Diabetes-related Amputations Up Significantly In California — And San Diego
Clinicians are amputating more toes, legs, ankles and feet of patients with diabetes in California — and San Diego County in particular — in a “shocking” trend that has mystified diabetes experts here and across the country. Though they often prolong lives, diabetes-related amputations deprive patients of independence, increase the need for social services and add to disability and medical costs. Statewide, lower-limb amputations increased by more than 31 percent from 2010 to 2016 when adjusted for population change. In San Diego County, the increase was more than twice that: 66.4 percent. Losing a foot, ankle or especially a leg robs patients of their independence, hampers their ability to walk and makes them more vulnerable to infection. It also can shorten their lives. This trend, which inewsource documented with state hospital data, is one physicians, surgeons and public health officials are at a loss to explain, though many have theories. Edward Gregg of the Centers for Disease Control and Prevention said the California numbers are worrisome. Public health officials consider amputations to be an important indicator of a region’s diabetes care because diabetes and its complications can be prevented, said Gregg, chief of epidemiology and statistics for the CDC’s Division of Diabetes Translation. “If we see it going down, then it’s a good sign, because so many aspects of good diabetes care are in theory affected. And when you see it going up, that’s a concern,” he said. The CDC has noticed an increase of 27 percent nationally in the rate of amputations among people with diabetes between 2010 and 2014. Previously, the numbers had been declining. Gregg suggested one cause for the increase could be that the country’s population is aging – advancin Continue reading >>
When Diabetic Neuropathy Leads To Amputation
Diabetic neuropathy increases the risk of amputation. Over half of all amputations per year are due to diabetes and diabetes-related complications. Most are lower-extremity amputations, such as foot amputation. This operation numbers about 86,000 per year, according to the National Institute of Health. It is estimated that careful foot care could prevent nearly half of those operations. Overview Diabetic neuropathy, or nerve damage, develops when nerves are damaged due to high glucose levels. There are different types of neuropathy. Peripheral neuropathy is a type of neuropathy that affects the toes, feet, legs, hands, and arms. The longest nerves are affected first Diabetic neuropathy develops in 60 to 70% of people with diabetes. Risk of neuropathy and amputation increases with advanced age, being overweight, and duration of diabetes with highest rates among those who have had diabetes for more than 25 years. Poor diabetes control, abnormal cholesterol levels, and high blood pressure also increase risk. The risk is significantly increased with smoking. Why Diabetic Neuropathy Can Lead to Amputation Risk Uncontrolled diabetes can cause damage to nerves and reduce sensation. Injuries (even small ones) can develop without notice or pain and develop into ulcers, infections, and cause tissue death (gangrene ). Poor circulation is a common problem for people with diabetes and this contributes to slowed healing. The feet are at higher risk because they are not easy to see. A foreign object such as a tack can get stuck in the bottom of the foot or an irritation can develop into an open wound or ulcer, and go unnoticed because sensation in the area has been lost. People with diabetes need to take special care of their feet, and regularly inspect them for problems. How to Reduc Continue reading >>
The Diabetic Insensitive Foot “from Callus To Amputation”
Diabetes and its complications are the leading cause of non-traumatic lower extremity amputations in the United States. Neuropathy, a common complication of diabetes, is a major contributing force leading to lower extremity amputation. Neuropathy leads to an anesthetic foot with increased pressure on the sole of the foot. This increased pressure can lead to a diabetic neuropathic ulceration. The vast majority of amputations are sequela of a non-healing foot ulcer. The precursor to ulcer formation is the development of a callus. The callus is the body’s response to the unnatural increased pressures on a neuropathic foot. The callus production actually increases the pressure below the prominence, i.e., metatarsal head. Hence, the callus is adding pressure to the increased pressure being observed on that area. If left untreated the callus and the underlying skin will begin to break down further. This process is noted when the callus presents with dark, discolored areas within it. The breakdown causes bleeding within the callus and an ulcer is eminent. It is imperative that the callus formation be removed. Who and how the callus should be removed is another question. Depending on the patient’s diabetes control, eye site, access to his or her foot, and understanding of the disease process, patients may play a role in removal of the callus formation by using a pumice stone or a callus file. Patients with diabetes should not use over-the-counter corn or callus removal medicines. These medicines contain acids that can be detrimental to their feet. Patients who are unable to see well, who cannot reach their feet, whose diabetes is out of control, and who do not have an understanding of how diabetes affect their feet should be seen by their podiatrist or medical doctor for th Continue reading >>
