Up above, the crashing of the wave tosses wild currents around the coral. A small damselfish swimming through the reef is tossed against the reef and nicks itself on the sharp coral. Three shiny scales scrape away and drift motionless, until the current starts to spin them about. A tiny drop of blood slowly seeps out into the ocean. Startled, the little damsel scurries away, out into the open ocean.
A mile away, a languishing bluetip reef shark senses an odor. The tiny droplet of blood, spread thin in the ocean, awakens the sharks hunger. He can smell the blood and weaves his way though the sea, continually tracking back and forth, to a stronger and stronger scent trail. The little damselfish, still barely bleeding, but leaving a trail to follow, is the end of the path for the shark. Jagged teeth, open wide, the damsel hasn’t a chance.
The story of the shark in the damsel provides a perfect analogy for the way your body fights bacteria when you develop a diabetic foot infection. The bacteria is much like the little damselfish. As it moves through the tissue in your foot, it leaves chemical markers that signal its presence.
The sharks are much like the white blood cells (known as macrophages) that track down the bacteria through a process known as chemotaxis. Once the macrophages locate the bacteria, thee actually surround the bacteria with the cell wall, effectively eating them. The way that they eat the bacteria in this way is known as phagocytosis. Unfortunately diabetes and the high levels of blood sugar that are associated with diabetes, can have a profound effect on both chemotaxis and phagocytosis.
When the serum blood glucose is high, the macrophages are not able to follow the scent that leads to the bacteria. In a way, the white blood cells are then much like a hungry blind shark, who cannot see or smell, drifting through the vast open ocean just hoping to bump into a damselfish.
To complicate matters further, the process of phagocytosis is also disabled when the blood sugar is elevated. So even if the blind, senseless shark does bump into a damselfish, is almost as if his mouth is wired shut. Even when the shark can find a damselfish, it still cannot eat it.
This is the reason that a diabetic foot infection is an emergency that quickly becomes limb or life-threatening. In less than 24 hours, a minor infection can kill a diabetic. In almost every amputation that is performed on diabetics, it is likely that earlier intervention could have prevented the extent of limb loss.
For this reason it is critical for a diabetic to check the feet every day. Otherwise, a minor blister, open sore or ingrown toenail can start with a small infection and quickly get much worse. As the bacteria divide, the sharks can do nothing to stop them.
In a normal healthy adult, an ingrown toenail can remain infected for days before the infection worsens. In a diabetic, this is simply not true. A diabetic with elevated blood sugar has an impaired immune system. The disabled immune system is incapable of controlling the growth of the bacteria and serious complications develop.
Every 30 seconds a limb, somewhere is amputated because of diabetes. Diabetes also accounts for more than half of all of the amputations that are performed. This problem is actually getting worse and not better. The rate of diagnosis of diabetes is continuing to skyrocket. It is also predicted that the prevalence of diabetes will continue to climb as the baby boomers age.
Given the current circumstances of Medicare and other insurance carriers not providing insurance coverage for preventative care such as aggressive monitoring and education of diabetic foot problems, the number of amputations will also continue to rise. Unfortunately this is all preventable, but it is not being usually prevented.
It has been well documented that performing daily foot checks, seeking early treatment for a diabetic foot problem, and maintaing low blood sugar can all help to avert the problems in diabetes that culminate in amputation. However the current trend is that insurance companies will only pay for care associated with the complications such as the diabetic foot infections, hospitalizations and diabetic amputations.
Because of the way these episodes unfold, this leaves many patients with no leg to left to stand on.
You must have a diabetic foot check every year. If you also have neuropathy or diabetic nerve damage, it is important to be seen more often. You must check your feet every day. You should also wear white diabetic socks so that you can detect any drainage in the event that you do get a sore on your feet, you cannot see. All of these minor interventions have shown to significantly reduce the rates of complications to the feet from diabetes.
Dr Christopher Segler