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Why Diabetes Amputation

When Patients With Diabetes May Benefit From Below-knee Amputation

When Patients With Diabetes May Benefit From Below-knee Amputation

Below-knee amputation. To see it in print conjures up images of failure. When we see it written in the OR schedule, we often ask ourselves, “What happened?” Was it a bypass that failed, a Charcot reconstruction that got infected or a heel ulcer in a patient with end-stage renal disease? Numerous publications and thought leaders have described the continued challenge and struggle to reduce the amputation rate, citing global studies saying that we have failed to achieve this goal. The implication of all of these studies is that the incidence of limb loss due to diabetes should be zero. The recent literature has signaled a change in perception. Surgeons are beginning to acknowledge that there is a small subset of patients who may actually benefit from early intervention such as a below-knee amputation. Certainly, much of the goals of diabetic limb salvage should be to avoid major amputation but should there also be a time when the patient and/or the doctor can choose to opt out of limb salvage and be better off for it? A Closer Look At The Research On Diabetic Amputation Lower extremity amputations are a serious process and do not come without risks. Aulivola and colleagues reported that the 30-day mortality rate following a major lower extremity amputation was 8.6 percent.1 Specifically, the rate was 16.5 percent for above-knee amputations (AKAs) and 5.7 percent for below-knee amputations (BKAs). These same authors showed an overall survival rate after a major lower extremity amputation of 69.7 percent and 34.7 percent at one and five years respectively. One- and five-year survival rates were significantly worse for AKAs (50.6 percent and 22.5 percent) than BKAs (74.5 percent and 37.8 percent). Survival rates in patients with diabetes and end-stage renal disease were Continue reading >>

How To Avoid Amputations If You Have Diabetes

How To Avoid Amputations If You Have Diabetes

In people with diabetes, a trifecta of trouble can set the stage for amputations: Numbness in the feet due to diabetic neuropathy (nerve damage) can make people less aware of injuries and foot ulcers. These ulcers may fail to heal, which can in turn lead to serious infections. "Normally a person with an injury on the bottom of their foot, such as a blister, will change the way they walk. Your gait will alter because you are going to protect that blistered spot until it heals up," says Joseph LeMaster, MD, an assistant professor at the University of Missouri–Columbia School of Medicine. "People with a loss of sensation don't do that. They will just walk right on top of that blister as though it wasn't there. It can burst, become infected, and turn into what we call a foot ulcer," he says. "That ulceration can go right down to the bone and become an avenue for infection into the whole foot. That's what leads to amputations." Foot injuries are the most common cause of hospitalizations About 15% of all diabetics will develop a foot ulcer at some point and up to 24% of people with a foot ulcer need an amputation. You're at extra-high risk if you're black, Hispanic, or Native American. These minority populations are two to three times more likely to have diabetes than non-Hispanic whites, and their rates of amputations are higher. "It's the most common reason that someone's going to be hospitalized with diabetesnot for high blood sugar or a heart attack or a stroke," says David G. Armstrong, DPM, a specialist in diabetic foot disease at Rosalind Franklin University of Medicine and Science in North Chicago. "It's for a hole in the foot, a wound." About a year ago, Dr. Armstrong treated a 59-year-old man with type 2 diabetes who had been working out at a local health club; 12 Continue reading >>

Why Is Foot Care Important If You Have Diabetes?

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

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 >>

Diabetes And Gangrene

Diabetes And Gangrene

Diabetes mellitus is a condition where the body is unable to control the blood sugar. Normally the body has a good immune system that fights against microbes and invading organisms that may lead to infections. The white blood cells are the main fighters in this respect to keep the body protected. (1-5) In patients with diabetes, the immune system of a person is affected. In addition, the blood vessels are damaged due to the excessive blood sugar running in the veins. Peripheral neuropathy and gangrene Also diabetes leads to damage to the nerves in the long run. This is called peripheral neuropathy. This leads to lack or decreased pain sensation. So if a diabetic patient gets accidentally poked, hurt, cut or burnt especially in the limbs or extremities like toes and fingers he or she may not be aware because the cut may not hurt. Pain usually alerts a normal person to care for a hurt area in order to prevent infections. In diabetics this is absent and the wound often gets infected. Diabetes and the immune system Further diabetes weakens the immune system which is unable to fight the invading organisms at the wound. High blood sugar makes the blood more favourable for bacterial and microorganisms to grow. Foot infections in diabetics In diabetics the common sensitive areas affected are lungs, skin, feet, urinary tract, genital area and mouth. In diabetics skin infections are detected commonly because of their visibility and not because of their pain. Diabetics commonly get foot infections. This is because the feet are commonly exposed to injury and bumps and bruises in the activities of daily living. Foot infections may begin as small ulcers and may invade deeper tissues, lead to gangrene or affect the bones and invade the blood stream as well. It is found that nearly hal Continue reading >>

