Tips for Preventing Diabetes-Related Health Problems
Diabetes is a disease that causes high blood sugar levels.
Uncontrolled, it can cause many health complications, including cardiovascular disease, heart attack, stroke, kidney damage, retinopathy (eye damage that can cause vision loss), and peripheral neuropathy (nerve damage resulting in the loss of sensation in hands and feet).
People who have peripheral neuropathy cannot feel pain in their feet. Because of the lack of feeling, even a minor wound that goes unnoticed and untreated will likely develop an infection. This can lead to the amputation of one or more toes, a foot, or a leg.
Lower-limb amputations among people with diabetes are a serious concern. According to the American Diabetes Association, in 2010, 73,000 non-traumatic lower-limb amputations were performed in the U.S. on people with diabetes who were age 20 or older.
Mark Hinkes, DPM, a Nashville, Tennessee-based, board-certified podiatrist with 39 years of experience, believes this total can be lowered.
“It’s a little-known fact that most lower-extremity amputations are preventable,” he says.
He has the expertise to back up that assertion. While Hinkes was chairman of the Preservation Amputation Care and Treatment (PACT) Program at the VA Medical Center-Nashville, amputation rates there decreased by 40 percent in patients with diabetes.
Much of the amputation prevention work depends on coordinated efforts among healthcare providers. However, Hinkes suggests that people with diabetes do the following things to preserve their health and prevent limb loss.
1. Control blood pressure
2. Control blood sugars
3. Control cholesterol and triglycerides (lipids)
4. Not smoke or use tobacco products
“Unless patients make an effort to control the things they can, they are not going to be successful at keeping their leg,” he cautions.
Hinkes points out that the people most likely to develop a foot ulcer or undergo amputation are those who have already had a diabetes-related foot ulcer or amputation. Why? Because they already have neuropathy and peripheral arterial disease (PAD), which makes them vulnerable to a subsequent ulcer or amputation.
Therefore, patients who have sensory neuropathy must wear appropriate shoes and socks and never walk barefoot.
“The shoes never come off, except when taking a shower or going to bed,” Hinkes says. “Every person with diabetes should visually and manually inspect their feet daily for a crack in the skin or a red, swollen, or warm area on their foot. This is the smartest strategy, because it will prevent a foot problem from going unrecognized and untreated, which could lead to an ulcer or amputation.”
People with diabetes should be aware of and try to prevent trauma to their feet. These are the triggers that can start the process that can end in an amputation.
While people with diabetes can take these steps to maintain their well-being and the viability of their limbs, the healthcare industry must play a central role in preventing amputations. For limb-loss prevention efforts to succeed, Hinkes says people with limb loss need a comprehensive diabetic foot examination annually.
“That should be in all capitals and have stars around it,” he says.
Included in that examination should be a Semmes-Weinstein monofilament (SWM) test, in which the physician touches the patient’s foot with a thin wire to check for loss of protective sensation. The International Working Group on the Diabetic Foot recommends this test for identifying people with diabetic sensory neuropathy.
Hinkes says that identifying patients who have lost the protective sensation in their feet and educating them about the importance of proper foot care and prevention would help prevent lower-limb amputations.
Following the advice of experts like Hinkes is essential to proper foot care. However, patients’ experiences can also be instructive. Following are accounts from three people who have dealt with diabetes and limb loss—either their own or that of a family member.
Pat Henley, a Dallas businessman, salesman, and retired naval reservist, began selling foreclosed homes in 2005 at age 65. He had always led an active life, and this pursuit was no different. After he closed on one property in 2009, he cleaned up its back lot and continued with his business.
Two weeks later, his right big toe was amputated. Although Henley had managed his diabetes well for 26 years, peripheral neuropathy affected his feet.
When he cleared the property that day, he had worn sturdy, comfortable shoes and thick socks. He didn’t expect a blister to develop on his foot. Yet, one did, and when Henley and his wife finally noticed it, it was too late to save the toe from the infection that had occurred.
Unfortunately, the infection soon returned, and it was necessary to amputate his right leg below the knee.
“Never regretted the decision, never doubted the physician, didn’t go for a second opinion,” he says.
