Gene Therapy may be the Future in Amputation Prevention in Diabetics with Poor Blood Flow

Cardiologists and vascular surgeons at Rush University Medical Center are now studying in innovative but investigational new medication that involves gene therapy. Researchers are working to determine whether or not gene therapy can promote new blood vessel growth in the feet and legs of patients who suffer from critical limb ischemia.

Critical limb ischemia is a condition that results in a severe lack of blood flow to the patient’s feet and legs. This often occurs in patients with diabetes. Peripheral vascular disease and disruptions in blood flow to the feet and legs are a major cause of amputation in the United States. At present, about 70% of all amputations are related to diabetes.

When a patient has diabetes, the process of atherosclerosis which clogs the arteries happens faster. If this process goes on for long enough, critical limb ischemia can develop. Because the arteries become clogged, there is less circulation to the feet and legs.

This results in a lack of oxygen and, in a sense, starves the tissues of nutrients. Without nutrients, the tissue start to die off and ulcers (or diabetic foot sores)can develop. “The goal of gene therapy is to stimulate the growth of new blood vessels. The additional blood vessels will carry more blood into the legs, alleviating pain and healing ulcers,” one of the researchers said.

The research is presently being done at Rush University involves Phase III clinical trials which will evaluate the effectiveness of gene therapy in preventing amputations in people with critical limb ischemia.

At present there are no prescription drugs at all available which can effectively treat critical limb ischemia. Because there are so few interventions that are effective, new therapies are needed in order to prevent the sorts of amputations.

This type of gene therapy is known as angiogenesis therapy, which means growth of new blood vessels. This sort of gene therapy appears to induce the production of a protein called fibroblast growth factor (FGF-1) which stimulates the growth of blood vessels at the site of injection.

The clinical trials that are now under way will last for one year. Participants are over 50 years of age, have stable ulcerations of the skin and noninfected gangrene on a foot or leg. All have also been diagnosed with peripheral arterial disease and critical limb ischemia. The participants will receive for injections of the investigational medication or a placebo into the leg muscle a two week intervals.

It is known that about 8 million people suffer from peripheral arterial disease. In the United States, that means one out of every 40 adults. It is a very common disease. It is often underdiagnosed. Because it is so common in diabetic patients, this might provide new hope for the prevention of diabetic foot amputations.


Dr. Christopher Segler is an author, inventor and award winning diabetic foot specialist. He is the founder of a private consulting firm specializing in the prevention of diabetic foot amputations. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

National Health Service Increases Funding for Diabetic Foot Programs Related to Podiatry

Children with diabetes in certain areas of the United Kingdom will be getting extra financial support.

The National Health Service has recognized the critical nature of funding diabetic programs for children. His most recent funding will help to pay for pediatric diabetic nurses as well as psychological support for children with type 1 diabetes. It is known that type 1 diabetes in children is linked with high levels of depression as well as eating disorders.

In addition to counselors who specialize in diabetes related to children and pregnancy, extra podiatrists have been added as well. For many years podiatrists in the United Kingdom have been recognized as critically important to preventing complications lead amputation. They have recognized that intensive monitoring by foot and ankle specialists, particularly podiatry, lead to early interventions and help to provide rapid treatment for diabetic foot ulcerations and open sores that can lead to amputation.

It has long been known that open sores in diabetic patients can rapidly become infected and lead to gangrene. Is also known that bone infections known as osteomyelitis are typically preceded by diabetic foot ulcers.

The hope of the additional funding is that diabetic patients will taking off of waiting lists and will be able to be evaluated sooner.

In addition to funding for type 1 diabetic patients, there’s a great need to assist with those with type 2 diabetes. Type 2 diabetes is becoming increasingly common. This rising type 2 diabetes, directly correlates with the increase in obesity within any given population.

At present, approximately 10% of the entire National Health Service annual budget is spent on treating diabetic foot ulcers, open sores on the feet, diabetic foot infections, and other diabetic foot complications.

Is well known that by having patient work closely with their primary care doctors and podiatrists, it is easier to keep diabetes under control and prevent diabetic foot amputations. It is also important to make sure that they podiatrist is closely involved one of diabetic patient begins a new program of exercise to help control the persons blood sugar.

Diabetes is not have to lead to amputation. With good blood sugar control, proper diet and exercise, diabetic patients can hope to lead a healthy and active life.



Dr. Christopher Segler is an award winning diabetic foot surgeon, author and inventor. He is the founder of a groundbreaking private consulting firm that specializes in diabetic amputation prevention. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

How Can Becoming an Athlete Prevent a Diabetic Foot Amputation?

