It’s one of the most traumatic diagnoses a patient can receive – and it often starts with a deceptively innocent misstep.
“Someone stubs their toe, or they cut their toenail a little too short. Maybe it’s a traumatic wound; they scrape their foot, or they get a blister. Any wound that can seem mundane.”
But Brett Fowler, M.D., knows all too well how incidents appearing to be “mundane” to those of us in good health can quickly turn into life-or-death crises for folks living with diabetes. As a vascular surgeon at Lexington Medical Center – an award-winning hospital system in the Midlands region of South Carolina – Fowler sees it all too often.
“The problem is that with diabetes, you don’t have the blood flow necessary to heal,” Fowler explained. “So any wound that develops – be it a sore, a cut, a scrape – must be watched carefully, and if there’s any change or any worsening, it really needs to be immediately seen and treated.”
Diabetes is often linked to obesity, which is rising at an ever-alarming rate in the United States. The problem is particularly bad in the Palmetto State. According to the Trust for America’s Health “State of Obesity” report, 35 percent of adults here were obese in 2022.
According to the S.C. Department of Health and Environmental Control (SCDHEC), that translates to one of every seven adult South Carolinians – or 500,000 people – being diabetic. It’s also estimated that diagnosed diabetes costs our state approximately $5.9 billion each year.
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Such statistics are deeply troubling to experts like Dr. Fowler.
“South Carolina is known to have a high prevalence of cardiovascular disease and a high prevalence of diabetes, and both of those combine to create the perfect storm of having diabetic-related complications where you’re looking at amputations. So it is a big, big healthcare challenge.”
The situation grows worse when additional elevated risk factors are included.
“Diabetes damages blood vessels,” Dr. Fowler explained. “When it accelerates to vascular disease, plaque builds up in the arteries, narrowing and hardening them. That accelerates the process. And even folks without diabetes, as they get older, have the propensity to develop vascular disease. So, when you add diabetes to it, the problem is really magnified.”
All of this can place diabetics in increased danger when they lose the feeling in their feet. At that point, the seemingly smallest thing can turn into an urgent situation.
“That’s a big deal for someone with diabetes,” Dr. Fowler continued. “Just consider things most of us take for granted, like well-fitting shoes. A lot of times, when someone has arterial disease, they also have nerve disease, so they aren’t able to feel the hotspots. If they stand on their foot too long and a pressure point builds, folks without diabetes subconsciously shift their weight. But folks with diabetes aren’t able to feel that pressure there. And if they wear the incorrect shoes that are ill-fitting or rubbing, they don’t feel that rub, and a wound can develop there.”
From there, things can turn very serious very fast – often leading to untreatable infections.
“A lot of times, with good wound care and with antibiotics, we're able to salvage the limb," Dr. Fowler said. "But a wound can rapidly get infected, and then, unfortunately, you're talking about an amputation. So they can come on pretty fast. And when that develops, it's an urgent matter."
“Obviously, amputations have a negative connotation,” Dr. Fowler added, “but a lot of times, it is the necessary medical treatment. We try to do everything that we can to prevent amputation, but sometimes, at certain points, whether it’s an infection that develops, or you're trying to prevent it from spreading, or you’ve just run out of options to increase the blood flow to the leg, the quickest way for the patient to be able to move on with their life and get back to walking is with the prosthetic. It's a difficult conversation to have with the patient.”
Unfortunately, difficult conversations like that are taking place all too often these days. According to the American Diabetes Association (ADA), 154,000 people with diabetes undergo amputation each year in our country. That equates to one lost limb every 3 minutes and 30 seconds.
As discouraging as that sounds, such outcomes are preventable. In many cases, diabetes and other factors that can lead to the loss of a limb can be avoided early on.
“Everything starts with good preventive care,” Dr. Fowler noted. “See your healthcare provider regularly. If you’re diabetic, there’s a lab test called A1C, and it's a measure of how well your diabetes is controlled. Make sure that it’s the correct number and that you have the correct medical supplies. Keeping your blood sugars under control can prevent a lot of the downstream complications."
"And I know - because I am the catchall for the downstream complications,” he added.
Proving once again the wisdom in the old saying that an ounce of prevention is worth a pound of cure.
ABOUT THE AUTHOR ...
J. Mark Powell is an award-winning former TV journalist, government communications veteran, and a political consultant. He is also an author and an avid Civil War enthusiast. Got a tip or a story idea for Mark? Email him at email@example.com.
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