Diabetes: Amputation For Foot Problems

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 >>

Using Data To Tackle The Burden Of Amputation In Diabetes

Using Data To Tackle The Burden Of Amputation In Diabetes

On Sept 5, 2017, Public Health England (PHE) published 2010–16 data on the incidence of amputation for diabetic foot ulcers in Clinical Commissioning Groups (CCGs) throughout the country, using data adjusted for known non-modifiable risk factors.1 The differences between localities revealed by these data highlight both the need for continued close surveillance of diabetes-related amputation rates and the opportunity for improvement. This article is available free of charge. Simply login to access the full article, or register for free if you do not yet have a username and password. Continue reading >>

Why Should I Care If I'm Diabetic? I Was Diagnosed About 10 Years Ago. I Have So Many Other Medical Issues That Diabetes Almost Seems Unimportant. What Can Really Happen If I Don't Take Care Of It?

Why Should I Care If I'm Diabetic? I Was Diagnosed About 10 Years Ago. I Have So Many Other Medical Issues That Diabetes Almost Seems Unimportant. What Can Really Happen If I Don't Take Care Of It?

In early November, we got a very young woman into the facility for wound treatment; at 22, she had been as care-less about her disease as you sound to be. Pretty thing, into all the usual 20-something activities, boyfriend, job, future, but she had neglected her diabetic protocol thinking it didn't really matter, and she injured her foot- no big deal, right? Except, for a diabetic, it is a big deal. Because diabetics heal much, much slower than usual, the wound infected, she went septic and nearly died, then nearly lost her foot, and came to us with MRSA in the wound so she was quarantined to her room for three weeks while the antibiotics did their job, and was, basically, imprisoned during her treatment. Now, she could have declined treatment, lost first her foot and then her life, but she chose treatment. And the treatment wasn't fun. Took a good month out of her life- which doesn't sound like much until it is you stuck in a 10' x 18' room with a TV and a phone- and everyone who visits you is wearing a gown and gloves- yep, even your boyfriend. I saw her, oddly enough, at DH's Christmas party; she was with one of DH's younger co-workers, her boyfriend. She looked good, healthy, shiny, happy, and, as we talked later, I asked if she was following her protocols, and she got very serious. "Oh, yes- I didn't believe it could kill me, but it can. I don't want to die." Which is why she is still alive. Diabetes kills. It can kill swiftly- through wounds and infections, through kidney failure, insulin shock- or it can kill slowly, through the same mechanisms. Diabetes complicates every other disease process as you age- heart disease, digestive problems, cancer, pulmonary diseases- it makes everything else even worse. Your choice. You can choose to follow your protocols and liv Continue reading >>

What Will Happen To An Elderly Person After The Legs Are Being Amputated Due To Diabetes ?

What Will Happen To An Elderly Person After The Legs Are Being Amputated Due To Diabetes ?

Diabetes is a systemic illness that accelerates the aging process and affects all aspects of the body. That someone has lost both legs to the illness shows that the disease is out of control for that person. It will take careful management of blood glucose levels and use of insulin to correct the situation if it can be corrected. Remember, all systems are involved, which means irreversible damage may have been done to areas of the body (such as the kidneys). In the meantime, the person will need PT and OT to learn how to live without legs. There may also be a need for daily care as the person recovers (activities of daily living care). Also, mental health counseling may be a good idea too, as losing both legs has the potential to precipitate situational depression. Thank you for asking me to answer this question. Continue reading >>

Diabetic Foot

Diabetic Foot

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.[1] 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%.[2] 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.[3] 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.[4] Prevention[edit] 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.[5] There is however only limited evidence that patient education has a long-term Continue reading >>

Doctors Debate Danger Of Popular Diabetes Drug After Fda Amputation Warning

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 >>

Amputation And Diabetes

Amputation And Diabetes

If you have diabetes, you're at higher risk for many related health problems, including foot or leg amputation. That's when you have surgery to remove a limb or a digit like a toe or finger. But you can do some things to keep your feet and legs healthy. And if your doctor recommends amputation, you can still protect your health and prevent future problems. Diabetes is linked to a condition called peripheral artery disease (PAD). It can narrow the arteries that carry blood to your legs and feet and make you more likely to get ulcers (open sores) and infections. It also can make those things heal more slowly. High blood sugar levels caused by diabetes can damage the nerves and blood vessels in your body. That includes the ones in your feet and legs. If your nerves are damaged, you might not feel pain or other symptoms of ulcers or infections. That raises your risk of serious infection or gangrene, which refers to the death of your tissue. In some severe cases, the only way doctors can treat the infection or gangrene is to amputate, or remove, the area that's affected. If you have diabetes, it's especially important to take good care of your feet to lower your risk of amputation. you might like Check your feet every day. Look for changes like: Cuts Cracks Sores Redness White spots or areas Different colors If they're colder or warmer than usual, that can also be a sign something's wrong. Run a feather or light object along your foot to make sure you can feel it. If you can't check your own feet, ask a family member to help you. If you notice a problem or aren't sure if something's normal, call your doctor. Don't smoke: Smoking damages your small blood vessels and affects blood flow to your feet. It also makes it harder for your body to heal. Those things raise your risk of Continue reading >>

