Foot ulceration in people with diabetes is an increasing problem which is costly to the NHS financially and to patients in terms of quality of life. Management is complex and involves a team approach to ensure the best results for patients.
This case study describes the diagnosis and management of 55-year old man with painful diabetic peripheral neuropathy. He is already receiving treatment for his diabetes but is experiencing burning pain in the soles of his feet, especially at night when lying in bed. He has paresthesia and numbness in toes and his sleep is interrupted because of his condition. He also presents with depression and has a number of diabetic complications and co-morbidities.
We all know that diabetes prevalence is increasing. It is estimated that by 2025, 5 million people will have Type 2 diabetes in the UK (Diabetes UK). That potentially means more pressure on an already creaking healthcare system and more people at risk of developing debilitating complications from their diabetes. It doesn’t have to be that way!
The annual diabetic foot check plays a vital part in the support and education of people with diabetes. This can be performed easily and with minimal expense, but despite the NICE recommendation (NG19) that everyone with diabetes should have a foot check at least once a year, Diabetes UK reports that up to 400,000 people are not having this performed.
The time of year is one of a number of factors shown to affect HbA1c levels. This study investigated seasonal variations in HbA1c in a large population of people with diabetes in Scotland. These variations appear to have clinical significance in terms of making medication decisions and other aspects of clinical care.
Volume 7, Supplement 2, Jul-Aug-Sep 2010
Diabetes clinics form a major part of the workload for practice nurses, but 95% of routine diabetes care is delivered by patients themselves or by family members and carers. It is imperative that we offer people with diabetes concise, up-to-date education for effective foot care and to prevent complications.
In the UK, an estimated 1 million people with diabetes use injectable therapies, and these patients are increasingly being managed in primary care. As a result, more primary care nurses are taking responsibility for the initiation and continuing management of injectable therapies, including advising on and reviewing an individual patient’s injection technique.
Insulin therapy is life-saving for people with type 1 diabetes, and a key component of the treatment regimen for many people with type 2 diabetes. At the same time, insulin is a major cause of adverse drug events, some of which are so severe that they cause emergency admission to hospital. There is therefore much that needs to be done to improve the safe use of insulin in order to reduce medication errors and hospitalisation associated with hypoglycaemia.
NICE recommends that all patients with diabetes should be offered a structured educational programme at diagnosis, together with regular reviews and updates. Several programmes are available that meet NICE criteria, and there is evidence that they can help to improve patients’ quality of life, well-being and diabetic control.
Unplanned pregnancy with poor glycaemic control at conception is associated with major maternal and perinatal complications. However, contraception is used haphazardly by women with diabetes and is often not discussed by diabetes professionals. GPs and practice nurses need to be able to give appropriate advice about contraception to the increasing numbers of women of childbearing age with type 1 and type 2 diabetes.
ALBUMIN:CREATININE ASSESSMENT IN CHRONIC KIDNEY DISEASE AND DIABETES