One of the very best ways to treat diabetes is with exercise. We know that when a patient has diabetes, diet and exercise can significantly change the course of the disease. In fact, we know that after 45 minutes of aerobic exercise, such as running, a diabetic patient’s insulin sensitivity may increase for up to 48 hours. This is extremely beneficial for type 2 diabetics.

Not only can exercise such as running help a diabetic patient by changing the way that the body can use insulin, it also can help a number of other conditions.

We know that in all people, exercise can dramatically affect cholesterol levels. Hyperlipidemia or high cholesterol is one common condition affecting diabetic patients. We know that the VLDL and LDL (bad cholesterol) is lowered with exercise, while HDL (good cholesterol) is increased.

In addition, regular exercise can significantly affect a person’s blood pressure. Hypertension or high blood pressure is a common complication of diabetes. We know that regular exercise can typically reduce blood pressure by an average of 10 mm/Hg.

Obesity is another problem that is commonly associated with diabetes. Obesity alone is a major cardiovascular risk factor. It also leads to insulin resistance, further complicating diabetes. When a diabetic patient loses at least 15 to 20 pounds, fasting insulin levels can drop by 30 to 50%. As a result, there is much better blood glucose control.

Heart attacks and strokes are very common in type 2 diabetic patients. Regular aerobic activity such as walking and running have been shown to reverse the effects of increased levels of an enzyme called plasminogen activator inhibitor-1, which can in turn significantly reduce the risk of heart attack and stroke.

All of the disease processes mentioned can help clog the arteries and decrease blood flow to the legs. When this happens, you can get an open sore... it doesn't heal... it gets infected... and then you get gangrene. Once you get a diabetic foot infection with gangrene of the foot you will either get an amputation or you will die. But not to worry... it is all preventable!

With all of these possible benefits of exercise, it is understandable why any diabetic patient would (and should) embark on a program of exercise. The whole emphasis with diabetes is preventing long-term complications. Train Smart...Live Long!



Dr. Christopher Segler is an award winning diabetic foot surgeon, author and inventor. He is the founder of a groundbreaking private consulting firm that specializes in diabetic amputation prevention. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://ineedmyfeet.com.

Is Diabetes a Handicap?

Although diabetes is a serious disease, it should only be considered a handicap when it limits the activities that allow you to enjoy life. One obvious way this can happen is through an amputation or blindness. But it doesn’t have to be this way.

Although we know that diabetes can lead to heart disease, stroke, blindness and open sores on the feet that lead to amputation or death, this is largely preventable.

Research shows that regular exercise and a healthy diet are two ways that can help people prevent diabetes, or even to alter the course of a person’s disease if they do already do have diabetes.

One of the very best ways to make sure the diabetes does not become a handicap is with exercise. We know that when a patient has diabetes, diet and exercise can significantly change the way your body uses insulin and help fight the disease. In fact, we know that after 45 minutes of aerobic exercise, such as running, a diabetic patient’s, insulin sensitivity may increase for up to 48 hours. This is extremely beneficial for type 2 diabetics.

Exercise not only changes the way that your body uses insulin, but it can reduce problems associated with cholesterol, blood pressure, risk of a heart attack or stroke and obesity. We know that when a diabetic patient will lose 15 to 20 pounds, it improves insulin levels from anywhere to 30 to 50%. This results in much better blood sugar control that can prevent many of the complications from diabetes that we worry about.

In United States diabetes is the fifth deadliest disease. We actually think it might be much worse than this because people who do have diabetes might die from other complications including heart attack, stroke or complications of an amputation with gangrene related to a diabetic foot sore.

Whether you are a type 1 or type 2 diabetic patient, exercise can provide a tremendous benefit. You just have to be careful and make sure that you manage your blood sugar correctly.

Oral hypoglycemic medicines ( pills to keep your blood sugar down) may also have a significant impact on your blood sugar when you exercise. For example, sulfonylureas (glipizide, glyburide, etc.) and meglitinides (prandin, starlix, etc.) may require dosing adjustments in order to prevent hypoglycemia (low blood sugar) during exercise. Metformin (glucophage) and thiazolinediones (actos and avandia) are less likely to cause hypoglycemia when you exercise. However if you are taking any of these medicines it is important to talk to your endocrinologist or primary care physician to make sure that you don’t get into trouble.

You should also make sure that you get checked by a podiatrist to make sure that you do not have any problems with your feet, such as diabetic peripheral neuropathy ( loss of feeling) that can put your risk of developing the kind of open sore that can lead to an amputation. An annual diabetic foot exam with a podiatrist is a good way to make sure that you are not at risk of an amputation.

