Diabetes:  Wellbeing  &  Feet  for  Life  

Dr  Michelle  Spruce  Blandford  Chiropody  Services  

Hon  Research  Fellow  London  South  Bank  University  

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What  do  you  know  about  Diabetes?  

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How  many  people  have  diabetes?  

UK  Scope  

3.2m

UK  Epidemiology  

*  Approx  3.2  Million  individuals  within  the  UK1  *  Increasing  daily  by  ...  ?  *  400  newly  diagnosed  per  day  *  3  every  10  minutes2  

*  2025  estimated  4  million3  *  Disease  of  the  foot  in  diabetes  is  associated  with                          more  deaths  than  the  four  most  common  cancers  

 

6%

5.3%

6.7%

5.6%

•  10%  of    total  NHS  budget  •  £9  billion  per  year  =    •  £25  million  a  day  •  £1  million  every  hour6        •  £17,000  a  minute  •  One  in  five  of  all  CHD,  foot  &  renal  admissions6a    

Economics    

The  Common  Link?  

What  is  Diabetes?  

*  Diabetes  mellitus  is  a  clinical  syndrome  which  is  characterised  by  hyperglycaemia  due  to  absolute  or  relative  deficiency  of  insulin.    *  Type  1  and  Type  2  Diabetes  *  Lack  of  insulin  affects  the  body  and  can  have  a  systemic  impact  

* General  wellbeing  can  tackle  complications  of  diabetes  

 

Healthy  living  

Lifestyle  changes  

Diagnosis  Recommendation(WHO)  that  diagnosis  of  DM  be  based  on  two  fasting  plasma  glucose  levels  of:  

 *  2  fasting  plasma  glucose  levels  of:  *  7.0  mmol  per  L  or  higher  

Or    *  2  casual  glucose  readings  of  11.1  mmol  per  L  or  higher    *  Normal  4  mmol/l  –  6.1  *  After  eating  can  rise  to  8mmol/l      IF  YOU  ARE  UNSURE  VISIT  YOUR  GP  OR  PHARMACIST    

*  Symptoms  occur  because  some  or  all  of  the  glucose  stays  in  the  blood  and  it  isn’t  being  used  as  fuel  for  energy.  The  body  tries  to  reduce  blood  glucose  levels  by  flushing  the  excess  glucose  out  of  the  body  in  the  urine.  

 *  passing  urine  more  often  than  usual,  especially  at  night  *  increased  thirst  *  extreme  tiredness  *  unexplained  weight  loss  *  regular  episodes  of  thrush  or  fungal  infections  (foot)  *  slow  healing  of  cuts  and  wounds  *  blurred  vision  

What  is  Diabetes  &  Symptoms?  

*  In  Type  2  diabetes  the  signs  and  symptoms  may  not  be  so  obvious,  up  to  7  years    *  May  only  be  picked  up  in  a  routine  medical  check  up.    *  Symptoms  are  quickly  relieved  once  diabetes  is  treated  and  under  control.  Early  diagnosis  is  very  beneficial.    *  In  Type  1  diabetes  the  signs  and  symptoms  are  usually  very  obvious  and  develop  very  quickly,  typically  over  a  few  weeks.    *  4Ts  

What  is  Diabetes  

Current  Type  1  Campaign  

*  Usually  appears  in  people  over  40  years  of  age  *  South  Asian  people  often  appears  earlier  age  *  Increasing  common  in  children  &  adolescents  *  Accounts  for  85-‐95%  of  all  people  with  diabetes  *  Treated  with  healthy  diet,  increased  physical  activity,  frequently  medication  and/or  insulin  

What  is  Type  2  Diabetes?  

*  high  cholesterol  levels  *  blood  glucose  (sugar)  levels  *  blood  pressure  levels  *  the  feet  and  lower  legs  (through  damage  to  blood  vessels  

and/or  nerves)  *  Increased  risk  of  stroke  or  heart  attack  *  Absent  foot  pluses    *  Eye  disease  *  Kidney  disease  

Research  shows  that  by  adopting  a  healthy  lifestyle,  maintaining  good  glucose  levels,  appropriate  weight,  blood  

pressure  and  cholesterol  levels  can  reduce  the  risk  of  developing  these  problems.  

General  Problems  in  People  with  Diabetes  

The  effects  of  Insulin  

*  Insulin  inhibits  fat  lysis  (breakdown)  *  Increases  lipid  synthesis  (increased  cholesterol)  *  Promotes  narrowing  of  the  arteries  

What  happens  in  Type  2  diabetes?  

Blood glucose levels rise

Body responds by secreting insulin

High insulin levels in the blood

Tissues respond to insulin (glucose uptake/storage by fat/muscle cells)

Blood glucose levels fall

Body responds – insulin secretion reduced

Food intake or energy released from tissues

Nerve Tissue

*  Diabetes  can  cause  damage  to  blood  vessels,  leading  to  poor  circulation  in  the  feet  and  legs  (and  elsewhere).    *  It  can  also  cause  nerve  damage,  which  may  cause  pain  or  uncomfortable  tingling  but  may  also  lead  to  numbness  or  even  complete  loss  of  feeling  in  the  feet  and  legs.    

Foot  and  leg  complications  (problems)  in  people  with  diabetes  

Healthy  Feet:  What  you  need  to  know  

*  Wound  healing  takes  longer  *  Shoes  could  rub  and  cause  a  wound  *  Bony  swelling  or  deformity  *  Increased  risk  of  developing  an  infection  *  Loss  of  protective  sensation  to  the  feet  (neuropathy)  *  Reduced  blood  flow  to  the  lower  limb  *  Mobility  difficulties  can  affect  the  way  you  stand  or  walk  and  

even  routine  tasks  such  as  nail  cutting  *  Balance  can  be  impaired  =  increased  risk  of  falls    

Prevention  is  the  best  approach!!    If  problems  do  arise  deal  with  them  quickly,  they  are  less  likely  to  

become  severe.  

NICE  Clinical  Guidelines  for  Type  2  diabetes:  prevention  of  foot  

problems  •  Regular  (at  least  annual)  examination*  of  patients  feet  should  include:  *  Foot  sensation  using  either  10g  monofilament  or  calibrated  

tuning  fork  *  Palpation  of  foot  pulses  *  Inspection  for  any  deformity  *  Inspection  of  footwear  

•  *  Conducted  by  trained  personnel  (HCPC  registrant)    

   *  Neuropathy  (loss  of  sensation)  or  absent  pulses  +      deformity  or  skin  changes  or  previous  ulcer    

*  Neuropathy  (loss  of  sensation),  absent  pulses  or  other  risk  factor  

*  Normal  sensation  and  palpable    pulses  

Risk  Stratification  

Diabetes  UK  &  NICE  Guidelines  

Smoking  increases  your  risk    

*  http://www.nice.org.uk/guidance/cg10/resources/cg10-‐type-‐2-‐diabetes-‐footcare-‐information-‐for-‐the-‐public2  *  Diabetes  UK  http://www.diabetes.org.uk/  *  http://www.blandfordchiropody.co.uk/    

Helpful  Links  

Key  Guidelines  * 9  annual  “Care  Processes”  are  recommended  by  NICE  for  all  individuals  with  diabetes  

* Urinary  albumin      Eye  Screening  * Smoking  review    BMI  * Cholesterol        Blood  creatinine  * HbA1c        Blood  pressure  * Foot  Examination