Important Information For Preventing Diabetic Amputation
Because diabetes impacts the body’s circulation and nerve health, diabetics are at risk for developing foot issues. Because diabetes impacts the body’s circulation and nerve health, individuals living with this disease are at risk for developing foot issues. Foot ulcers, which resemble open sores, are among the most common orthopedic problems that diabetic patients have to deal with. If left unattended, these lacerations can become severe, and even result in the need for amputation. The good news is that with proper diabetic and wound care management, as well as simple enhancements to your lifestyle, it is possible to avoid amputation due to ulcers. Here are some useful tips for maintaining your health: Do a foot inspection everyday While doing a thorough foot check each day might feel excessive, this is one of the best – and easiest – ways to avoid an unwanted ulcer. The Mayo Clinic recommended taking a few minutes each day to inspect for any damage, including cracks, blisters, sores, scrapes and bruises of all sizes. You should also take note of any swelling, redness or other irregularities. The source suggested using a hand mirror or asking a friend to assist you when looking at the bottoms of your feet. In addition to physically inspecting your feet, it is important to assess how they feel whenexposed to certain sensations, explained Healthline. Use feathers to gage how your feet respond to light touching, and regularly check if you can feel the difference between warm and cool temperatures, recommended the source. Quit smoking Smoking cigarettes negatively impacts your overall health and can exacerbate the medical issues associated with diabetes. Diabetics who smoke are at a higher risk of developing foot complications, as smoking slows circulation, impedes Continue reading >>
Diabetes Epidemic Causing 160 Amputations A Week - Are You At Risk?
More than a third of people remain unaware foot ulcers are a serious complication of the disease and the leading cause of lost limbs. Figures show eight in 10 sufferers die within five years of surgery. Foot ulcers and amputations are also very costly with £1 in every £140 of NHS spending in England going on foot care for people with diabetes. Type 2 diabetes symptoms: is it possible to REVERSE the condition? Dan Howarth, head of care at charity Diabetes UK, said: “Diabetes-related amputations devastate lives. While it’s positive that the majority of people are aware that amputation is a complication of diabetes, it’s very worrying that so many don’t know the dangers posed by foot ulcers. “That’s why it’s essential that people living with diabetes know how to look after their feet, and that they check them daily. "It’s also crucial they know to seek urgent medical attention if they notice any problems with their feet; a matter of hours can make the difference between losing and keeping a limb. "With the right support four out of five amputations are preventable. But the quality and availability of services still varies significantly across England. "We want to see greater commitment from Government to improving diabetes foot services, ensuring routine, high-quality care to those who need it, regardless of where they live.” Figures from Public Health England and the Cardiovascular Intelligence Network analysed by Diabetes UK showed there are more than 8,500 diabetes-related amputations carried out in England each year, equivalent to 23 each day. Ben Harris, 42, from Berkshire, was diagnosed with Type 2 when he was 18 and had his right leg amputated aged 36 after three years of treatment for an ulcer that had formed on his big toe. He is also due to ha Continue reading >>
Diabetes Complications And Amputation Prevention
People living with diabetes are prone to having foot problems, often because of two complications of diabetes: nerve damage (neuropathy) and poor circulation. Neuropathy causes loss of feeling in your feet, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation. Poor circulation in your feet reduces your ability to heal, making it hard for even a tiny cut to resist infection. Having diabetes increases the risk of developing a wide range of foot problems. Furthermore, with diabetes, small foot problems can turn into serious complications. Diabetes-Related Foot & Leg Problems Infections and ulcers (sores) that do not heal. An ulcer is a sore in the skin that may go all the way to the bone. Because of poor circulation and neuropathy in the feet, cuts or blisters can easily turn into ulcers that become infected and will not heal. This is a common—and serious—complication of diabetes and can lead to a loss of your foot, your leg or your life. Corns and calluses. When neuropathy is present, you cannot tell if your shoes are causing pressure and producing corns or calluses. Corns and calluses must be properly treated or they can develop into ulcers. Dry, cracked skin. Poor circulation and neuropathy can make your skin dry. This may seem harmless, but dry skin can result in cracks that may become sores and can lead to infection. Nail disorders. Ingrown toenails (which curve into the skin on the sides of the nail) and fungal infections can go unnoticed because of loss of feeling. If they are not properly treated, they can lead to infection. Hammertoes and bunions. Nerve damage affecting muscles can cause muscle weakness and loss of tone in the feet, resulting in hammertoes and bunions. If left untreated, these deformities can caus Continue reading >>
