Losing Legs

How do PWD lose their legs, how bad does it need to be. Could you just lose a leg by having a cut on it that doesn't heal. Could you lose one by having decent control but being D a long time. Does it happen much now ? I've been controlling my bg now for a while and now seem to think I'm off the hook. Can I be complacent ? I suppose this applies to eyes and kidneys too.

Diabetes is still the leading cause of non-injury related ampuations, but the rate is way down. According to the CDC, between 1996 and 2008, the rate of leg and foot amputations dropped 65%. I attribute this decrease to the acceptance that poor blood sugar control leads to these complications. Before the DCCT trial, many doctors advised patients to maintain high blood sugars believing (incorrectly) that complications risks were not related to blood sugar control. Obviously in hindsight, they were absolutely wrong (and I'm still angry about it).

The two main mechanisms that lead to amputations are Perhiperal Arterial Disease (PAD) and neuropathy, both of which a results of high blood sugars. PAD results in a loss of circulation in your extremities, circulation is vital to healing. And with neuropathy, you can have an injury (and more injuries) that you just can't feel. And when even a small injury doesn't heal well and you don't feel it, it can cause a cascade of problems which have historically resulted in lots of amputations.

But I would like to assure you that with good blood sugar control and consistent attention to your extremeties, there is no reason to believe that you need ever suffer the loss of a leg. But it is up to you to do what is necessary to avoid these outcomes. I decided that I would accept that I may suffer complications over my life. Stuff happens. But I'll never have any regrets as long as I feel like I did all the right things to prevent and avoid complications.

ps. I actually expect that the rate of amputations will continue to decrease as more and more of us attain better blood sugar control and pay attention to our extremeties.

I believe that we lose our legs exactly through having cuts that don't heal. If you are on top of a situation like that and go to the doctor immediately, I think that you have very good chances. I think that many people are "off the ranch" and may not go to the doctor, nor test their BG nor take medications regularly, e.g. T2 whose rx runs out and they blow off getting more for a while. Then something innocuous happens, stubbing toe, a blister, cut or whatever and faced with the choice of going to the doc who will probably yell at them, they try home remedies or maybe don't do anything about that either. There's a possibility that when something goes south, particularly in a person with uncontrolled diabetes (I'm saying the person is not doing much to control it, not because their doctor labelled them as such, although I believe that's what the designation is for, not someone who works hard at it but is > 7.0 or whatever the medical "goal" is!), that an infection can set in and you can lose toes and limbs.

The first time I ran > 30 miles/ week, it was cold out (January 2011 I think, maybe 2010, I don't recall exactly...) and, accordingly, I wore extra socks that beat up one of my toenails which turned black. I was alarmed and went to the doc. Both at the convenient care place and the subsequent podiatrist were effusive in saying "good job getting this checked out, it shouldn't be any problem but you *always* want to get these sort of things checked out..." and rx'ed some sort of strong antibiotic and took the nail off to fix it. Not a big deal but I interpreted their reactions as indicative that they'd seen worse things before, that many not have had a pleasant ending?

Thank you Brian, with this new control of mine I no longer worry myself sick about this, but must remain vigilant. Hopefully now that we are on the right road with regard to advice on bg, we will mostly attain good control.

Hopefully PWD do take good care of their feet. I remember it being way down on my list of priorities when younger. I was wondering how someone would have something wrong with their feet and not know, but I suppose they just rather not go to the doc. I remember once while I lived in Dublin, I was in hospital with DKA. When I was on the mend the nurses took me around the ward to show me all the men who had lost toes and stuff. It did frighten the life out of me. I only get my feet checked once a year, I don't think this is enough really.

Josephine - I'm a long-term T1. A few years ago I decided to visit my podiatrist once a month. He clips my toenails and has treated several ingrown toenail episodes before they got infected. He's also prescribed orthotics to treat/correct plantar fasciitis.

His attention to my feet has allowed me to continue my exercise routine of walking 2-5 miles each day, This exercise is one of the main reasons I have been able to maintain reasonable control (last A1c, 6.2%, no lows under 55, lows 55-70, only one or two per week).

He has told me several horror stories about diabetic foot neglect that led to loss of toes and feet.

Starting my monthly visit to the podiatrist is one of the smartest things I have done. I'm lucky to have good insurance that pays for it!

This has been one of my biggest fears about my diabetes. I've been diabetic for over 18 years now and fortunately have had no complications. I do my best to take care of myself but I do wonder just how much all of the occasional highs over the years have affected my body. I do actually have leg and foot pain from time to time (I love foot massages) but I also wonder if the amputations are more common in elderly type 2 diabetics since they seem to commonly not keep in tight control...

Nerve damage and poor circulation are contributing factors. Keeping your feet warm and tending to cuts are important.

Winter hasn't been too cold yet, January will be the cold one. I have many a pair of fur lined boots for the bad snow we got one year.

my uncle, who was morbidly obese, would not take his insulin nor would he adjust his eating habits. 1st he ended up losing his eyes, then he ended up in a wheel chair once his right foot was amputated. he died very young of diabetes related cancer. very sad. he was a lovely man who didnt care for himself.

Hi Daisy, missed you round here, hope you got over the storm or are ok at least. It's very sad about your uncle, I wonder with all these new cases of D will people be able to cope. At least we are fighting it, there are thousands who don't want to know.

I would like to add that if one has an infection on an extremity, the person to go to, if in an urban area and one is available, is an infectious disease specialist, not the family doctor. So much time is saved.