The No. 1 cause of hospitalizations in people with type 2 diabetes is a foot injury, which can rapidly escalate into an amputation (there are approximately 86,000 diabetes-related lower-limb amputations each year in the United States). Any foot injury a person with diabetes experiences should be treated as a potentially limb-threatening medical emergency.
After her doctor told her she had type 2 diabetes, Christine spent the next 10 years trying not to think about it. Her blood sugar was too high, but she only checked it when she "absolutely had to." Her doctor warned her that she was at risk for a health crisis, but she still didn't get her diabetes under control.
Then in July 2006, Christine was helping her child move home, and she was taking a break from loading boxes. The Canajoharie, N.Y., resident, now 56, leaped up to answer a phone across the room and steppedbarefooton a piece of metal sticking out from a bed frame. "It bled a little bit between my big toe and the next one, so I put peroxide on it, and it seemed to heal over and I didn't think about it again," she recalls.
The bottom of her foot turned black
Because of the diabetes, her feet had been numb for quite some time. At the end of September, she noticed an angry red spot on her big toe. The next morning, her whole foot was red.
Since it was a Sunday, she went to an urgent-care clinic, where they told her, "No way can we deal with youyou're going to the emergency room." So she ended up in the ER, where the redness quickly spread up her leg.
To her horror, the bottom of her foot turned black.
Christine's foot infection had rapidly turned into a problem that threatened her lower leg. In addition to the treatment she received immediately at the ER, a surgeon had to remove the blackened tissue from her foot during repeated procedures.
After eight days in the hospital, Christine started getting better, and she realized that it was time to get her diabetes under control and avoid future emergencies.
"I figured, if you don't acknowledge it, it's not there. It's a coping mechanism that I've used a lot in my life. People can say to you, 'Do you want to lose a leg? Do you want to lose a foot?' But it didn't hit me until the day that I saw that black underneath my toes. I now have my head up out of the sand and I deal," Christine says.
Check for a limb salvage program near you
Foot experts are starting to recognize the importance of using teams of doctors from different specialties to address diabetic foot injuries. You may need a vascular surgeon to improve blood flow to the foot, a foot surgeon to repair the wound, and an endocrinologist to bring down high blood sugar.
Some hospitals and centers now combine such teams of doctors in "limb salvage" programs that can help you keep your feet. Some examples include New York University Medical Center in New York; the Wisconsin Heart Hospital outside of Milwaukee; Riverside Methodist Hospital in Columbus, Ohio; and University Foot & Ankle Institute at various locations in California.
There's wide variability in amputation rates among patients with diabetes; some groups of people with diabetes, such as African Americans, are more likely to have an amputation than others.
If you're facing a foot emergency, ask your doctor where you can find the best foot-saving expertise in your area.