A diabetic foot is a foot that exhibits any pathology that results directly from diabetes mellitus or any long-term (or "chronic") complication of diabetes mellitus. Presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer and neuropathic osteoarthropathy is called diabetic foot syndrome. Due to the peripheral nerve dysfunction associated with diabetes (diabetic neuropathy), patients have a reduced ability to feel pain. This means that minor injuries may remain undiscovered for a long while. People with diabetes are also at risk of developing a diabetic foot ulcer. Research estimates that the lifetime incidence of foot ulcers within the diabetic community is around 15% and may become as high as 25%. In diabetes, peripheral nerve dysfunction can be combined with peripheral artery disease (PAD) causing poor blood circulation to the extremities (diabetic angiopathy). Around half of patients with a diabetic foot ulcer have co-existing PAD. Where wounds take a long time to heal, infection may set in and lower limb amputation may be necessary. Foot infection is the most common cause of non-traumatic amputation in people with diabetes. Prevention Prevention of diabetic foot may include optimising metabolic control (regulating glucose levels); identification and screening of people at high risk for diabetic foot ulceration; and patient education in order to promote foot self-examination and foot care knowledge. Patients would be taught routinely to inspect their feet for hyperkeratosis, fungal infection, skin lesions and foot deformities. Control of footwear is also important as repeated trauma from tight shoes can be a triggering factor. There is however only limited evidence that patient education has a long-term Continue reading >>
What Is Diabetes? Dangerous Condition Affecting Thousands Can Lead To Amputation
Diabetes occurs where there is too much glucose in the blood because the body cannot use it properly. There are two forms of the condition - Type 1 diabetes occurs when the body cannot produce insulin. Around one in 10 people with diabetes have Type 1 and it usually affects children or young adults. Type 1 diabetes means the body’s immune system attacks and destroys the cells that produce insulin. When insulin is not produced a person’s glucose levels increase, which can result in the body's organs being damaged. People living with Type 1 diabetes are reliant on insulin injections and they need to keep a close eye on their blood glucose levels to ensure they stay balanced. Type 2 diabetes occurs when the body does not produce enough insulin or the insulin produced does not work properly and can be linked to lifestyle factors such as being overweight. However, one man, who was diagnosed with type 2 diabetes, has cured himself of the disease just by changing his diet. If diabetes is not properly managed it can lead to serious consequences such as sight loss, limb amputation, kidney failure and stroke. Figures have revealed that every week there are over 100 amputations due to people controlling their diabetes poorly. Chris Askew, Chief executive of Diabetes UK, has warned there is a ‘crisis’ surrounding the illness and said people aren’t aware of the seriousness of the condition. There is still a lack of understanding when it comes to people being aware of the seriousness of diabetes and this worries us at Diabetes UK. He said: "There is still a lack of understanding when it comes to people being aware of the seriousness of diabetes and this worries us at Diabetes UK. "There are over four million people living with the condition in the UK. The fact that 4,500 pe Continue reading >>
How Can We Be Safe From Amputation In Diabetes?
Amputation is not a direct result of the diabetes, but a consequence of chronically high blood sugar levels over a long period of time in diabetic patients who ignore their condition. Basically, a surge of little sugar crystals with sharp edges circulate through your blood stream when blood glucose levels are too high. This is less of an issue when they travel through the arteries (interstates) and large veins (highways), but when they enter the tiny capillaries (narrow streets) where blood oxygen and waste are exchanged at the cellular level they start to have issues and scrape up against the sides. This damages the capillary blood vessels (often in the feet due to gravity) and interferes with healthy circulation. As a result the tissue in the affected areas are starved of oxygen and unable to get rid of the metabolic waste they produce - when this damage reaches a level where there are more damaged vessels than healthy ones it can act like a tourniquet on the affected limb. In order to prevent this from happening you need to stay on top of your diabetes. Find a doctor (physician, not a chiropractor or other alternative medicine practitioner) you like and see them regularly. Follow the advice they give you and always take your medication as instructed. Check your blood sugar regularly to make sure it is not too high or too low. Eat healthy to reduce the amount of simple sugars that surge through your bloodstream. Exercise regularly to improve your cardiovascular health. By doing all of these things to stay on top of your diabetes you can maintain the same blood glucose levels of a non-diabetic and lead a normal healthy life. I have a close friend who is diabetic and in much better shape than I am. He eats well and lifts weights everyday. He is jacked! He also checks hi Continue reading >>
How Does Diabetes Cause Blindness And Leg Amputation?
