Lower-Extremity Amputations in Diabetes Are Back on the Rise, but Why?

Commentary:
Medical Student:

As you know, SGLT2i’s improve cardiovascular outcomes and provide the benefit of weight loss (as well as potential benefits for HF) and are generally a well tolerated class overall. I would hope that doctors would inform their patient of the small and controversial risk of amputation from starting a SGLT2i and it is excessively inflammatory to say that an informed patient should sue their doctor for prescribing it. Of course medications have side effects, but is it likely to benefit the patient overall is the main question.

        Probably author know benefits of SGLT2i's for CVD, I do not see any of them for me. It is very strong diuretic, and diuretics are danger for diabetics type 2.  They lead to MI, stroke, and severe increase of sugar in blood. At first any diuretic leads to decrease weight, but then this effect reversed, and replaced by severe water retention, Edema. No treatment at all. On one hand diabetic cannot take diuretic due to heart failure. On the other hand, severe edema effect lungs, and increase severity of COPD, every one diabetic type 2 do have diagnosed or not.
      Severe edema lead to lost circulation, and as a result, to inflammation and amputation. No effective treatment for this condition. At first rise of sugar in blood must be stopped, but only effective medicine is not in diabetic type 2 medical box. Diabetes type 2 is non insulin dependent diabetes mellitus, so no insulin needed. At first there are small amputations, then full leg would be removed, above knee. I would not say it is small amputation. After first leg removed the second will be taken off. Really, diabetic type 2 beg God for Mercy.
     The amputations can be prevented with proper and timely diabetes type 2 treatment. It is insulin, and insulin only. In stead, there are all junk in diabetic's type 2 medical box, but no insulin. BTW, insulin does not have side effect, only low sugar, the effectiveness of therapy.

My main concern is medical-legal fear of surgery by surgeons who are capable of these procedures. I did these procedures routinely with uniformly good results. If a DPM/DO/MD surgeon is in a position to offer these procedures to their diabetic patients, but fear them for medical legal reasons, they should REFER the patient to a large medical center with the resources to back courageous surgeons who are willing to offer diabetic patients the surgery they need.

There is the problem with surgery.  After one part of body was removed, the cause of problem why this must be done left un- addressed, and so soon after another surgery will be needed. This is difference between wounded military who undergo amputations and diabetics type 2. Surgery caused by trauma is final, and patient recovery. Diabetic will not recovery because of surgery did not remove cause of complication. Diabetic's body slow rotten, regardless of amount of carbs of fat or calories diabetic type 2 eat. Check up level of sugar in diabetics type 2 who need surgery, small one or big one. Sugar is high. With surgery it is going higher. Next surgery will be needed sooner.
    I was able to stop this process. My man wrap my legs every day. Now there is no opened wounds. But the color of skin still dark. If legs are not wrapped for some time the inflammation stated deeper onside, pain, deep inside, and soon after wounds are opened.  This was condition I was discharged from hospital. There was only the matter of time when I would be amputated. Now my legs are both dry and no wounds at all. 450 units of Lantus Solo Start daily done good job.

Why is a diabetes patient noncompliant or why is opiate addiction and obesity growing? Are those who suffer just lesser humans who are lazy or careless, or might there be genuine reasons why it's more difficult for some people. Sometimes it's obvious, such as one who simply can't pay for their meds if they wish to eat and pay for housing. Lack of funds affects many aspects of people's lives and care. There are also other factors such as lack of a support network that make everything in life more difficult. More compliant patients often have adequate, or better finances and good social and family support.  

At first, why obesity growing?  Take insulin in stead of Glipizide and Metformin, and there would not be diabetic type 2 obesity. But who will be in medical clinics? That's right. Too little patients will have diabetic complications, and will be needed surgery and home care. Diabetes type 2 is not metabolic disorder. In is social issue. Wrong medicine the same as right medicine can do fantastic job, but in opposite directions. With diabetes type 2 which effect millions medical clinics never will be empty. Insulin will take profit from MD and all medical industry.  This is why insulin is not in medical box of diabetics.
       Do not say it is too expensive and diabetics cannot pay for this medicine. Many do have health plan which will pay for insulin. The problem is, insulin is Rx medicine, and only MD can give that Rx.  As usual, there are a lot of those to whom to blame. Diabetics type 2 are careless and lazy, insulin is expensive, doctors do not have time, too little of diabetics educators, and so so so on.  But only one stone, right classification of diabetes that it is chronicle disease which is resulted by unknown cause of insulin producing beta cells, and this disease can be effectively treated with right insulin daily dose.

bad control of diabetes is the main cause of need to do below knee amputation,if a doc examines suck case every-time he evaluates the pt and adjusts drugs it may reduce the amputation.with teleygliptin or sitagliptin oral dosage,the resistance to inj insulin may not matter;in older cases,hypoglycemia causes more damage to cvsone must always avoid hyperglycemia,acidosis and neuropathy.

Very interesting post. It is doctor. Can I trust in this doctor? Does this doctor know what he is posting? I am very doubt it. Well, I am ESL, and I did not study in college for so long as MD suppose to do. But the post?! If it possible to understand it? I am sure author has no one idea in brain.
 They Are Our Educators!!!!!!!!!!!!!!!!!
If someone expect to have better future for diabetics type 2 and for all our human population, then I am not. What I do very hope that AI will successfully replace idiots like this one, and finally this nightmare with diabetes type 2 would be over. 

 Lower-Extremity Amputations in Diabetes Are Back on the Rise, but Why?
by Gregory A. Nichols, PhD
March 14, 2019

https://www.medscape.com/viewarticle/910139?nlid=128730_1521&src=WNL_mdplsfeat_190319_mscpedit_wir&uac=164666HZ&spon=17&impID=1912505&faf=1  

via Ravenvoron