagnosis of diabetes). Better testing, for both neuropathy and arterial disease, would also help. Understandably, podiatric medicine is in a unique position to make these goals a reality. If you or someone you know has diabetes, get educated about diabetic foot care. It can literally save your life.