 Hi guys, this is Dr. Ahmet Ergin. I'm an endocrinologist and I'm a diabetes educator. I see a ton of diabetic patients in my office and sometimes they come with diabetic foot ulcers. Sometimes they come to see me first time with the missing limbs and that really really makes me sad and I want the awareness to go up and today I'm going to talk to you about why diabetics sometimes lose limbs and how to prevent that. Let's get started. How these limb amputations develop, why it ends up being there. So a couple things. Let's discuss about the vascular system and neurological system. Now diabetes is a vascular disease. So when your blood sugars go up, when you're insulin resistant, these things will definitely create a pressure in your blood vessels and you will start getting narrowing of your blood vessels, especially the arteries. Now the most affected blood vessels in diabetes are the small arteries, which are the ones that cost your hands, your feet, etc. Now in the kidneys, right, those are also very small arteries. Now what happens is when these blood vessels start getting clogged up, the nerve cells that are getting nourished through those blood vessels or arteries, they also start dying. So it's a combination of multiple things. So what ends up happening is diabetics start losing the sensation under their feet. They sometimes walk around barefoot, they step on things, they don't realize it's your foot. I mean, it's not the cleanest place and eventually it gets very infected. Now when a diabetic has an opening in on their skin, it's like opening your doors to the enemy. So the bacteria will sneak in as even if you're totally clean and you're protecting your feet, the skin bacteria that is living on your skin on a normal basis can sneak into the system because of the high blood sugars, those bacteria will thrive in there and they will create an infection and you may not be even aware of it until it gets really bad because you don't even feel it in most cases. Now the problem is most diabetics don't even know that they don't feel what they don't feel. So as a result, you know, you have to be really careful. Check the bottom of your feet a couple times a week. A lot of people expect doctors to do their foot exams, but guess what? You can get a foot infection tomorrow right after you see the doctor. So it's not necessarily the doctor, you have to be your own doctor and make sure you check your feet all the time and check the bottom of your feet, make sure nothing is there. So that's number one rule. Now what happens if it is neuropathy, they get to the infection, the infection gets deeper and deeper and then sometimes it eventually reaches the bone. When the infection gets so deep, it becomes hard to heal. We sometimes give antibiotics, of course, you know, and we wait for it to heal. If it is not healing, there are some other treatments that can be done. When there's a bad tissue where the infection lives, there is no way for that infection to go away. It turns into an opsis. It is an area that the blood vessels or body's healing mechanisms cannot reach out. And then that tissue starts decomposing and start affecting the tissue that is next to it. And if it reaches the bone, that becomes a real problem because then it is almost impossible to get that infection out. Now the problem with diabetes, again, the high blood sugars feed the infection and the body's immune system is weak. When you have diabetes, just like you're affected more from any other infection like coronavirus, COVID-19, same thing with bacteria, it's going to be more difficult for your body to defeat the bacteria. So that's another reason. And then, of course, all these emergencies, supplies that is trying to come to the wound, the body is trying to heal itself, but your arteries are clogged up. So if your main arteries, think about like a city, if your main arteries are clogged up, that ambulance is not going to get there on time. So as a result, diabetics with vascular problems sometimes need to see vascular doctors to open up their arteries. And even then, sometimes it's not helpful because the small vessels cannot really, the doctors cannot really go into those small, tiny, tiny arteries that are clogged up. So as a result, sometimes to save the rest of the tissue, doctors will end up amputating, getting rid of the problem totally so that the other tissues are not affected from the spread of that infection. So that's the bottom line. That's why they lose limbs. Again, if you are aware of the problems that you have neuropathy, you have vascular problems, that you have an infection, if you act early, you will be able to salvage or save that limb. However, if you're not aware of it, if you sleep on it, if you ignore your infection, if you're late, because of all the factors we have discussed, it may be way too late for you to save that limb. So I hope that helps, guys. Again, diabetic wound management is a team management. Make sure that if you have a primary care doctor giving you an antibiotic and your infection is not getting better, make sure you contact your podiatrist. If you don't have one, get one immediately. Go to ER. Sometimes the ERs or hospitals will have wound care centers that employees, podiatrist doctors, food doctors, or the petitions, whoever are dealing with those wound infections. But it's a teamwork. It has to be observed very carefully until it heals up. And sometimes they will consult vascular surgeons to help open up the ERs. So it's, again, so it could be your podiatrist, your endocrinologist, your vascular surgeon, even sometimes infectious disease specialist and wound care nurses will work together to get rid of that infection and to save the limb. So I hope that helps, guys. And I hope you never get that problem. And we will see you in the next video.