Diabetic retinopathy is a side effect related to diabetes and it can cause blindness if ignored. When there is too much sugar flowing in the bloodstream, the sharp sugar molecules damage the blood vessels as they travel along them. If the tiny vessels which nourish your eyes are injured, blood and fluids leak, causing blurry vision and eventually blindness. The best way to avoid it is to keep yourself healthy, and regularly have your eyes checked. Here is an article to start you off with more information about diabetes related blindness. Continue reading >>
Doctors Debate Danger Of Popular Diabetes Drug After Fda Amputation Warning
Many San Diego doctors are taking their patients off of Invokana, a widely used diabetes drug, after a large industry-sponsored trial found it doubled the risk of lower limb amputations compared with those taking a placebo. With 23.1 million people in the U.S. diagnosed with diabetes, many of them are taking newer drugs to control glucose. But new research involving one of those drugs, Invokana, shows a doubled rate of leg, foot and toe amputations. Patients are being switched to other medications even though the study’s authors say the drug’s benefits — a reduced risk of cardiovascular events including death, non-fatal heart attacks and non-fatal strokes — outweigh its risk of amputations. The drug is prescribed for people with Type 2 diabetes. The patients in the trial were already at high risk for heart disease and other diabetes complications including amputations. While a number of physicians interviewed said they still prescribe the drug to lower their patients’ glucose levels, attitudes among others began to change after the U.S. Food and Drug Administration on May 16 issued what’s called a black box warning about amputations. It urges patients taking canagliflozin, sold under the brand name Invokana, Invokamet and Invokamet XR, to contact their doctors “right away” if they notice pain or tenderness, sores, ulcers or infections in their legs or feet. About half of the amputations occurring among patients in the trial were of toes, while the rest were across the foot, at the ankle, below the knee and above the knee. The FDA warning suggests physicians should consider factors that predispose patients to amputations, such as prior amputations, peripheral vascular disease, neuropathy and diabetic foot ulcers, before prescribing the drug. Physicians sh Continue reading >>
Diabetes: Amputation For Foot Problems
Topic Overview Blood vessel and nerve damage linked with diabetes can lead to serious infections that are extremely hard to treat. Often the first place you have a problem is your feet. When you lose the ability to feel your toes and feet, you are more likely to injure them without knowing it. Even a minor injury, such as a small cut, can develop into an ulcer and a serious infection. Infections of the feet can spread up into the leg. Sometimes the infection is so severe that toes, the foot, and/or possibly part of the leg must be amputated. Amputations are done when efforts to save the foot or leg are unsuccessful or the infection is causing extensive tissue damage. In all cases, doctors save as much of a person's foot or leg as possible. But they try to make sure that the remaining part of the limb will heal so that further surgery is not needed. A serious infection can be life-threatening. In these cases, an amputation may save your life. If you are faced with needing an amputation, talk with your doctor about how it can benefit you. Often amputation relieves the severe pain linked with an infection, as well as getting rid of the infection and the need to take strong antibiotics. Also, modern prosthetic devices are lightweight, making walking as easy as possible after an amputation. Having a foot or leg amputated is traumatic and means a major body-image change. Allow yourself time to grieve and deal with what losing a part of your body means to you. If you need help, talk with your doctor about emotional counseling. You may also find it helpful to talk with a person who has had an amputation. Continue reading >>
Why Is Foot Care Important If You Have Diabetes?
