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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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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