Why Diabetes Can Lead To Amputation

Why Diabetes Can Lead To Amputation

A circulatory problem that starts at the arteries has a part to play. Every year, Singapore hospitals perform roughly 1,500 diabetes-related amputations. This works out to about four amputations a day – a number that may go up as Singapore deals with a growing diabetes problem. The amputations are mainly due to peripheral arterial disease (PAD) – the narrowing or blockage of lower limb arteries. As a result, muscles and tissues in the lower limbs receive little to no oxygen- and nutrient-rich blood. It is especially prevalent in diabetic patients who have poor or suboptimal blood glucose control, said Dr Benjamin Chua, a vascular and endovascular surgeon at Mount Elizabeth Hospital. “This is further aggravated if patients also have poorly controlled blood cholesterol levels or continue to smoke cigarettes. (Also Read: 9 Shocking Facts and Statistics About Diabetes) “Aside from diabetes, other risk factors include chronic smoking, hypertension and end-stage renal failure,” he said. There are some signs that indicate the onset of PAD, including severe cramping pain at the affected part of the legs, such as the thigh, calf or foot. “This severe cramping pain usually sets in after a repeated, fixed distance of walking or duration of exercise and is relieved by simply standing still,” said Dr Chua. “If left untreated, these patients may gradually find they can no longer walk or exercise for long without pain. “As a result, many of these patients find themselves limiting their mobility to avoid the pain.” As PAD progresses, patients may start to feel pain in their lower limb even at rest, especially when lying down. They may also find their affected lower limb cold and pale. “Some of these patients may go on to develop non-healing foot ulcers, or their t Continue reading >>

Diabetic Amputation Rates Soar In California, Nationally

Diabetic Amputation Rates Soar In California, Nationally

Over the past 7 years, California clinicians have been amputating toes, feet, ankles and legs of patients with diabetes-related ischemia with much greater frequency than before, and public health officials, diabetes clinicians, and surgeons said they're puzzled by the trend. Statewide, there was a 31% increase in these non-trauma amputations after adjusting for changes in population from 2010 to 2016. Adjusted increases reached 66% in San Diego County, with a population of 3.3 million. In other populous areas of the state, Riverside County (population 2.4 million) had a 62% increase in diabetes amputations among residents. San Bernardino County (2.1 million) had a 61% increase. Sacramento County (1.5 million people), 47%. And Los Angeles County, with more than 10 million people, saw a 20% increase. By raw numbers statewide, there were 12,490 diabetes-related amputations in 2016, up from 8,980 in 2010, with almost all counties seeing steady increases year over year. The data -- filtered for more than 100 ICD-9 and ICD-10 codes by county, hospital, body part surgery, and payer -- was requested from the Office of Statewide Health Planning and Development, the California agency that collects diagnostic codes for inpatients treated by all hospitals within the state. It was then analyzed to adjust for changes in population. Asked for comment, officials for the California Department of Public Health responded with one sentence, saying it "does not have information" on possible reasons. CDC Taking Note Edward Gregg, chief of epidemiology and statistics for the CDC, said the trend is troublesome. National statistics for 2010 to 2014 show a 27% increase; before 2009, amputation rates had been dropping. Gregg said that from a public health standpoint, "the rate of amputations is a Continue reading >>

Diabetes Canada's Position On Amputation Prevention

Diabetes Canada's Position On Amputation Prevention

Position statement Diabetes Canada: Calls for affordable and timely access to medications, devices, education and care that are necessary to achieve optimal diabetes control, and prevent serious complications such as amputation. Calls for access to publicly funded services and devices for all people with diabetes to prevent and treat foot ulcers and avoid amputation, including foot care education, professionally fitted footwear and devices, timely referrals and visits to a foot care specialist. Recommends that health care professionals screen for diabetic neuropathy and peripheral vascular disease, perform annual examinations for foot complications (more frequent for those at high risk), and educate people with diabetes about proper foot care as an integral component of diabetes management, as outlined in the most current Canadian Diabetes Association Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Calls for an interdisciplinary approach to the prevention and management of diabetes foot complications, including coordination of care and communication between health care professionals who support people with diabetes in managing their disease. Urges people with diabetes to check their feet daily for cuts, cracks, bruises, blisters, sores, infection, and unusual markings. Background and rationale Diabetes is the leading cause of non-traumatic lower limb amputation in Canadian adults, associated with approximately 70% of amputations performed in hospital. Compared to the general population, Canadian adults with diabetes are over 20 times more likely to undergo non-traumatic lower limb amputations, 85% of which are preceded by a foot ulcer.1,2 Diabetes foot ulcerations are often the result of diabetic neuropathy and/or peripheral vascula Continue reading >>

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