Diabetic gangrene is a potential complication of long-term or poorly managed diabetes that involves skin, nerve, and muscle tissue death. Diabetes can damage blood vessels, preventing tissues from receiving a steady supply of oxygen- and nutrient-rich blood and ultimately leading to their decay. When gangrene occurs in diabetic patients, it is almost always isolated to the toes. It is possible, however, for the condition to affect the soles of the feet, the fingers, and other areas along the extremities. Diabetic gangrene is usually treatable when it is discovered in its early stages, though patients who do not receive prompt care may need to have amputation surgery to prevent fatal complications.
Diabetes triggers blood vessel degeneration that is most prominent in the tiny vessels of the extremities. When cells in the toes or fingers are deprived of oxygen, they begin to die. Open lesions may appear that are highly susceptible to infection and worsening gangrene complications. In addition to blood vessel degeneration, diabetes can cause nerve problems that further increase the likelihood of developing diabetic gangrene. Nerve damage may lead to numbness in the extremities, so patients may be unaware that they are developing the skin ulcers and infected lesions that are characteristic of early gangrene.
Ulcers may be very small and painless at first. As diabetic gangrene spreads, a larger area of skin becomes dry, cold, and harder than usual to the touch. Over several days to weeks, the skin begins to turn a dark blue or purple color as more tissue is destroyed. Untreated gangrene leaves a dead area that is completely black and extremely brittle. In the final stages, the toes may wither, expose underlying dead bone and muscle tissue, and possibly break off of the feet if pressure is applied.
It is usually easy for doctors to diagnose gangrene, even in the earliest stages. A physician will carefully review the patient's medical history to confirm that diabetes is most likely cause. Blood tests may be performed to check for signs of infection, and imaging scans are taken to determine how badly tissues underneath the skin have been damaged.
Once diabetic gangrene has been confirmed, doctors can consider different treatment options. If tissue damage is minimal and there are no signs of infection, a surgeon may be able to remove only the dead cells while leaving the healthy ones intact. In addition, damaged blood vessels may need to be bypassed or replaced to restore normal blood flow. Following surgery, medications may be prescribed to further improve blood flow and help reduce the risk of future gangrene episodes.
If considerable areas of skin and bone have already decayed prior to treatment, amputation may be the best option to prevent gangrene from spreading and reduce the risks of major infections. Modern amputation procedures have very high success rates, and patients are usually able to recover with minimal physical handicaps with the aid of prosthetic devices and physical therapy.