Henley stresses that he didn’t lose his leg because he didn’t control his diabetes. He has always checked his pulse, blood pressure, and blood sugars daily and recorded the information to give to his physician at his quarterly checkup; they are always at acceptable levels.
“The problem was not that I wasn’t managing my diabetes well; it was a case of not recognizing that an injury had occurred,” he says.
Consequently, Henley now frequently inspects the bottom of his remaining foot, which he says is easy enough to do sitting in his wheelchair in front of a full-length mirror.
“Losing one leg is enough, thank you,” he concludes.
Deborah Shuck’s website is called “A Woman of Steel.” The name is apt. Shuck was born with proximal femoral focal deficiency, which caused her to have no left hip socket, a shortened femur, and a smaller-than-normal foot. She was fitted with a prosthetic leg when she was 10 months old to address the difference in the length of her legs and learned to walk that way. When she was 2, her left foot was amputated. From that first extension prosthesis to the prostheses that followed after her amputation, she has been walking with prostheses since she was less than a year old.
Shuck has snow skied, scuba dived, sailed, and golfed. She has also owned two manufacturing companies and founded Women Owners of Florida, a nonprofit organization that helps professional women build business connections. Today, she also works as an inspirational speaker. She has done all this while taking good care of her type 1 diabetes, which was diagnosed when she was 16.
The doctor in Shuck’s small town did not know what to make of the disease more than 40 years ago. To best control her diabetes, Shuck traveled to Boston’s Joslin Clinic, now the Joslin Diabetes Center, a teaching hospital where she learned how to manage the disease. While in succeeding decades she has carefully managed her diabetes, she describes those early days of urine tests and multiple injections each day, with no blood sugar monitors or insulin pumps, as “exasperating.”
She notes that she did have diabetes-related eye surgery this year, despite her efforts to control the disease. She also has pain in her leg and residual limb, which has limited her activities, but it cannot be treated with steroids because of her diabetes. She no longer skis, and had to give up small racing boats for a larger boat, but she plays golf regularly and has begun writing about adaptive golf for a golfing magazine.
Of coping with limb loss, managing type 1 diabetes, and enduring her residual limb and leg pain, the Woman of Steel says, “It’s all about adapting to the situation.”
Sharon Rae North is an accomplished jazz singer, recording artist, freelance journalist, and children’s book author living in Virginia. She also lost her father to diabetes.
“My dad had adult-onset diabetes; he was maybe in his 50s when he was diagnosed, which would be around the early 1980s,” she says.
Dennis “Buck” North kept the disease in check for several years, but in the late 1980s, he began having eye problems from diabetic retinopathy. Over time, the retinopathy grew worse, and he became nearly blind. Other complications arose as well. In the 1990s, non-healing foot ulcers first cost him his right leg, then his left. Soon, diabetes cost him his life.
As North grieved her father’s death, she recalled an encounter he had while in the hospital after his first amputation. A young girl visiting him hesitantly asked about his missing limb. Gently, he explained his illness and the amputated leg.
“I thought it was great because this was a lesson for her,” North says. “This is a kid who would probably not ever tease anyone about their leg because now she has an understanding of what happens when you lose a leg.”
North drew on that incident to write a book, My Brand New Leg, writing from the standpoint of two kids talking, one with a prosthesis and one without.
“It was to teach about acceptance and differences and to let people know that just because someone has a disability, it doesn’t mean they can’t do all the things that everyone else does,” she explains.
After publishing the book in 2003, North traveled around the country promoting it and raising awareness of diabetes. She says she now has type 2 diabetes too. Remembering her father’s passing, she is managing her diabetes well, watching her diet, monitoring her blood sugars and blood pressure, and taking care of herself.
Whether the motivation for vigilance in managing diabetes comes from the advice of healthcare providers or from witnessing its more dramatic complications, taking an active role in controlling the disease is essential for people with diabetes. That attention could prevent additional limb loss and devastating health problems. Even more importantly, it could also save a life.
This article is for general informational purposes only and does not constitute medical advice. Always seek the advice of a qualified healthcare professional for your specific situation.
By Scott McNutt
