Putting Feet First Aims to Reduce Diabetic Foot Amputations

WHO: too many amputations are preventable
Seven years ago, on World Diabetes Day 2005, the WHO also said 80 percent of leg and foot amputations on diabetics across the world could have been preventable.

“It is unacceptable that so much disability and death are caused by leg amputations, when the solutions are clear and affordable,” said Dr. Catherine Le Galès-Camus, who was then WHO Assistant Director-General for Noncommunicable Diseases and Mental Health. “Small investments in prevention and education can mean fewer leg amputations, increased quality of life for individuals and dramatic reductions in health-care costs.”

“People with diabetes need to take an active role in their own care,” said Professor Pierre Lefèbvre, President of International Diabetes Foundation, “but they need to be supported by their health-care system to learn how to self-manage effectively. Timely access to proper treatment and medical advice is also vital.”

Leg and foot amputations of people with diabetes can be prevented using low cost, low technology solutions. Simple behaviors can prevent amputations and should be encouraged:
• Regular foot examination
• Examining the inside of shoes before putting them on
• Not walking barefoot
• Wearing comfortable footwear
• Keeping feet clean
• Maintaining good care of the skin and nails

Type 1 and type 2 diabetes
Diabetes could be type 1 or type 2.

People who have type 1 diabetes have dysfunctional immune systems that attack and destroy cells in the pancreas that create insulin. Because the body’s cells use insulin as a chemical switch to control glucose levels, without this hormone, people with type 1 diabetes are forced to ride a dangerous blood sugar rollercoaster: High blood sugar levels making them feel fatigued and low levels bringing blackouts and seizures.

To guard against this, people with type 1 diabetes depend on a daily insulin injection or an insulin pump. Without either, their blood sugar levels would fluctuate uncontrollably and they would risk organ failure and death. Unfortunately, the cause of type 1 diabetes isn’t fully known and it’s not preventable with current medical science.

Almost all — or 90 percent — of all diabetics worldwide suffer from type 2 diabetes, however, which is linked to lack of exercise and poor diets.

Symptoms are similar to those of type 1 diabetes, but are often less marked. But, because the disease develops gradually over many years, it may be diagnosed only once complications have already risen.
Pregnant women may also suffer from a form of the diabetes called gestational diabetes.

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves. It also increases the risk of heart disease and stroke; 50 percent of people with diabetes die of cardiovascular diseases.

Other severe complications include kidney failure — which kills 10 to 20 percent of people with diabetes, and diabetic retinopathy — an important cause of blindness — that occurs from long-term, accumulated damage to the small blood vessels in the retina. About 10 percent of diabetics develop severe visual impairment and two percent of people become blind after only 15 years of living with diabetes.

Foot ulcers and the amputations they bring are the other severe complication.

Diagnosing and treating diabetes
Relatively inexpensive blood tests can diagnose diabetes.

Controlling blood glucose levels is the key to treating diabetes: people with type 1 diabetes require insulin but people with type 2 diabetes can be treated with oral medication — although some may also require insulin.

Other aspects of managing diabetes are:
• Controlling blood pressure
• Foot care
• Screening and treatment for retinopathy that causes blindness
• Blood lipid control to regulate cholesterol levels
• Screening for early signs of diabetes-related kidney disease

A healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are among the measures should be supported by.

Diabetes prevention
Doctors say simple lifestyle measures can effectively prevent or delaying the onset of type 2 diabetes:
• Achieve and maintain healthy body weight
• Be physically active — at least 30 minutes of regular, moderate-intensity activity on most days.
• Eat a healthy diet of between three and five servings of fruit and vegetables a day
• Reduce sugar and saturated fats intake
• Avoid tobacco use – smoking increases the risk of cardiovascular diseases

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Putting Feet First Aims to Reduce Diabetic Foot Amputations. Posted 19 March 2012.