Post-Amputation Concerns for Diabetic Patients: A Guide

What are some issues after amputation due to diabetes?

Hello, Dr.
Shi.
My mother is 66 years old and has a history of diabetes for 30 years.
Six months ago, she accidentally fell and had both of her lower legs amputated.
Currently, her wounds have healed, and we are considering prosthetics.
However, about two weeks ago, she started experiencing tingling sensations in her feet, and occasionally her feet will twitch.
Is this a phenomenon that can occur after amputation, or could it be related to poor blood sugar control? Additionally, given my mother's age and her overall physical condition, along with the fact that both of her lower legs have been amputated, is it appropriate for her to get prosthetics? If she does not get them and continues to use a wheelchair, will her health deteriorate further? Thank you for your response.
Wishing you good health.

Ms. Huang, 30~39 year old female. Ask Date: 2007/09/11

Dr. Shi Guangzhong reply Internal Medicine

Dear Ms.
Huang, I apologize for the delayed response as I was abroad.
If the wound has healed for more than six months, you may consider getting a prosthesis.
If you are experiencing symptoms such as tingling and bouncing in both legs, these are primarily chronic complications of diabetes that can lead to poor blood circulation.
After amputation, this condition may worsen.
To alleviate these symptoms, it is essential to strictly control blood sugar levels and consider medications that promote blood circulation.
Remaining in a wheelchair without a prosthesis may lead to a decline in physical health, especially if caregivers are not very proactive.
Lack of activity can not only worsen blood circulation but also cause stiffness in the knee joints, potentially leading to immobility in the future, which may result in further deterioration of health.

Reply Date: 2007/09/11

More Info

Post-amputation concerns for diabetic patients, especially those who have undergone lower limb amputations, are multifaceted and require careful consideration of both physical and psychological aspects. Your mother's situation, given her long history of diabetes and recent amputations, presents unique challenges that need to be addressed holistically.

Firstly, the tingling and occasional twitching sensations in her feet could be attributed to several factors. One possibility is neuropathy, a common complication of diabetes that affects nerve function, leading to sensations such as tingling, numbness, or pain. This condition can persist even after amputation, particularly if the nerves were already damaged prior to the surgery. Another possibility is related to phantom limb sensations, where patients experience feelings in the part of the limb that has been amputated. This phenomenon can include sensations of itching, tingling, or even pain in the area where the limb used to be. It is essential to discuss these symptoms with her healthcare provider, as they may require specific management strategies.

Regarding blood sugar control, it is crucial for diabetic patients to maintain stable glucose levels, especially after an amputation. Poorly controlled blood sugar can lead to complications such as delayed wound healing, increased risk of infections, and further neuropathy. If your mother’s blood sugar levels have been fluctuating, this could exacerbate her symptoms and hinder her recovery process. Regular monitoring of her blood glucose levels and adherence to her diabetes management plan, including medication, diet, and exercise, is vital.

As for the decision to fit her with prosthetics, several factors need to be considered. The suitability of prosthetic limbs depends on her overall health, mobility, and willingness to engage in rehabilitation. Given her age and the fact that she has undergone bilateral amputations, the process of adapting to prosthetics may be more challenging. However, many individuals with similar conditions successfully use prosthetics and regain a significant degree of mobility and independence. It is essential to involve a multidisciplinary team, including a prosthetist, physical therapist, and her primary care physician, to evaluate her specific needs and capabilities.

If she chooses not to use prosthetics and relies solely on a wheelchair, it is important to recognize that while this may provide immediate comfort and ease of mobility, it can also lead to other health issues over time. Prolonged wheelchair use can result in decreased muscle strength, pressure sores, and reduced cardiovascular fitness. Encouraging some form of physical activity, even if it is limited, can help maintain her overall health. This could include upper body exercises or seated exercises that promote circulation and muscle engagement.

In conclusion, your mother's post-amputation care should focus on managing her diabetes effectively, addressing any neuropathic symptoms, and considering the potential benefits of prosthetics versus wheelchair use. Open communication with her healthcare team is essential to tailor a plan that meets her needs and supports her quality of life. Regular follow-ups and adjustments to her treatment plan will be crucial in ensuring her well-being as she navigates this new phase of her life.

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