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Even a small cut can end in amputation

  Thursday, 26 l 08 l 2010 Source:  Mind Your Body; The Straits Times   
By: April Chong

For a diabetic with poor blood circulation, a wound may not heal and the limb or digit may turn gangrenous. APRIL CHONG reports

I t is just a cut to the foot, but for a diabetic, it is an invitation to a surgeon’s saw.

That is because diabetics have poor blood circulation.

One theory is that excess blood sugars binds to proteins in the blood vessels and alters the structure and function of the blood vessels, making them less elastic. Hence, this interferes with the flow of blood. Damaged blood vessels also tend to attract fatty deposit build-up and, over time, this narrows the blood vessels.

Therefore, when there is a wound or infection, it is tougher for blood to reach the extremities to heal the area.

Gangrene sets in and strikes harder and faster than other complications that can result from the disease, such as renal failure and blindness.

Within weeks, the area around the wound will become purplish. It refuses to heal. That is when the doctor’s saw comes in.

Worldwide, a gangrene infected limb is lost to diabetes every 30 seconds, a study published in the International Wound Journal last year said. This figure may be higher in future, as the International Diabetes Federation estimates that 438 million people worldwide will have diabetes in the year 2030, compared to 285 million now.

In Singapore, there is some good news though: The number of diabetic leg amputations dropped from 413 in 2004 to 203 last year, according to a Straits Times report earlier this month.

If the gangrene is detected early, procedures such as ballooning and stenting can help save an infected leg by widening the blood vessels in the leg to improve blood circulation, said Dr Steven Kum, a consultant at the department of surgery at Changi General Hospital.

For example, in ballooning, a balloon is inserted up a narrowed artery via a wire, then inflated to squash the plaque build-up against the vessel wall. Stents also work to widen blood vessels (see graphic).

saving limbs

Dr Kevin Tan, the vice-president of the Diabetic Society of Singapore, reckons that more than 85 per cent of amputations here could have been avoided.

Along with the Podiatry Association of Singapore and nutrition product company Abbott Nutrition, the Diabetic Society of Singapore will start a drive next month to reach out to 800 general practitioners here to increase their awareness of diabetes and diabetic foot care.

Proper foot care techniques include keeping the feet dry and wearing proper shoes and socks.

Usually, gangrene starts with ulcers on the feet. Hence, amputation can be avoided if the patient takes care of his feet and inspects them every day for signs of problems, said Dr Tan.

“Many people are just needlessly losing their feet,” he added.

Tell-tale signs

The Diabetic Society of Singapore and doctors say diabetes symptoms include:

■ Increased urination
■ Blurred vision
■ Fatigue or drowsiness
■ Poor wound healing
■ Increased hunger and thirst
■ Rapid weight loss
■ Nausea and vomiting
■ Dry, itchy skin
■ Loss of sensation in hands or feet
■ Ants are attracted to the sweet urine in the toilet, but doctors say this may not be reliable and it is still best to get a blood test done.

Managing diabetes

Polyclinics run family physician clinics which better monitor patients with chronic conditions such as diabetes. There, general diabetic patients pay no more than $10 for a week’s supply of generic diabetes medication
and insulin. The cost is even lower if no insulin is needed.

Diabetics can use up to $300 annually from their Medisave account to pay for their treatment.

Getting regular health checks, including a blood test for diabetes, is important. Testing for diabetes is recommended every three years.

Here, diabetes screening can be found in clinics, polyclinics, hospitals and some welfare associations. Free checks are available during community screenings held by welfare organisations such as the Diabetic Society of
Singapore, the National Kidney Foundation and community centres.

Under the national Integrated Screening Programme, those aged above 40 can get their blood sugar levels tested at a subsidised rate of $8 at participating clinics.

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