Friday, June 14, 2013

Stem Cell Regrowth of Toes

Stem cells from under nails tissue has been shown to regrow soft tissue and bone. Research published from New York University Langone Medical Center has shown bone and soft tissue has been regrown in cases where a partial amputation has occurred of a finger or toe. In cases where a part of the nail matrix or base of the nail bed has been retained doctors at New York University have been able to regrow bone and soft tissue. This can have some implications in our diabetic patients who are always at risk of an amputation.

Diabetes can many affects on the body. In regards to the feet there are three major effects. First, the blood sugar that is broken down from food should get absrobed by organs to get used for energy. However, because the body does not produce enough insulin, the chemical that moves the sugar into the organs, or does not recognize the insulin the body is making, the sugar stays in the blood stream. Ultimately, the sugar can get absorbed into the outside lining of the small blood vessels. The sugar can then develop calcification within the walls of the vessels and create plaques similar to cholestrol plaques. This can affect the blood flow beyond the plaque creating poor blood flow to the area. This normally affects the smaller vessels, such as in the toes and fingers.

Secondly, the blood sugar can also get absorbed into the nerves. This will cause a chemical nerve damage called neuropathy. Early symptoms include burning or tingling first just at night and then can progress to during the day. In diabetes, the hands and feet are often affected equally. Eventually both the hands and feet can become completely numb. This is a problem when you can no longer feel if you step on something or feel if your shoes are too loose or tight resulting in blisters. Often, a patient does not even realize there is a problem unti they see drainage on their sock.

Thirdly, the higher a patient's blood sugar the less able they are to fight off infection. The blood sugar will inhibit the white blood cells which are the main fighter cells of the body.

So you can see for a diabetic patient once they develop a problem it can be difficult to treat. Below is information from the National Diabetes Information Clearinghouse (NDIC)
  • More than 60 percent of nontraumatic lower-limb amputations occur in people with diabetes.
  • In 2006, about 65,700 nontraumatic lower-limb amputations were performed in people with diabetes.

With such a high risk of amputation with our diabetic patients the opportunity to regrow a toe or finger is exciting news. We will keep updating our information as further studies became available.

Dr. Alexandra "Sandie" Grulke

Tuesday, April 2, 2013

New Diabetic Drug !

The FDA has approved a new diabetic drug aimed at lowering blood sugar called Invokana by Johnson and Johnson. Diabetes results from too much sugar in the bloodstream and the insulin that prevents this from happening is reduced or non-existent. This drug will block the sugar from entering the blood stream and force excretion of the sugar into the urine. This is a new line of thinking in the treatment of diabetes.

Current medication such as Metformin, target lowering the body's own production of glucose from the liver in an effort to control blood sugar. Invokana is a new drug in a class called sodium-glucose-transporter 2 inhibtiors, SLGT2. These drugs focus on removing the blood sugar from the breakdown of food as it is filtered from the kidneys. This would increase the amount of sugar excreted from the kidney's and lowers the blood sugar. Invokana is still being investigated by the FDA but early results have been promising. This drug, as in all drugs, do have some side effects. With the increased sugar in the urine, an increased incidence of urinary tract infections and yeast infections have been noted. Also, there is a greater chance of cardiovascular events within the first 30 days of treatment, however the risks are then lower after that.

More information is needed on this drug but the early results look promising in the treatment of diabetes.

Dr. Alexandra 'Sandie" Grulke