And amputation is one sure way they diabetes can become a handicap. Once a leg is amputated, it’s very difficult to move around the home. Even something as simple as turning on a ceiling fan can become a major challenge. We also know that there are a number of risks associated with having an amputation. About half of all patients who have an amputation on one foot will have any vacation on the other leg within five years.

We also know that diabetic patients who have indications on both feet will most often die within five years.

In spite of all this gloom and doom, there is hope for diabetes. There are a number of available technologies which can significantly reduce the risk of amputation of diabetes. This requires intensive intervention from a specialist in diabetic limb preservation. Unfortunately, not covered by insurance, but is essential to making sure that in amputation is prevented.

Although it can be frustrating when you find out you have diabetes, it does not have to be a negative life altering situation. They can be a very positive thing because many of these people will start a new exercise routine, lose weight, and develop a healthy lifestyle that includes athletic activities that they might find intensely enjoyable.

For many of these people, what started out as a bad thing turns into a way to begin to enjoy life. So if you have been diagnosed with diabetes, don’t worry, it doesn’t have to become a handicap.

Dr. Christopher Segler believes diabetic amputations are preventable. He teaches strategies that help his clients avoid amputation. He is also and award-winning diabetic foot surgeon, inventor and author. If you have diabetes, you can learn how to avoid amputation by more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://ineedmyfeet.com.

39-Year-Old Woman's Diabetic Foot Amputation: an Illustration in Real Life

Most people think that amputations are for crusty old pirates.  Well think again. Rebecca is a 39-year-old woman who recently lost her right foot and lower leg to a diabetic foot amputation. Following the amputation she had to spend five months in a nursing home. She felt out of place there, as most of the other residents were twice her age. But she had no choice as she simply could not fully recover from the tragic operation at home.  Now that her surgical wound (at the stump where her foot and ankle used to be) is healed she is back home with her husband David and her dog Rusty.If you have ever been to a nursing home, you can understand why she would be grateful to be back home. 

“It's a huge responsibility to move someone out of a nursing home,” Rebecca said. “The process of moving out really tests them.”  Most people don't even realize that their home will need expensive structural modifications, such as widening doors, reconfiguring bathrooms, and installing wheelchair ramps.  They also usually need remote controls for ceiling fans and light switches that are impossible to reach from a wheelchair. In can be financially destructive. 

All of this started when two sores (known as diabetic foot ulcers) started to appear on Rebecca's right foot. Eventually gangrene set in and the leg had to be cut off. “Once gangrene sets in, (amputation) is pretty inevitable,” she said. Gangrene is basically the death of a persons living tissue. The dying tissue becomes a breeding ground for bacteria which quickly spreads through the body. Without quickly removing the infected limb through amputation or limb salvage. If not, the person can die. 

Even though the sores that typically start these sorts of episodes are largely preventable, insurance companies don't pay for preventative care.  As a result, many patients like Rebecca can wind up missing a leg and feeling stranded in a nursing home. Most people don't realize the amount of care that is required when someone has this type of surgery. They need to be in a bed 24/7. If not cared for properly, they can get bed sores. 

Given the huge cost associated with this sort of preventable amputation, you would think that more would be done to stop the amputations. But insurance companies refuse to pay for the care and monitoring to prevent diabetic sores and diabetic foot amputations. Rebecca was able to get government assistance, but not everyone can qualify.

The thing to keep in mind is that even if you or someone you love has diabetes, these sorts of episodes are preventable. Doctor's today have the capabilities to prevent most diabetic foot amputations. With intense monitoring, patient education, and access to the latest technologies, diabetic foot amputations are preventable. Don't let the insurance companies tell you otherwise.

Dr. Christopher Segler is an author, inventor and award winning diabetic foot doctor. After discovering how amputations resulted from a failing health care system, it became his passion to teach strategies to stop diabetic amputation. If you have diabetes, you can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://ineedmyfeet.com.

Diabetes and Feet...What’s the Big Deal?

Whenever I have a new diabetic patient in my practice, I always ask them if they have know anyone who had a diabetic amputation. Almost all say yes. Then I ask if they know what happened to the friend, relative or co-worker that led to them losing the leg. In most cases there is some vague mumbling about an open sore or some kind of infection, but never any details. No real clear understanding of what transpired.

Shouldn’t every diabetic know the details so this could be prevented?

