You may have heard that people with diabetes need to be more careful because they are at a higher risk of getting gangrene. Why is that? There are a few reasons for this, and it is good to be aware of how you can protect yourself from infection and severe injury if you have diabetes. Living with diabetes is not always easy but taking good care of yourself will allow you to avoid major complications such as gangrene and loss of limbs.
Diabetic neuropathy is a common complication of diabetes that affects about 1 in 2 diabetic patients. It is a condition where your nerves are damaged by high blood glucose (sugar) levels, and they no longer allow you to feel pain in certain areas. As a result, diabetic patients tend to get injured without their knowledge, leading to a greater chance of infection at the site of injury. They are also unlikely to treat the injuries if they do not feel the pain from it, which would allow further worsening of the infection that leads to wet gangrene. (The various types of gangrene have been explained in more detail here [What is gangrene?]
There are 4 different types of neuropathy, each affecting different parts of your body and presenting itself with different symptoms.
● Peripheral neuropathy: Usually affects legs and feet first before the arms and hands. Symptoms include a tingling/burning feeling, numbness, and a reduced ability to feel pain  This is the main type of diabetic neuropathy that is related to a higher risk of gangrene.
● Autonomic neuropathy: As the name suggests, this affects the organs controlled by the autonomic system, consisting of the stomach, sex organs, heart, bladder, stomach and eyes.  Symptoms include bladder/bowel problems, nausea, hypoglycemia unawareness (not recognizing when blood sugars are low), loss of appetite etc.
● Proximal neuropathy: Affects the thighs, hips, buttocks or legs. You may have difficulty standing up, and may experience pain in your hips, thighs, buttocks, and stomach. Your thigh muscles could weaken and shrink as well.
● Mononeuropathy: Also known as focal neuropathy, mononeuropathy tends to affect nerves outside of the brain and spinal cord. It is usually due to direct injury to the nerve. Tingling and numbness are among the symptoms of this type of neuropathy.
The high blood sugar levels of someone who has diabetes can cause atherosclerosis, which is the build-up of fats in the blood vessel walls, causing the blood vessel to become narrower, impeding the flow of blood. Poor blood circulation is the most prominent cause of gangrene, as the tissues begin to degenerate and die when they do not receive sufficient oxygen or nutrients from the circulatory system. Hence, diabetes puts a person at a higher risk of developing gangrene.
High blood sugar levels trigger an inflammatory response, and in the long term, the cells of the pancreas will be damaged. Insulin can no longer be produced, perpetuating the cycle of high blood sugar levels, leading to hyperglycemia. This weakens a person’s immune system and causes a person to become even more susceptible to infection.  Paired with poor blood circulation and neuropathy, gangrene can spread much more easily in diabetics.
For anyone who wants to protect themselves from getting gangrene, there are a few crucial pointers that should be abided by. Very often, these will lead to a healthier and happier life in general, while also helping to reduce your chances of contracting any other diseases. These pointers are listed below:
● Have a healthy and balanced diet. Consume fats in moderation as excess fats are more likely to build up in your blood vessels and cause atherosclerosis.
● Exercise regularly (do moderate-intensity activities, eg. cycling, walking, swimming)
● Maintain a healthy weight
● Don’t smoke (avoid tobacco products). They encourage atherosclerosis and arteriosclerosis (hardening of blood vessels)
● Minimize your alcohol intake. This is to keep blood pressure and blood cholesterol at healthy levels.
Take a look at [How to prevent gangrene — Lifestyle] to find out in more detail how you can apply the above suggestions to your life.
For those with diabetes, extra care has to be taken to guard against gangrene. Firstly, check your hands and feet every day to ensure that you do not have any signs of infection like swelling, redness, or pus. See a doctor immediately if you do notice these signs. Check carefully for whether you have any cuts, sores or other injuries. Because you may not experience the pain that usually comes with injuries, you have to be extremely conscious about examining your body. At least once a year, you should ask to be checked by your doctor. Continue receiving treatment for your diabetes and control your blood sugar levels as much as possible. 
Additionally, diabetics should keep their feet dry and warm, to maintain good circulation and avoid infection. 
Care should be taken to choose shoes that accommodate diabetics. Special foot soles and pads can help to minimize the chances of injury, which is especially helpful since diabetics may be prone to foot ulcers and injuries. Slippers and high heeled shoes should be avoided when ever possible, because they provide less stable support to your feet. 
When living with diabetes, knowing how to prevent gangrene is very important as severe gangrene can be limb and life-threatening, and the condition can progress quickly when you have poor blood circulation and a weak immune system. With gangrene, time is of the essence and the infection should be stopped as early as possible to improve your chances of recovering from it. If you would like a check-up or treatment for gangrene, do book an appointment with us! Contact details can be found below:
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