Early detection, intervention key in reducing diabetes-associated amputations, says Manitoba doctor

There was a time Christian Swan would dream about being able to walk again. 

The 46-year-old has diabetes and had his ankle and foot amputated more than two years ago, following complications from an infection.

“I was dreaming I was walking, and if that sounds crazy, that’s how it happened for me,” he said.

“I dreamt I was walking and eventually I got to the stage where I started walking.” 

Swan learned to walk again just over a year ago, with the help of a prosthetic leg.

His amputation happened in 2022, meaning it’s likely one of the cases represented in a Canadian Institute for Health Information report published last week examining diabetes and lower-limb amputations.

The CIHI report said Manitoba saw more than double the national average of diabetes-associated leg amputations between 2020 and 2023. Age-standardized rates of diabetes-associated leg amputations were 19 per 100,000 in Manitoba, compared with nine per 100,000 nationally, the report says.

The report, titled Equity in Diabetes Care, also found Manitoba saw more ankle-and-below amputations compared to the national average, with 19 per 100,000 compared with 14. 

It also said lower limb complications were more common for people who live in neighbourhoods with lower income, lower high school completion and higher social deprivation, as well as in rural and remote communities.

Swan said at the time of his amputation, he was living in Lake Manitoba First Nation, but had taken a family road trip to Edmonton. He developed a wound on his foot and went to a hospital there. Swan said he was given medication and told there was no sign of infection, and was cleared to drive back to Winnipeg to visit a hospital there. 

It was either sometime during the drive back, or during the eight to 10 hours he says he spent in a Winnipeg waiting room, that infection set in. 

“The toe started turning black.… You knew that something was going on, and then they broke the news to me that they had to transport me from the Seven Oaks [General Hospital] to Health Sciences Centre, and they rushed the surgery,” said Swan. 

Complications ‘can be head to toe’: specialist

Diabetes can lead to a loss of feeling in the feet and affect blood supply to the lower limbs, which means people with the disease are at high risk of foot wounds and foot infections, said infectious diseases specialist Dr. John Embil.   

Embil works with the Health Sciences Centre’s limb preservation program, which he estimates sees upwards of 3,000 patients a year, from all over Manitoba. The majority of patients have diabetes, he said. 

The infections and cases can be quite significant, involving care from a range of doctors and medical professionals, including orthopedic surgeons, vascular surgeons, plastic surgeons, infectious disease specialists and physical medicine rehabilitation specialists, said Embil.

“They’re with us as long as it takes, and we continue to follow people for life,” he said.  

Manitoba has a very high prevalence of diabetes, Embil said, so the rate of complications such as those affecting lower limbs, kidneys, the heart and eyes is high. 

“The complications of diabetes can be head to toe and right and left,” said Embil. “So you don’t want to leave any part of the body unchecked.” 

Early detection and early intervention in the management of diabetes are key in trying to reduce the number of amputations, he said.

“If you can prevent end-stage complications such as lack of sensation in the feet and suboptimal blood supply to the feet, you can prevent many of those complications, and you can prevent the amputations,” he said. 

Embil points to the importance of primary care. 

“People need primary care providers … and a focus on diabetes detection and management is critical.”

‘Like I walked into a cement wall’

Darleen Tunny was diagnosed with Type 2 diabetes at age 30. Now, at 60, she’s learning how to live with a new reality following an amputation below her left knee.

Tunny had gone into hospital with pneumonia in November 2023. Up until then, she had been checking her feet almost daily and seeing a foot specialist for her right foot, where she had two toes amputated. 

She didn’t know about a cut or issue with her left foot, but things quickly changed in hospital. It was during that stay she found out she would lose part of her leg.

“That was like I walked into a cement wall,” said Tunny. 

“What am I going to do?” she immediately thought. “How am I going to survive? How am I going to live?”

Tunny had to find a new and accessible home. Everything from trying to book home-care services to transportation has been frustrating, she said. Many places aren’t accessible for wheelchair users.

“It’s been really difficult, because I was a really independent person,” said Tunny.

When she thinks about her experience over the years, she said she’d like to see more services for people such as the Youville Diabetes Centre, an education and support centre in Winnipeg where she has seen a nutritionist, a diabetes nurse and a counsellor at different times of her life.

“Having a counsellor available is awesome,” she said, explaining that’s helped her navigate the emotional side of the disease and what she’s gone through.

Another thing that’s important to Tunny is telling people to pay attention to their health and the serious risks linked to diabetes. 

Anyone who notices symptoms that could signal diabetes should get checked, and if you do have diabetes, pay attention to the advice of health-care professionals, she said.

“You can’t play around with this disease. It will kill you.”

A spokesperson for Manitoba’s health minister said in a statement that investing in primary and preventative health-care services is “one of the best ways we can prevent diabetes-associated amputations.”

The spokesperson said the province’s latest budget included $500,000 for initiatives under Manitoba’s Diabetes Action Plan, focused on improving prevention and education, screening and diabetes management efforts.

The spokesperson also said the province is establishing dialysis services in areas such as Norway House and Pimicikamak Cree Nation so people can get care close to home.

Swan said he feels he didn’t know enough about the risks linked to diabetes and lower-limb complications leading up to his amputation.

He’d like to see more education around diabetes and how serious the disease is in different communities. 

He’s recently learned a lot about the illness and tries to share his story publicly in an effort to help keep others from experiencing what he did, he said.

“I found that it helped a lot of people,” said Swan. “People have reached out to me, asked questions, and then the next thing you know they’re in the hospital and they’re getting treated.”