With each and every new patient with diabetes, they either fully comprehend the risks of diabetes to their feet (very rare) or they have no clue (very common). With every one of these folks I feel that the one goal is to get them to understand that diabetic foot problems are optional. 

Diabetes can be a tough disease to deal with.  Your doctor starts telling you what to eat, telling you to exercise, lecturing about heart attacks. Then you are at home learning about blood sugar monitoring, taking medicine, pricking your finger every day. Now I gotta  think about my feet too?  Seems like such a hassle.

And it is.

But the good news in all of this is that everything bad that can happen to you because of diabetes is preventable. Everything. All it takes is the right learning, a little lifestyle change, and  little daily effort. The goal of this article is to get you to understand the basics of how diabetes can affect your feet...so you can do something about it.

When you have diabetes you have three main problems, all working together and conspiring against you, that can lead to a diabetic foot amputation. It involves your nerves, blood flow and immune system.

When your blood sugar is high, there is a chemical reaction that directly damages the ends of the longest nerves in your body.  The longest ones start in your back (where they exit the spine) and head all the way down to the toes in one long piece. Because the ends get damaged first, any nerve damage starts in the toes and gradually creeps up the foot toward the ankles. 

It is always damaged at the same level in both feet. For example, if you have nerve damage (neuropathy) at the ball of the foot, the nerve damage is only in the toes. In this case the arches and heels might be fine. 

Neuropathy makes it hard for you to tell if you are getting a blister or an open sore, and puts you at risk for problems. It is deceptive because you might be able to feel other things like the position of your feet, shoes and socks squeezing, but not a blister, cut or sore. 

The second problem is blood flow or circulation in the feet and legs.  The arteries get clogged faster when you have diabetes. If you take two people who are identical except one is diabetic, the one who is diabetic is four times more likely to have a heart attack. That is because of the increased rate of clogging up those arteries through the process called atherosclerosis.  But this process happens everywhere, not just the heart. The blood vessels to the legs get plugged up too. Then when you get a sore it takes longer to heal. It is also harder for your infection fighting white blood cells to get down there. 

The last problem is your immune system. When your blood sugar is high, the white blood cells (called macrophages) have a hard to time fighting off those nasty bacteria. The white macrophages find bacteria through a process called chemotaxis. It is like following a trail of chemicals to its source. This is not very effective when the blood sugar is elevated. In effect, they are lost in the dark, simply bumping around hoping stumble into some bacteria to kill. Very inefficient and not very effective.

Once they do find the bacteria they have a bigger problem. The high blood sugar prevents them from eating the bacteria. The process where the white blood cells engulf the bacteria (called phagocytosis) is essentially disabled. So they bump up against they bacteria, but can’t do anything. Imaging a great white shark with his mouth wired shut trying to eat a smaller fish for dinner. Because of all of the this, the immune system is ineffective, the bacteria continue to grow and the infection quickly gets out of hand.

So an amputation goes something like this.  You get a little nerve damage, can’t feel a blister starting, and it pops.  Just like that, you have an open sore. Your blood flow is a little sluggish and takes a long time to heal. Then it gets infected while it is trying to heal. If you blood sugar is high, all of those sharks are wandering around in the dark, mouths wired shut, and the infection spreads. 

If it spread enough, one of the bones gets infected. And a bone infection is the kiss of death for the diabetic foot. The only reliable way to heal a bone infection in an adult diabetic is to remove the infected bone.  And that is where the amputation begins.

The moral of the story is watch your blood sugar, and your nerve damage will never get any worse. If you walk 30 minutes a day, fives days a week, your blood flow will never get any worse. If you have any nerve damage, you need close monitoring by a diabetic foot expert. If you ever get an any open sore, blister or ingrown toenail it is an emergency...no joke. Get that foot checked out or it might chopped off!

Dr. Christopher Segler is an award winning diabetic foot surgeon, author and inventor. He is the founder of a groundbreaking private consulting firm that specializes in diabetic amputation prevention. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Harvard Study Shows Diabetic Testing Is Not Great

A new study published by the New England Journal of Medicine today says that genetic testing is not much better than the low cost method of looking at traditional risk factors when trying to determine if a person will develop type-2 diabetes. 

Doctors and scientists already know that a person's risk of developing diabetes increases significantly if they have diabetic relatives. The researches said that they have always thought inherited genes might be responsible, but acknowledged that family associations and learned behaviors such as a poor diet and sedentary lifestyle might also play a role.

One of the Harvard investigators who conducted the research explained "With the current state of knowledge, the genotype score doesn't help us sort out who is at elevated risk any better than measures like weight. We may eventually find out that those individuals without known risk factors who still develop type 2 diabetes have more diabetes-risk genes, once we know what more of those genes are," he added.