Amputation is a major complication of diabetes. If you have diabetes, your doctor has likely recommended that you check your feet each day, but you may not have known why. Read on to learn how diabetes can lead to amputation and how to help prevent it. In some cases, diabetes can lead to peripheral artery disease (PAD). PAD causes your blood vessels to narrow and reduces blood flow to your legs and feet. It may also cause nerve damage, known as peripheral neuropathy. This could prevent you from feeling pain. If you can’t feel pain, you may not realize you have a wound or ulcer on your feet. You may continue putting pressure on the affected area, which can cause it to grow and become infected. Reduced blood flow can slow wound healing. It can also make your body less effective at fighting infection. As a result, your wound may not heal. Tissue damage or death (gangrene) may occur, and any existing infection may spread to your bone. If the infection cannot be stopped or the damage is irreparable, amputation may be necessary. The most common amputations in people with diabetes are the toes, feet, and lower legs. In 2010, 73,000 American adults who have diabetes and are over age 20 had amputations. That may sound like a lot, but amputations account for only a small percentage of the over 29 million people in the United States with diabetes. Better diabetes management and foot care has caused lower limb amputations to be reduced by half over the last 20 years. With ongoing diabetes management, foot care, and wound care, many people with diabetes can limit their risk of amputation or prevent it entirely. The best way to prevent amputation and other severe diabetes complications is to manage your blood sugar. There are several ways you can do this, including: eating a health Continue reading >>
Diabetes, Lower-extremity Amputation, And Death
Abstract OBJECTIVE The goal of the study was to determine whether complications of diabetes well-known to be associated with death such as cardiovascular disease and renal failure fully explain the higher rate of death in those who have undergone a lower-extremity amputation (LEA). RESEARCH DESIGN AND METHODS This was a longitudinal cohort study of patients cared for in the Health Improvement Network. Our primary exposure was LEA and outcome was all-cause death. Our “risk factor variables” included a history of cardiovascular disease (a history of myocardial infarctions, cerebrovascular accident, and peripheral vascular disease/arterial insufficiency), Charlson index, and a history of chronic kidney disease. We estimated the effect of LEA on death using Cox proportional hazards models. RESULTS The hazard ratio (HR) for death after an LEA was 3.02 (95% CI 2.90, 3.14). The fully adjusted (all risk factor variables) LEA HR was diminished only by ∼22% to 2.37 (2.27, 2.48). Furthermore, LEA had an area under the receiver operating curve (AUC) of 0.51, which is poorly predictive, and the fully adjusted model had an AUC of 0.77, which is better but not strongly predictive. Sensitivity analysis revealed that it is unlikely that there exists an unmeasured confounder that can fully explain the association of LEA with death. CONCLUSIONS Individuals with diabetes and an LEA are more likely to die at any given point in time than those who have diabetes but no LEA. While some of this variation can be explained by known complications of diabetes, there remains a large amount of unexplained variation. Worldwide, every 30 s, a limb is lost to diabetes (1,2). Nearly 2 million people living in the U.S. are living with limb loss (1). According to the World Health Organization, lower- Continue reading >>
25 Must Know Statistics About Amputation Due To Diabetes
Diabetes is a common medical condition in the United States – at least 9% of Americans are living with diabetes.[i] Diabetes affects many areas of the body. If you’ve been diagnosed with diabetes, you need to be aware of your feet and watch out for diabetic foot ulcers. What are diabetic foot ulcers? Diabetic foot ulcers are sores that develop on your feet, and they can develop even from seemingly trivial injuries to the feet. Diabetic foot ulcers are a common cause of amputation due to diabetes. If you’re wondering about diabetic foot amputation statistics, be warned: these statistics may seem discouraging. But keep in mind that information can be empowering, and these stats emphasize the importance of seeking medical care for foot ulcers as soon as you notice them. The list also highlights the close connection between peripheral artery disease (PAD), which involves the blockage of the blood vessels in the legs, and what the likelihood is that diabetic foot ulcers will heal. Hopefully this knowledge will remind you to take care of your feet if you have diabetes. If you have a diabetic foot ulcer that hasn’t been treated, show it to your doctor as soon as possible. 25 Statistics Every Person Living with Diabetes Must Know About Amputation Diabetic Foot Ulcers and Amputation There are some surprising statistics about how common diabetic foot ulcers are, how often they can lead to amputation and the ultimate cost of having a foot ulcer that results in an amputation. 1. A foot ulcer is the initial event in more than 85% of major amputations that are performed on people with diabetes.[ii] 2. In the United States, every year about 73,000 amputations of the lower limb not related to trauma are performed on people with diabetes.[i] 3. Of non-traumatic amputations in th Continue reading >>