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Every year, Singapore hospitals perform roughly 1,500 diabetes-related amputations.

This computes to about four amputations each and every day – several which will elevate as Singapore handles an expanding diabetes problem.

The amputations are generally on account of peripheral arterial disease (PAD) – the narrowing or blockage of lower limb arteries.

As a consequence, muscles and tissues during the lower limbs receive very little oxygen- and nutrient-rich blood.

It is extremely prevalent in diabetic patients which have poor or suboptimal blood glucose control, said Dr Benjamin Chua, a vascular and endovascular surgeon at Mount Elizabeth Hospital.

“This really is further aggravated if patients also have poorly controlled blood cholesterol levels or go on to light up.

(Also Read: 9 Shocking Facts and Statistics About Diabetes)

“Aside from diabetes, other risks include chronic smoking, hypertension and end-stage renal failure,” he said.

There couple of signs that indicate the beginning of PAD, including severe cramping pain at the affected part of the legs, much like the thigh, calf or foot.

“This severe cramping pain usually begins from a repeated, fixed distance of walking or time period of exercise and it is relieved by just standing still,” said Dr Chua.

“If not treated, these patients may gradually find they\’ll no longer walk or exercise for lengthy pain free.

“Due to this fact, several patients feel limiting their mobility to prevent yourself from the discomfort.”

As PAD progresses, patients may turn to feel pain for their lower limb even while resting, specially when lying down. Some may also find their affected lower limb cold and pale.

“A few of these patients may go to develop non-healing foot ulcers, or their toes or foot lose body tissues as a result of lack of blood,” said Dr Chua.

This may lead to life-threatening sepsis, a condition where infection-fighting chemicals released into the blood cause inflammation instead, he added.

“Other indication of advancement of PAD include absent limb pulses and pus discharge in the wounds.

“These patients require urgent treatment since they use a significant chances of undergoing major below-knee or above-knee amputations leading to limb loss.”

But amputations need not happen if detected early.

Simple tests to diagnose PAD, like the ankle-brachial pressure index, are often used to determine the degree of PAD.

The test involves taking systolic hypertension levels within the legs and comparing it to be able within the arms.

Once diagnosed, additional ultrasound or CT scans from the lower limb arteries might help weigh up which components of the arteries are diseased.

Medical therapy

For patients with mild to moderate PAD, medical therapy – monitoring risk factors, exercise therapy and anti-platelet drugs – successful.

Exercise therapy, that concerns getting patients to keep at it walking inspite of the pain, can encourage small arteries to enlarge to be able to supplement new blood supply to the limb muscles, Dr Chua explained.

Antibiotics can also be prescribed for wound infections which are detected early, and infected tissues can be taken out while making sure if you can , to preserve a functional lower limb and foot.

“After taking off the infected tissues, a wide array of techniques are around for look after the resultant wound.

“Whether it is large, skin may perhaps be taken away from other areas of the body to pay for the wounds. The process then allows the patient to regain their mobility and resume their activities of everyday living,” said Dr Chua.

For individuals with severe conditions, angioplasty and stenting could possibly be recommended to reopen or widen the blocked arteries, and get away from them from narrowing or becoming blocked again.

Noting that amputations affect don\’t just the patients but in addition put emotional and financial strains on people around them, Dr Chua said: “Early intervention for diabetics with PAD is extremely important in ensuring patients retain mobility.

“The rapidly improving techniques and technology now offer most sufferers a lower-risk treatment for saving their lower limbs. When along with advanced wound care techniques, patients whose methods of limb salvage were once limited are able to enjoy avoiding limb loss.”

(Also Read: Your 4-Step Will Beating Diabetes)

A version of this story first appeared during the New Paper on September 11, 2017, using the headline, ‘Prompt treatment may help to limbs from diabetes’.

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