One new possibility is to study genetic markers in those people who make lifestyle changes to reduce risk, and then see of genetic testing becomes more reliable.  Based on the study, it would appear that at present the standard prevention and lifestyle strategies are still most effective in determining who will be at risk from diabetes.

Dr. Christopher Segler

Diabetic Clinical Researcher

Award Winning Foot Surgeon

Dr. Christopher Segler is an author, inventor and award winning diabetic foot doctor. After discovering how amputations resulted from a failing health care system, it became his passion to teach strategies to stop diabetic amputation. If you have diabetes, you can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” 

at http://www.ineedmyfeet.com.

$218 Billion: The Cost of Diabetes Care in the U.S.

On November 18, 2008 the Associated Press released a new study that shoes the totl cost for diabetes in America to be $218 billion. This is the first time a comprehensive estimate of the total financial cost diabetes takes, according to Danish pharmaceutical company Novo Nordisk A/S, which paid for the study.

The $218 Billion figure includes direct medical care costs, including amputations, hospitalization, medicines including insulin and pills for controlling patients' blood sugar, plus indirect costs such as disability due to amputation, lost productivity, disability, and forced early retirement.

The study, conducted by the Lewin Group consultants conducted the study, estimated that it costs to society society for people known to have Type 1 or Type 2 diabetes are estimated at $174.4 billion.

The firm explain that part of that $174 billion included an estimated $10.5 billion in medical costs and $4.4 billion in indirect costs, or a total of $14.9 billion, for people with Type 1 diabetes. This is the type of diabetes, which begins much earlier in life and was previously called childhood or juvenile diabetes. It’s been estimated that about 6 percent of the 17.5 million Americans diagnosed with diabetes actually have Type 1.

The study demonstrated that the vast majority of cost, which was estimated at $105.7 billion in direct costs and another $53.8 billion in indirect costs, for a whopping total of $159.5 billion, for people with Type 2 diabetes. This shows that Nearly 10 times the amount of health care dollars are spent on type 2 diabetes as opposed to type 1 diabetes. Type 2 diabetes has previously been referred to as adult-onset diabetes because of the average age at diagnosis is typically much later in life. This type of diabetes is also directly correlated with obesity and sedentary lifestyles.

This study does also add in estimates for people who have not yet been diagnosed ($18 billion), women who develop , gestational diabetes (diabetes which is only temporary and occurs during pregnancy) ($636 million), and those who exhibit characteristics of diabetes, and maybe in the process of developing the condition which is now frequently referred to as pre-diabetes ($25 billion).

These findings were recently presented at a healthcare conference for corporate executives. The firm that produced and funded the study does plan to publish a full report in a medical journal soon. These figures were produced based on numbers from sources including databases on treatment of people with Medicare, Medicaid, private and commercial insurance, federally funded public health surveys, and other sources.

Dr. Christopher Segler

Diabetic Clinical Researcher

Award Winning Foot Surgeon

Dr. Christopher Segler is an author, inventor and award winning diabetic foot specialist. He is the founder of a private consulting firm specializing in the prevention of diabetic foot amputations. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

"I Need My Feet!"

Today I saw one of my favorite patients. He is a true success story. He has diabetes. He has neuropathy. He cannot feel pain in his feet. He cannot feel a new sore starting. He has had Charcot Foot (where the bones get weak, the whole foot breaks down and collapses). He has been hospitalized. He had surgery for this that healed in a position that actually puts him at risk for more problems.

But he still does great!

Today he said that since we met, he has had several episodes where a little sore started to appear, yet he hasn't been able to tell in 50% of cases if it is serious or not. He comes in, gets treated and all is well. Last week he just noticed a "red spot" on the big toe. He came in and we saw he actually had a nasty infection.

We treated him and he is again on his way to recovery. He always seems to bounce back.

It isn't just that he checks his feet, or watches his blood sugar, or calls when he gets a problem. It seems that he has a real appreciation for life, a positive outlook, and gratitude for what he has. Today he said "I need my feet!" What a remarkable statement. It so clearly defines the obvious challenge faced by diabetics that others take for granted.

I will continue to enjoy being his foot doctor. He will continue to enjoy his feet.

Dr. Christopher Segler

Diabetic Clinical Researcher

Award Winning Foot Surgeon

Dr. Christopher Segler is an author, inventor and award winning diabetic foot specialist. He is the founder of a private consulting firm specializing in the prevention of diabetic foot amputations. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report:

“No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.