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I have diabetes.

For the past three months, I have been battling not just diabetes, but also cellulitis which turned into sepsis, all from a tiny cut that became a diabetic foot infection.

Ever since I developed LADA, which is a kind of type 1 diabetes that occurs in adulthood, rather than in childhood, about 20 years ago, I have dreaded the potential complications of diabetes. Nephropathy (kidney failure), retinopathy (the leading cause of blindness in diabetics), and hypoglycemia (from taking too much insulin) were certainly on my radar screen. I developed the tingling, burning, and then numbness of neuropathy in my feet early on, after just two years of being a diabetic, but I had never given a lot of thought. I still had (and have) good circulation in my feet, so I figured nothing could go wrong.

I was wrong about that.

About six months ago, I started having unusual dryness in my feet. What I realize now is that the neuropathy had begun to affect the nerves that control my sweat glands. I did use moisturizer before I put on my socks most mornings, but I really didn't give the matter a lot of thought.

Then in May I moved from one of the largest cities in the United States to the countryside, far enough out it was not all that easy to get to a supermarket or pharmacy. I had forgotten my Eucerin, the brand of moisturizer I used, so I went without it for a couple of weeks. What could possibly go wrong?

What went wrong was we had a series of floods. Several times I had to wade through dirty, just plain disgusting water to get into my little house. My dry feet, it turned out, had cracked skin. Into one of those cracks, on my big toe, a variety of bacteria found their way and started to multiply.

The first thing to go wrong was I had a really obnoxious sewer-like smell emanating from my big toe on my left foot. I wore clean socks. I had new shoes. I bathed and moisturized and deodorized, but it still smelled like a dead rat.

After about two weeks I noticed a red rash on my foot. I happen to have venous insufficiency (the veins in my feet and lower legs don't work as well as they should), and when I went to see a doctor about it, she assured me that the problem was with my blood vessels, not with an infection. The skin was still unbroken.

However, the skin on my foot turned an odd kind of brown. It looked like it had been covered with dried blood, only there was no bleeding. The odor intensified, and one day the rash moved up from my foot all the way to my knee. This was cellulitis.

Then I started feeling like I had the flu, only ten times worse. This was sepsis, the immune system's reaction to the infection. (Septicemia is the presence of live bacteria in the bloodstream; sepsis is the inflammatory reaction.) I was admitted to the hospital and put on IV antibiotics. A physical therapist came in once a day to do debridement, removal of dead skin, to keep the skin from getting so tough that it blocked off circulation to the wound on my toe. This went on for a week, and I was sent home.

They told me to take antibiotics for a week, and then to see my doctor in a month. I took my antibiotics, but about three weeks later I once again felt like I had the flu, but ten times worse than the time before. When I went to bed about 11 pm the skin on my toe was intact. When I woke up at 4 am I could see the bone in my toe. The bacteria were flesh-eating, and they were causing not just cellulitis (my leg had turned pink and black and blue overnight) but also sepsis and necrotizing fasciitis. I was facing a life-threatening emergency.

I called 911. They sent an ambulance. It was back to the hospital, this time for four weeks (counting an interlude in a nursing home). I was put on high-strength intravenous antibiotics 24 hours a day, and I had debridement (removal of dead flesh, with a scalpel, without painkillers) eleven times. I finally got out of the hospital and I am now taking antibiotic pills to keep the infection from coming back.

What do diabetics need to know about infections, cellulitis, and serious diabetic complications?
  • Simply keeping the skin of your feet and lower legs moisturized (with an alcohol-free cream, not with water) will help prevent infections.
  • When you have broken skin on the bottom of your foot, stay out of the shower unless you have clean shower shoes. Your wound can pick up bacteria from the shower floor, or the bathroom floor, and they can get inside your soft tissues and even your bloodstream.
  • Redness that you always have on your foot and lower leg, if you are diabetic, is probably due to venous insufficiency or peripheral arterial disease (PAD). Redness you haven't had before, especially if it is spreading, is likely to be cellulitis.
  • One you get cellulitis, you will probably need IV antibiotics to get it under control. In the United States, this means you will probably have to be admitted to the hospital. There are ways to give them at home, through a PICC stent, but this is a way to get an even worse infection.
  • Always take all of your antibiotics. I did, of course, but I shudder to think how bad my situation would have been if I had not.
Diabetic foot infections aren't a sign you have bad hygiene. They can happen to any diabetic. See your doctor right away to prevent further complications such as cellulitis, sepsis, septicemia, amputation, and death.

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