World Diabetes Day is observed on November 14.
"Every 17 seconds, a diabetic is diagnosed and every 30 seconds a diabetic leg amputation takes place somewhere in the world". This seems unbelievable, but true...This is what the official journal of the American Diabetic Association says... (Article link at the end of the posting).
While it cripples a Diabetic once his leg gets amputated, but the good news is that in most cases, a diabetic leg amputation can be prevented if we remain alert when the early signs/symptoms appear and we seek timely and necessary medical intervention...
The early signs are:
(1) Leg getting fatigue easily at a short walk
(2) Muscle cramps at the lower limbs: ankles, toes, and feet....
(3) Restless Leg Syndrome
(4) Wounds not getting healed easily...
(5) Loss of sensation in lower limbs such as feet, toes..
(6) Eruption of itching ulcers all of a sudden...and ulcers not getting healed.
Why does this happens to a Diabetic?
The main cause is the Etiology of the disease itself. This can happen especially If the blood sugar level remains elevated which can lead to a host of complications. Diabetic Leg Syndrome is one of the major complications.
(1) PAD (Peripheral Artery Disease) occurs when the arteries leading to the lower limbs get clogged with Plaque. This results in restricted blood flow to the feet and toes and so the oxygen rich blood does not reach the tissues in the lower limbs.
(2) PN (Peripheral Neuropathy)
This is a condition where the nerves can get damaged. While PAD and PN may be different disorder independent of each other, however recent studies Indicate both could co-exist in a Diabetic and that PN comes at a later stage than PAD....
(You must read this interesting article - 2nd link).
(3) Varicose vein :
This is independent of diabetic diseases. But, it has been seen that the symptoms are similar to PAD and older obese diabetics are likely to have this too...
Veins are not able to return the blood from the lower limbs due to weak vein valves resulting in to pooling of blood....
(4) DVT- Deep Vein Thrombosis
The symptoms could be similar to PAD- leg pain.
This may be independent of DM, but especially if one is obese more than BMI is 30 and also a person with Atherosclerosis/PAD, this can happen..
The blood clot in the vein can break and reach the lungs or even heart and can cause heart failure.
So, when there is a restricted blood flow to our lower limbs, the tissues don't get enough Oxygen rich blood leading to poor tissue health which results in to foot ulcers, non- healing wounds and if care is not taken, it can result in getting an infection, Gangrene, which can spread all over and the only solution .... Leg amputation.
Diagnosis and treatment:
(1) PAD can be diagnosed by ABI
(Ankle Brachial Index) - A noninvasive method by measuring Blood Pressure at ankle and at the arm and the ratio. If less than 0.9, then it could be PAD.
It can also be further confirmed by Doppler ultrasound of the leg arteries and measuring the blood flow/velocity...
Also Computer Tomography and magnetic resonance imaging could reveal the PAD...And the Angiography is the invasive method in which a dye is injected and the arteries are examined to see if there is a clog.
(2) Vericose vein and DVT can also be checked visually and confirmed by Venous Doppler ultrasound... And the best treatment is wearing Graduated Compression Stockings...it helps in returning the blood from the lower limbs.
(3) The most important point for all diabetics is to keep their feet clean - physical examination of feet daily, washing and drying at least twice a day with soap and water.. or even emersing the feet in sea salt water in a bucket. Warm saline water is ideal, but needs to be avoided since in case one has neuropathy he can not get the heat sensation. Suitable footwear is important as well... Changing socks daily if worn....
(4) Nowadays, there is a podiatry department in almost all hospitals . Ensure you have a complete leg check up which checks all parameters.
Also please watch what an endochrinologist has to say on diabetic link given at the end.
Here is what an Endocrinologist has to say on diabetic leg- In Hindi.