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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I actually always wanted to ask this question but never remembered to look it up. Since I got Type 1 Diabetes I have an endocrinologist test the sensation in my feet every checkup
At its core diabetes mellitus is a micro-vascular disease. Sure, it’s endocrine and insulin and hyperglycemia, but the cause of its side effects is micro-vascular.
High blood sugar damages the lining of small blood vessels. Like, vessels the width of one or two red blood cells. This damage causes platelet adhesion which results in a clot formation. This blocks the vessel and no blood can move forward in that vessel. But is a TINY vessel, so no big deal…. Until it’s happening everywhere, all at once, all the time. Then, big deal.
Those vessels feed the nerves in your feet and hands, and your feet and hands are PACKED with nerves. As those nerves lose blood flow they die and you develop progressive numbness. Similar damage can happen to your stomach causing gastroparesis (stomach paralysis).
Besides that your retinas, kidneys, and heart are all collections of tiny blood vessels or rely on tiny blood vessels to function. Hence diabetic retinopathy (blindness being the end), renal disease (most dialysis patients are diabetics), and coronary artery disease. Also peripheral artery disease, vascular dementia (brain slowly destroying for lack of micro blood flow), and susceptibility to common bacterial infections (repeated abscesses, pneumonia, etc) because your immune system uses those micro-vessels to get to infection sites.
Diabetes is a huuuuuge problem
My wife with diabetes, got a nasty cut while mowing the lawn. She did not feel it at all. It got very dusty dirty before she noticed, which wasn’t until she exited the shower and saw the blood. Since then my hubby duties include checking her feet anytime a cut, blister or sore is possible and caring for any I may find.
– Diabetics’ vascular system deteriorates over time, so the extremities lose proper blood circulation.
– The feet are furthest from the heart, so they are generally the most affected.
– The feet are also prone to injury, from stepping on sharp things, stubbing toes…etc.
– When blood flow gets worse, so does sensation in those areas, so injuries to the feet can go unnoticed and fester. Before you know it, you get gangrene.
It causes poor circulation and the parts of your body with the worst circulation are your extremities i.e your hands and feet. That’s why when your in super cold water for a long time your radial pulse (The pulse on your wrist) feels weaker or lighter than the carotid pulse (The pulse on your neck)
Diabetes disrupts your blood flow to extremities. Bad blood flow = poor healing. Diabetes also affects nerves. This creates a perfect storm of not feeling wounds and them not healing. They then get infected and in worst cases need to be amputated.
Diabetes affect blood circulation in your whole body. Usually the first thing people will notice is their feet since it is the farthest point from the heart.
You begin losing sensation, then any injuries will take a long time to heal up to a point where no blood will reach the foot and will need to be amputated. There are procedures to help with this, but it usually only delay the inevitable.
Apart from the feet, usually people with diabetes will have kidney problems and will often necessitate dyalisis.
One of the hallmarks of diabetes is elevated blood sugar.
High amounts of sugar in your blood causes damage to blood vessels that builds up over time, eventually resulting in reduced blood flow to the extremities which results in necrosis if left unchecked.
It isn’t like this is specific to the feet, either. Uncontrolled diabetes can also cause blindness.
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!
When you have diabetes, your body doesn’t properly regulate blood sugar levels. This can be because your pancreas doesn’t produce enough insulin, or your body becomes resistant to insulin function. Either way, people with diabetes have chronically high blood sugar levels.
Sugar has an interesting effect on the insides of our veins and arteries. It causes them to become rough on the insides. This roughness causes fat to stick to the insides and form deposits. These fat deposits inhibit circulation.
So you start from an inability to regulate blood sugar, this causes high blood sugar, this causes damage to your circulatory system, and this causes fat to build up. As you can see, this is a cascading failure. But why does it affect your legs?
Our heart is in our chest, but our legs are down near the ground. This makes it hard to get good circulation to begin with, but the damage due to the cascading failures above makes this circulation less efficient.
Poor circulation has its own set of cascading consequences. Our circulatory system carries nutrients to our cells. It also brings healing agents and carries away dead cells and pathogens that have been killed by our immune system.
A body part without good circulation is like a car without oil, fuel, or air intake. Over time, this lack of supply takes its toll on the body parts it affects the most. Our legs happen to be particularly susceptible to the cascading effects of diabetes.
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