Copyright (c) 2009 Mountain West Foot & Ankle Institute

Larry H Miller is well known as the owner of the Utah Jazz NBA team, but also has multiple business and personal accomplishments that have helped rocket him to notoriety. He became co-owner of the Utah Jazz with a 50% purchase of the team on 11 April 1985. In June 1986, he purchased the remaining 50% and became the sole owner. He has since made it one of the most stable teams in the NBA.

Although Larry H Miller has been in declining health for several years, diabetic complications seemed to play a greater role in his health problems and his death. In June 2008, he suffered a heart attack and was hospitalized for 59 days with bleeding problems and kidney failure. In October of the same year, he developed a bone infection (osteomyelitis) from diabetic ulcerations. He underwent foot surgery at that time, and later progressed to below knee amputations of both legs “as a result of complications of diabetes.”

Larry H Miller’s story is not that different from many diabetics. Diabetes is becoming better known throughout the world as patients and physicians alike study and learn more about this growing disease. The American diet has been implicated with increasing the rate of diagnosis of diabetes, and greater complications are being recognized, including many parts of the body. Many of these complications affected Larry H Miller, but may not be directly related to his death, as he had a rare condition called calciphylaxis that may have aggrevated some of the complications of diabetes.

When you discuss complications of diabetes, three primary systems of the body should be discussed: 1) Circulation (blood flow), 2) Nervous System (nerves), 3) Immune System (infections). I will discuss each of these here.

First, circulation or blood flow, includes the heart and blood vessels that help supply the blood and oxygen throughout the body. In a diabetic, the blood vessels (arteries) become calcified and loose some of their elasticity. To a lesser extent, this can also affect smaller vessels. As part of these complications, people will often have decreased blood flow to the feet and legs and possibly even the hands. This decreased blood flow is often described as Peripheral Vascular Disease (PVD) or may interfere with healing of sores throughout the body. The blood flow issue may also interfere with the functioning of the heart and can lead to heart attacks, the functioning of the kidneys leading to kidney failure or affect the small vessels of the eyes causing decreased vision. Every system in the body needs blood flow to function as is worsened by the lack thereof.

Second, the nervous system or nerves, includes the peripheral nerves (nerves outside the brain or spinal column) and the autonomic system. Often these peripheral nerves will malfunction and produce a condition called neuropathy which can be seen as numbness, tingling, burning pain, electrical shocks or shooting pain, and hypersensitivity (over sensitive to minor stimuli). In these cases, the feet fail to function as they should and the protective nature of pain is disrupted. This can lead to calluses or blisters becoming sores that can become infected and heal poorly. It may also lead to poor balance as proprioception (feeling of pressure to feet) is disrupted. Nerve abnormalities can also lead to deformities of the feet including dryness as oils and sweat aren’t released as normal, and contracture or angling of toes as muscle fail to act normally (hammer toes or bunions).

Third, the immune system, includes the fighting of infections and the healing of wounds. A diabetic is unable to heal wounds or fight infections as well. This leads to simple conditions like Onychomycosis (fungal nails) and complex conditions like diabetic wounds and osteomyelitis (bone infections). The body fails to recover as it should and often produces long term wounds and health risks including possible toe, foot or leg amputations. Amputations then further increase the load on the heart and can lead to further health risks and even death.

The best ways to decrease the risks of these complications include strict blood sugar control, aggressive care by your diabetic specialist, regular examination of your feet and exercise. Although complications can’t be completely eliminated, these modalities have been shown to improve overall diabetic health and long term results. Diabetes continues to lead to amputation and death, and should be aggressively understood and treated to improve everyday life. As we work together, we may be able to extend the lives of every diabetic and limit the complications they encounter.