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Amputees’ regret

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

Two men tell how their stubbornness led to their losing their limbs. Despite being diagnosed with diabetes, they made no effort to change their unhealthy lifestyles. One even ignored the medication his doctor prescribed

The bad news about diabetes is that complacency can lead to serious complications, like limb amputation.

The good news is that, for those who diligently manage their disease, such complications can be averted.

amputeeFormer factory worker Kim Joo Swan was too happy-go-lucky.

Mr Kim, 56, used to down four cans of carbonated drinks every day and would eat “all the time”. He was overweight and was more than 110kg at his heaviest.

Even after he was diagnosed with diabetes more than two decades ago during a routine workplace health check, he continued with his lifestyle and put aside the diabetes medicine he was prescribed.

He was then in his 30s.

Diabetes, a common disease here, is still all too often dismissed because many people may not see any outward symptoms.

“I did not feel unwell and I was still strong enough to carry goods weighing 43kg in each hand,” he said.

However, a cut on his right toe – which he ignored because “injury was common for his kind of work” – led to gangrene. In 2003, his badly infected right leg had to be amputated below the knee.

He was more careful about what he ate after that and took his medication but his efforts were too late. Two years later, he lost his other leg.

Not managing his diabetes well had also left him with renal failure, which requires him to go for dialysis three times a week.

His 30-year-old son and his daughter-in-law now take care of him with the help of a maid. He also has a daughter, who is married.

Mr Kim, who stopped work in 2003 after his first leg was amputated, is now able to walk slowly with the help of two prosthetic legs and walking sticks.

He now spends most of the day in his neighbourhood, sitting at the coffeeshop or at the void deck, not wanting to “waste away at home”.
diabetes typeDiabetes occurs when high levels of sugar are present in the blood, either because the body does not produce enough of the hormone insulin to metabolise the sugar (Type 1 diabetes) or the body becomes resistant to insulin (Type 2 diabetes).

About 9 per cent of people here have diabetes, with the majority above the age of 40.

Type 2 diabetes, which Mr Kim has, is more common here, affecting 85 to 90 per cent of diabetics.

Although it usually hits older persons, it is affecting children too. It now accounts for a third of childhood diabetes, which was uncommon in the past. Doctors attribute this to the rising obesity in children.

Among adults, the disease afflicts those who are overweight and have high blood pressure or high cholesterol levels, said Dr Goh Su-Yen, the director of diabetes clinical services at Singapore General Hospital.

The long-term complications from diabetes include kidney failure, blindness, heart attacks and gangrene of the feet.

It usually takes years for complications to develop, said Dr Peter Eng, an endocrine specialist at Mount Elizabeth Medical Centre.

However, once skin infection and gangrene appear, they can render the limb useless within weeks.

Why are diabetics more prone to skin infections and poor recovery?

The disease causes blood vessels to narrow. The resultant poor circulation leads to slow wound healing and higher chances of infection, said Dr Steven Thng, a consultant dermatologist at the National Skin Centre.

To make matters worse, diabetes damages nerves and causes limbs to have reduced sensation to pain.
As a result, diabetics may not be aware that they have injured themselves, resulting in infections, said Dr Thng.

amputeeRetiree Narayanasamy Tharlingam, 77, is another Type 2 diabetic who did not control his condition well. He also did not realise he had a leg injury.

The former manual worker lost his right leg to diabetes about a decade ago, after an infection in his foot led to gangrene.

“I had started drinking from age 15 and easily consumed 10 to 12 bottles of beer a day,” recalled Mr Narayanasamy.

He also enjoyed his “makan”, from curries to oily stir-fried food.

Even after he was found to have diabetes when he was about 40 years old, he did not change his diet.

However, after he lost his leg, he cut down on his drinking, allowing himself only an occasional swig of beer. He now drinks coffee without sugar and Chinese tea and eats foods which are less oily such as thosai and
lentil dahl.

He also diligently takes his diabetes medication and gives himself insulin jabs twice a day in his tummy from an insulin pen injector, which dispenses a pre-set volume of the hormone.

Mr Narayanasamy, who is on the Public Assistance scheme, gets free treatment, medication and syringes from places such as the Diabetic Society of Singapore and hospitals.

He visits various hospitals about twice a month for doctors to monitor his chronic conditions, heart and eyes.

“I used to play a lot of football in my school days. Now, I can’t even leave my house without help from someone. I didn’t expect that diabetes can be so serious,” said the divorcee, who lives alone.

In his one-room flat, Mr Narayanasamy moves around on his wheelchair and uses his hands to support himself whenever he needs to get onto his bed or go to the toilet.

Now, he keeps his blood sugar levels under control. He does not want to lose his other leg to gangrene, he said.

Normal blood sugar levels fall in the range of 5 to 7mmol/L (millimoles per litre of blood) before meals and below 10mmol/L after meals, said Dr Goh.

However, targets may differ for diabetic patients of different conditions and ages. Targets are stricter for pregnant mothers and young adult patients.

Elderly patients would have less strict targets as they are at higher risk of having an adverse outcome – like falling – if their sugar levels are low, explained Dr Goh.

For example, Dr Eng said that the target for a 40-year-old man with mild diabetes would be close to the normal range but for a 60-year-old man with more serious diabetes, the target may be set higher at 6 to 8 mmol/L before meals.

To keep diabetes in check, doctors advocate a healthy lifestyle: Eat and drink in moderation and exercise regularly.

However, the number of diabetic patients is expected to rise as more people start leading urban lifestyles, eating rich foods and not exercising, said Dr Kevin Tan, the vice-president of the Diabetic Society of Singapore.

Mr Kim, who had ignored his condition for years, said: “I wanted to die when I knew my legs had to be cut off. If I had known earlier, I would have done more to control my disease.”

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