My 63 year old mother, who lives in India and has had type�2 diabetes for about 12 years, developed a foot ulcer, and doctors are recommending amputation of foot since there is risk of gangrene. She used medicines in capsule form for a long time, but, since her sugar levels was high, last year she started taking insulin. Despite this, her sugar levels remain high and she is not responding to increased doses of insulin. Is there any new type of insulin that would help? I am hoping that if her sugar levels are reduced, her injury will heal, and I want her to retain her foot.

I am sorry to hear about your mother. At the point where the foot ulcer is getting worse, it requires the combination of good blood sugar control, antibiotics, and wound debridement. This is a very labor intensive form of therapy. The healing is slow because of high sugars and also because blood flow is often compromised in the area of the ulcer (which does not allow the antibiotic to gain access to the wound).

There is no “best” insulin in this case. Usually, patients require multiple injections of long and short acting insulin with frequent blood sugar monitoring to document treatment success.

If the risk of leaving the foot on becomes so serious as to compromise your mother’s life, the decision to amputate has to be addressed. I hope her doctors do not have to do this.

JTL