Losing a limb is a very real threat to patients with diabetes.
For ten years, St. Mary's Diabetic Foot Clinic has helped patients keep their feet healthy, so they can keep them altogether.
Richard Lurker, a diabetes patient, says, "It's kind of like gaining or losing weight over time. You don't notice it."
Lurker didn't realize he was gradually losing sensation in his feet until he had a sore that wouldn't heal.
"I'd get up in the middle of the night and go to the bathroom or something, and stub my toe, and it didn't hurt, and I thought, 'Hey, I'm pretty tough.' But in fact, I didn't have any feeling in my feet," he explains.
A trip to the doctor for the foot ulcer led to the discovery of diabetes. Richard's uncontrolled blood sugar had damaged the nerve endings in his feet, a condition called neuropathy.
What's called a Semmes-Weinstein Test reveals just how much sensation he's lost.
Physical therapist Claire Vukovich, a certified wound specialist, says, "There's three levels of feeling, normal, protective and then loss of protective sensation or absent sensation."
Richard can't tell where Vukovich is pressing because he can't feel it. This is how patients get into trouble. If they can't feel anything, they don't know when they're hurt.
Vukovich adds, "Something as simple as a wrinkle in your sock, but over 10,000 steps during the day, it can cause a blister or an ulcer. So, it's not necessarily that you need a big event to cause a problem. But because of the number of steps you take every day, that's why you're especially at risk."
She says patients need to inspect their feet for injuries every day and wear protective footwear.
"It's like wearing your seatbelt. You don't know when you're going to have an accident, so you wear it all the time," states Vukovich.
Minor injuries can become ulcers and then develop into deep infection. When antibiotics and surgery fail, amputation is necessary.
Unfortunately, 60 percent of patients never regain the same kind of function they had before the amputation. They never learn how to walk or work or drive again. They become sedentary, and that's what leads to the deaths.