DIABETES DANGERS BETTER UNDERSTANDING OF DISEASE NEEDED TO DECREASE FREQUENCY OF AMPUTATIONS.

Byline: Steven Rosen Correspondent

When Bill Hill of Sherman Oaks decided to splurge on two pairs of expensive loafers, he trusted the shoe clerk to fit him correctly.

He has to; as a diabetic for 20 years, the 70-year-old Hill has neuropathy, a common nerve disorder of diabetes mellitus that can lead to the loss of sensation in the feet and other parts of the body.

As a result, he was unaware he had developed an ulcer on his right foot from the ill-fitting shoes until it was almost too late.

``I didn't feel the pain of the discomfort,'' he says. ``But there was an abrasion from the rubbing against the toes, and a wound that had progressed.''

He quickly went to the Providence Diabetic Foot Center in Burbank, where a doctor gave him strong antibiotics, removed the dead skin tissue from his foot, and made a mark on Hill's ankle.

``He said, 'If the redness reaches that mark, call me and meet at the emergency room,' '' Hill recalls.

The wound eventually healed, but Hill learned how dangerous foot abrasions can be for diabetics.

In fact, diabetic foot wounds are the leading cause of nontraumatic foot amputations in the United States. Of more than 80,000 amputations performed annually on diabetic patients nationwide, 72,000 are preventable, according to statistics provided by Providence St. Joseph Medical Center, which oversees the Providence Diabetic Foot Center.

An estimated 4,000 of those amputations occur in Los Angeles, Orange and Riverside counties, which have the largest concentration of diabetics, age 50 and over, in the country, according to Dr. George Andros, medical director of Providence St. Joseph's Vascular Center.

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy.

Although the cause of diabetes is still not fully understood, heredity, environmental factors, obesity, poor nutrition and lack of exercise all appear to play roles. The disease disproportionately affects Latinos, African-Americans, American Indians and Asian/Pacific Islanders - communities that represent 67 percent of the population in Los Angeles County.

Nationwide, efforts are under way to combat the disease. The American Diabetes Association fears the number of diabetics will jump from 18 million in 2002 to 30 million by 2030 - largely fueled by the nation's obesity epidemic.

Among those speaking out about the diabetes risk is actor Edward James Olmos, national spokesman for the Juvenile Diabetes Foundation. He has a family history of diabetes - his father and uncles all died from complications of the disease.

``I sure as hell know that if I don't watch my diet and take care of my health, I could get it,'' he says. ``I'm well into my 50s and have yet to have it.''

At the same time, there is a parallel effort to reduce the number of foot amputations for diabetics. Andros was co-chairman of this month's Global Diabetic Foot Conference in Hollywood, an international symposium that attracted hundreds of physicians, podiatrists, surgeons, nurses and diabetic educators.

Andros says the number of amputations can be reduced dramatically with better, faster diagnosis of foot problems and more frequent use of bypass surgery to help heal dangerous foot wounds. Unfortunately, he says, many podiatric surgeons are too quick to amputate.

``There's a thing called diabetic microangiopathy - a disease of the blood vessels,'' he explains. ``Diabetics get a unique blockage (of circulation) below the knee and above the ankle. Then diabetics get a sore on the foot and there's not enough circulation to heal it. They get an ulcer, which increases the circulation demand.''

That can lead to a gangrenous infection from lack of oxygen, and then amputation.

But Andros says bypass surgery - or, in some cases, angioplasty - can achieve flow around that blockage into small arteries in the foot to promote healing. Providence St. Joseph performs about 100 bypasses a year, a number that approximately ties it with Boston's Joslin Diabetes Center for the most in the country.

``If we can get them up to a level to heal, then if they take proper foot care, they may have no further foot trouble,'' Andros says.

Other medical procedures are available, too, when cases warrant - such as vacuum-assisted instruments that can help in wound closure and biologic dressings made of neonatal foreskins to stimulate healing once a wound is clean and dry. And doctors are salvaging limbs by performing only partial amputations when they must cut. That allows for prosthetic devices that allow people ``to walk in a meaningful way,'' says Dr. Franklin Case, of Providence St. Joseph's Diabetic Foot Center.

But diabetics at risk can help themselves, too, Case says. He recommends frequent visual inspection of the feet, although he concedes such tasks can be a challenge for the obese.

``We've had people walk in here with keys, rocks, all sorts of things in their shoes and never notice anything hurt,'' he says. ``I had a blind woman with diabetes who had a sewing needle stuck right through her toe and couldn't feel it.''

Case recommends diabetics have primary-care physicians routinely inspect their feet. And if there is a problem, such as a callus, they should seek treatment from a podiatrist. They also need supportive shoes, perhaps with orthotic devices. And he recommends exercise - walking for 30 minutes a day, three or four times a week to improve circulation.

His fellow physician at the foot center, Dr. Oliver Wang, also notes that individuals recently diagnosed with type-2 diabetes can sometimes correct early nerve damage.

``There have been cases with an early onset of neuropathy where people have gone on a strict sugar-level control and been able to reverse it,'' Wang says.

Beyond the preventive measures taken by diabetics and their physicians, society at large needs to help fight the looming diabetes epidemic by taking it more seriously, says Dr. Francine Kaufman, professor of pediatrics at USC's Keck School of Medicine and author of the new book ``Diabesity'' (Bantam; $27).

``Many people feel 'I have a touch of sugar' and that they don't need to pay attention in a significant way,'' she says. ``But this is a disease that impacts your life in a serious way. Limb loss is something people sort of know about, but, at the same time, they don't understand it, really.

``Diabetes is a huge deal,'' she says. ``We all have to care about it and do something in our own lives, in our own homes and our own communities and schools to help prevent it. And then we have to help the people who have it live productive lives. It can be managed in a way to mitigate the complications.''

CAPTION(S):

3 photos

Photo:

(1 -- cover -- color) The face of diabetes

(2) a diabetic for 20 years, Sherman Oaks resident Bill Hill, 70, nearly lost his foot due to neuropathy, a common and dangerous complication of the disease.

Hans Gutknecht/Staff Photographer

(3) - Edward James Olmos

National spokesman for Juvenile Diabetes Foundation