Mary is a lady I have taken care of for several years. Every time she comes in I check her heart and lungs. Then, when I go to check for swelling in her legs, we have a good laugh. See, the first time I saw her, I checked for swelling and only then realized something pretty important.
Mary’s lower left leg is missing.
She is diabetic and developed gangrene in her left leg some time before she started seeing me and had to have her left leg amputated below the knee. She is a very sweet lady but now has some significant trouble getting around.
Why would Mary need to get her leg amputated? There are a number of possible reasons. Diabetics can lose feeling in their feet and if they hurt themselves they may not feel it. They don’t generally have good circulation and wounds take longer to heal. Diabetics also have immune systems that don’t work right and they have trouble fighting infections.
Unfortunately Mary is in good company. The rates of diabetic amputation are risking across the country. For instance, in California, the rate of diabetic amputation rose 31% between 2010 and 2016. Some counties like San Diego and Riverside counties had over 60% increases. Across the United States the rate of diabetic amputation rose 27% between 2010 and 2014. Before 2009 the rates had been dropping.
Why is this happening? Why are people losing toes and feet, ankles and legs to diabetic amputation?
There are a number of possible reasons.
- More diabetics. The number of Americans with diabetes is on the rise. This doesn’t explain it all, though, because even just looking at diabetic patients the rates are rising.
- Access to care. Before the Medicaid expansion that came with the Affordable Care Act many low-income diabetics went without care for their illness. Also, coverage for podiatric care (which includes care for foot wounds and chronic foot infections) is not consistent across the country and across insurers. If you can’t afford medication and see the specialists you need, you’re at increased risk for complications like amputation.
- Health literacy. Many diabetics don’t understand why they need to see the doctor regularly. They don’t know all the bad things that can happen as a result of diabetes. They don’t know they could lose their vision, have a heart attack, wind up on kidney dialysis, have a diabetic amputation. Education is key.
- Lifestyle factors. If you’ve ever tried to lose weight you know how hard it is to change your lifestyle. Eating a healthy, mostly-plant-based fresh-food diet, exercising regularly and drinking water are critically important for diabetics but many patients seem to think as long as they take their pills or their shots that’s all they need to do. NO medication can make up for a crappy lifestyle!
If you are a diabetic, please make sure to see your doctor regularly. If your doctor wants you to check your blood sugar and blood pressure, PLEASE do it, and keep a written log. (It’s really hard for us to scroll through your glucometer’s tiny screen, so please bring us an organized log. It will save time for more important things!)
Don’t smoke. Whatever you need to do to quit, do it.
Get. Serious. About your diet. NOT kidding. What we put in our mouths determines the majority of health for ALL of us, not just diabetics. Even if you have a low income, you can make healthy choices in your diet.
Walk. Get outside and walk. Go to the mall and walk. It doesn’t matter WHERE you walk, as long as you do it. Research has shown that walking is an excellent intervention for those who have circulatory problems in their legs. It actually helps grow new blood vessels around any blockages that are there.
Look at your feet every day. If you can’t reach them, get a mirror on a stick or have a family member check your feet. All parts of them, tops and bottoms and between the toes. Report ANY wounds or cuts or scaly, red areas to your doctor, even if they’re not painful. Remember, diabetics lose feeling in their feet and it can be subtle so that they don’t realize the sensation is not normal. Wear sturdy protective shoes to keep from injuring your feet, especially if you know the sensation isn’t normal. Cute little sandals and flip-flops will NOT protect your feet from injury.
A diabetic amputation is a huge deal. Amputation affects independence, the ability to walk and drive and get done the things that we need to do every day. We need to do a better job preventing the need for diabetic amputations. That means being aggressive about diabetes and blood pressure treatment, protecting our feet, staying active and being engaged with our doctor and an active member of the treatment team.
God gave you two legs, two feet and ten toes. There’s a reason for that, and we need to do everything we can to keep all those parts in good working order!
QUESTION: Do you know anyone who has lost part of their foot or leg to diabetic amputation?