Aging Begins at 30

Monitoring Diabetic's Blood Saves Amputation

In United States hospitals, the 60,000 yearly amputations not resulting from trauma are caused by diabetes in 55%. Half of these occur in persons 65 or older. Leg amputations in diabetics are 13 times more common than in similar-aged persons without diabetes. Diabetes is responsible for 80% of two-sided amputations below the knee.

Leg amputations in Minnesota cost $10 million yearly, and $6 million of this is for diabetics. The average hospital care alone costs $11,000, with or without diabetes. Half of all amputations occur in the 5% of the population with diabetes. Amputation rates were higher in men than in women. It is most often needed for those 75 and older.

Peripheral nerve damage, peripheral vessel damage, and infection all contribute to the loss of a leg. First the patient loses sensation in the feet, then injury, corns, and infection go unnoticed. Bone infection (osteomyelitis) and gangrene (death of skin and muscle with infection) are complicated by the narrowing of blood vessels that fail to deliver an adequate anti-infection response. Poor blood sugar control, long duration of the diabetes, and poor preventive health care are risk factors for later amputation. Many of the amputations reported recently from Minnesota may have been preventable. Good blood sugar control in Type 1 diabetes (formerly juvenile) and type 2 diabetes (formerly late onset) can reduce or delay nerve and blood vessel damage. The same study of 552 diabetic Minnesotan amputees agrees with other studies and national data.

A national health objective for 2000 is to decrease diabetes-related amputation rates by 40% from 8.2 to 4.9 per thousand diabetics. Prevention with foot hygiene, proper shoes, no self-performed foot surgery, and attendance at diabetic clinic is essential.

The American Diabetes Association guidelines are not followed by about 50% of primary care physicians. At present many diabetics (especially the elderly) don’t get the three essential tests they need to be monitored appropriately. Nearly 85% don’t get hemoglobin A1C measurements (a measure of long term sugar control), 54% don’t get yearly expert eye exams, and 45% get no cholesterol screening. These compliance figures are lower in rural than in urban areas. Intensive treatment can reduce the risk of eye complications by 50 to 75%, kidney damage by 54%, nerve damage by 60%, and large vessel damage by 41%. Tight control increases the danger of low blood sugar threefold, but this is free of residual damage in the young. There might be a slight increase in strokes in the elderly. Daily management of diabetes is burdensome but well worth the cost.

Loss of the opposite leg occurs at about 35% within 5 years. One author puts the number of walking bilateral amputees as "minuscule." They will be using a wheel chair for life. The majority of amputees will die of the disease before they lose a second leg. Survival rates of amputees are 74% at one year, 62% at two, and 56% at 5 years. Much can now be done to save a leg by artificial blood vessel grafting. Nonetheless the moral of the story is that it is better to preserve your legs by the best possible control of blood sugar.

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See related Patient Topics Amputees, Bones, Joints and Muscles, Diabetes, Endocrine System (Hormones), Food, Nutrition and Metabolism, Immune System/AIDS or Seniors' Health.

See related Provider Topics Bones, Joints and Muscles, Diabetes, Endocrine System (Hormones), Food, Nutrition and Metabolism, Immune System/AIDS or Seniors' Health.

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