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Amputation is one of the scariest possible diabetes complications.

Amputation of the extremities, in particular of the lower extremities (toes and sometimes feet), is far more common in people with diabetes than those in the general population. Amputation is a serious health complication that not only decreases the quality of life for the patient but is also associated with earlier death.

This article discusses the specific risk statistics, the reasons for the increased risk, and effective preventive strategies.

Facts About Amputation

It is estimated that a person with diabetes is something like 10 to 40 times more likely to require amputation than one without the condition.

Despite recent advancements in diabetes medication and technology, the risk of amputation may be getting higher, not lower. A 2018 study found that lower extremity amputations have increased in recent years, in particular in younger adults and in the middle-aged population.

Why Is the Risk Higher for People with Diabetes?

Like most other complications of diabetes, amputation is ultimately caused by chronic high blood sugar levels.

Long-term hyperglycemia can cause blood vessel damage, decreasing circulation. This can impede the body’s ability to heal wounds, in particular at the extremities, as the immune cells cannot effectively reach and fight infection. Diabetes is strongly associated with a reduced ability to fight infections, especially in the feet.

Amputations are often precipitated by small wounds. Many people with diabetes experience some measure of neuropathy, nerve damage that can hinder patients’ ability to feel and recognize these small wounds. When these little cuts and sores are ignored, the resulting delay in treating the wound can promote infection. Coupled with poor circulation and poor wound healing, these issues can spiral out of control quickly, necessitating amputation.

According to the American Podiatric Medical Association (APMA), “approximately 14-24 percent of patients with diabetes who develop a foot ulcer will require an amputation. Foot ulceration precedes 85 percent of diabetes-related amputations.”

Prevention Strategies

The good news is that being aware of the causes and warning symptoms can help all patients to take proactive steps to minimize their amputation risk. Here are the major ways to do so:

Optimize Glycemic Control

Amputation risk is strongly associated with blood glucose control, with the risk increasing proportionately to the hemoglobin A1c level. Making sure that your blood glucose levels are as well-controlled as possible is the number one thing you can do to reduce your risk of serious infections that can lead to amputation.

Related metabolic factors, such as smoking and nutrition, can also play a role.

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Ensure Early Detection

Early detection and treatment are key when it comes to wounds, especially on the feet, toes, and fingers for people with diabetes. The American Diabetes Association recommends practicing daily foot care:

  • Wash your feet daily with warm soapy water.
  • Check your feet for cuts, sores, and other issues.
  • Keep your toenails neatly trimmed.
  • Check your footwear for pebbles and other sharp objects.
  • Choose footwear that is padded, dry, and comfy.

Do not wait to seek medical care if you notice a cut or if you have any concerns that you are developing an infection. Some early symptoms of infection include:

  • Pain
  • Warmth
  • Swelling
  • Discharge of any kind

Note that patients with neuropathy may not feel pain from a small injury, so it is very important to be vigilant and aware of any cuts, wounds, etc. All people with diabetes should keep a close eye on their feet and toes and note any changes and promptly seek care if needed.


Amputation of the extremities is a relatively rare complication but occurs in people with diabetes much more frequently than in the general population. The best way to prevent amputation is through good glucose management. In addition, people with diabetes should be dedicated to the health of their feet, especially those with neuropathy. Regular health care visits and optimal lifestyle choices can go a long way to minimize the risk.

Read more about A1c, amputation, complications, diabetes and infections, diabetes management.

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