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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Your feet and more specifically your toes are the furthest body part away from your heart. In diabetes, your body is unable to regulate sugar in your blood appropriately. People who are poorly controlled tend to have much higher levels of blood sugar. The further away your blood gets from the heart, the more affect the varying concentrations of metabolites (like sugar for diabetes, or uric acid crystals in gout) start messing around. The excess sugar can damage the smaller blood vessels causing them to fail to appropriately deliver oxygenated blood. When the nerves lose that oxygen they start to die as well.
Now here’s where it gets tricky. All of that in and of itself doesn’t cause the toes and feet to require amputation. That comes from the lack of sensation resulting in individuals not knowing something has happened. Toe nails grow too long and you cut the side of one your toes? Didn’t feel it so now you don’t know you have a problem. Rock stuck in your shoe? Didn’t feel it so now your heel is being worn down and you get an ulcer. These micro wounds that a normal healthy foot would have been able to detect or avoid now become infected. But guess what, YOU STILL CANT FEEL IT! So you’ve got an infected wound just festering, and unless you’re routinely checking your feet it could go undetected for days or weeks or months. It’s these wounds that, when they come in to the doctor to finally get it looked at, result in amputation becomes the tissue has died and as there’s no coming back and it will just continue to be a nidus for infection which can turn into sepsis which can turn into death.
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