Sparing the details, a colleague of mine recently had his big toe amputated due to diabetes. I wondered why being diabetic could lead to this as it’s common.
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The extra sugar causes circulation issues in the small arteries which can cause injuries to not heal or cells to start dying. It’ll only get worse so they have to remove the affected tissue otherwise it will go necrotic.
The way it was explained to me was that the sugar is jagged and damages the arteries and get stuck together in the narrow ones at your extremities, blocking blood flow.
Diabetes causes nerve damage if not managed well. People with this nerve damage in their feet can’t feel them properly. Then any injuries that their feet may get are not felt and therefore not treated. This causes the injuries to become more serious than they would normally be and can result in the need for amputation.
Sugar builds up in blood vessels to such high levels that it starts to crystallize (in your eyes this can cause blindness). Blood stops circulating enough which effects your extremities the most. In extreme cases ppls feet will rot and require amputation.
Relatedly, how preventable is all that? Or are some cases of diabetes so severe that there’s no escaping it?
It effects all extremities by cuasing popr circulation and therefor cell and netve deafh.. Your feet are just your biggest ones and the fathest away. It can definitely effect eyes as well..
And for men, please note. I said ALL extremities. Ya hear? So watch your sugar
High blood sugar disrupts vascular integrity, among MANY other severely detrimental effects.
High blood sugar also partially explains the cholesterol clogs your arteries hypothesis.
The reason we find clumps of cholesterol in arteries is probably an attempt at the body from repairing damage caused by hyperglycemia.
The main reason for this is that 80%+ of cholesterol is synthethized in your liver, not absorbed from food. If you have high cholesterol, it is likely your body’s intent to produce that cholesterol. As a significant component of cell membranes, it becomes clear why it accumulates around vasculature, they are suffering damage and it’s being repaired inneffectively, since hyperglycemia usually continues, and efforts to lower cholesterol are usually started.
An analogy so basic it could come from a caveman: Sort of like trying to duct tape a hole in a bucket, but it’s full of water. You end up using way too much tape and it’s still leaking.
Sugar sticks to stuff (non-enzymatic glycosylation) and that damaged tissue. It does this under normal circumstances but having more sugar in your blood means it does it too much.
The way I always thought of it was lots of sugar in blood makes blood thicker, thicker blood plus small veins = easy blockages, blockages lead to tissue damage/death. Something like that.
A short ELI5: one of my diabetes educators explained it as, “sugar is sharp”. High blood sugar damages our circulatory system, and it’s first noticeable in our extremities. In addition our skin is more prone to infection and wounds heal slower. Combine nerve damage (I haven’t felt my toes for 20 years) with issues healing wounds and it’s easy to end up with a seriously infected toe without knowing about it until it’s too late. This is why diabetics are encouraged to examine our feet daily.
In non-diabetics, blood sugar never gets very high, the body regulates how much stays in circulation.
In people with poorly controlled diabetes, the constantly extremely elevated blood sugar has a couple effects.
The sugar causes nerve damage. The longest and smallest nerves are affected first (the ones further from your spinal cord, so fingers and toes). The nerve damage affects your gait, your brain isn’t able to sense your feet hitting the ground in a coordinated manner, and you damage your feet while you walk. You also don’t feel the small injuries that happen because of the reduced pain sensation.
The sugar also causes small blood vessels to get thickened, and therefore narrowed. You get less blood supply, and therefore less oxygen to the fingers and toes, so small injuries can’t heal well.
All of this results in multiple poorly healing or non-healing ulcers on your feet over time. Bacteria from the environment and skin get inside your foot and cause bad feet infections. Left alone, those infections can spread to the rest of your body so there is a certain point where it becomes amputation or death.
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