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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Lots of people are talking about nerve damage and poor circulation, but the immune system is also impaired here because of these factors. In diabetics, the immune cells responsible for fighting infections are less recruited. Skin wounds heal more slowly, and some cells, the T cells, even have impaired differentiation. Without enough differentiated T cells (the cells that kill infected cells and help eat pathogens), they can’t fight off infections properly. This is especially common in foot ulcers, which don’t recruit the cells needed to kill off the bacteria/virus/etc. The infection can spread to the bone and end up causing major problems. Often, the tissue ends up dying and needs to be amputated so that it doesn’t spread upwards
There’s also something called Diabetic chronic inflammation. Sugar, glucose, is inflammatory, and in high quantities over a long time, it can end up disrupting the immune system. Cells start producing too many inflammation messengers to tell other cells to react, and this can tire the overall system. It’s always super active, so when there’s actually an infection, it might respond slower or less effectively.
There’s a bunch of other immune factors and I’m not an expert, just an immunology student!
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