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Pauline had had diabetes for around 20 years when she started having serious problems with her feet. Never really paying close attention to her blood sugar levels, at first Pauline had been mildly troubled by the tingling, burning, and pins and needles feeling that is caused by diabetic neuropathy.

After a couple of years, however, the unpleasant sensation went away and Pauline thought her feet were actually better. At the same time, unfortunately, Pauline suffered a combination of nerve-related problems which she didn't realize were associated with diabetic neuropathy, including irritable bowel syndrome, migraine headaches, and acid reflux.
That might seem like enough of a challenge all on its own, but that wasn't the end of the story. One day, Pauline looked down and saw what looked a little like a gray blob on her foot. An area of skin about half the size of a biscuit was covered by dead, gray skin filled with watery fluid. The infection didn't hurt, but it looked really horrible, so Pauline did what she should have done much earlier — she made an appointment with her doctor.
Pauline's doctor ran a culture taken from the wound and came back with the news that the gray blob on the foot was a virulent infection with a bacterium called Klebsiella. And the doctor also told Pauline that her x-ray showed that the infection had spread to the bone, and the only way to stop the infection from spreading up into her leg and onward to the rest of her body would be an immediate amputation.
Diabetic Foot Problems Are Common
Not everyone who has diabetes develops severe and widespread foot infections that will eventually lead to amputation, but people who have poorly controlled diabetes do tend to have serious problems with their feet. A combination of blood vessel disease causing poor circulation to the feet with a condition of nerve deterioration known as neuropathy makes the feet highly susceptible to injury. Some diabetic people, however, who only have neuropathy, and not damage to the blood vessels, have to have amputations.
Many diabetics have limited sensation in their feet, so they simply do not feel injuries to bones, tendons, muscles, or skin, and may not even notice serious ongoing problems for a while. Bacterial infections in the foot can necessitate the amputation of the foot to prevent the spread of bacterial gangrene to the rest of the body — and when this happens, death often follows in just 1 to 2 years.
Diabetic Wounds Are Slow to Heal
The reason that amputation so often leads to death in diabetics is that diabetic wounds are slow to heal. After an amputation, it may be necessary to stay in a wheelchair for weeks or months on end while the injury heals and prosthetics are designed for the person, and the person slowly learns to use the prosthetic (which can itself cause new friction injuries).
Exercise to control diabetes becomes impossible, and constantly staying in the same position leads to the formation of skin wounds, which can also become infected, on other parts of the body. Many diabetics facing the loss of independence caused by an amputation just give up, but fortunately a new technology involving the injection of amniotic fluid, the fluid surrounding the baby in the womb, collected from women after they give birth, may hold an answer to this age-old problem.
- Mohammadi AA, Johari HG, Eskandari S. Effect of amniotic membrane on graft take in extremity burns. Burns. 2013 Sep. 39(6):1137-41. doi: 10.1016/j.burns.2013.01.017. Epub 2013 Mar 21.
- Pan HC, Chin CS, Yang DY, Ho SP, Chen CJ, Hwang SM, Chang MH, Cheng FC. Human amniotic fluid mesenchymal stem cells in combination with hyperbaric oxygen augment peripheral nerve regeneration. Neurochem Res. 2009 Jul. 34(7):1304-16. doi: 10.1007/s11064-008-9910-7. Epub 2009 Jan 17.
- Photo courtesy of Ryan Somma by Flickr : www.flickr.com/photos/ideonexus/3224918409/
- Photo courtesy of USFWSmidwest by Flickr : www.flickr.com/photos/usfwsmidwest/6165875821/
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