It's your health - get checked
Management and monitoring are the magic words when it comes to reducing long-term complications in diabetes, but many people with diabetes are not attending routine checks. Why aren't they, and why should they?
Last year, just 39% of people with Type 1 received all eight annual health checks designed to avoid problems such as foot ulcers and heart disease, the National Diabetes Audit found.
Dr Partha Kar, Associate National Clinical Director for Diabetes and Reach clinical editor, said the only way to increase uptake was to put the person with diabetes at the centre.
"It is easy to sit behind a desk as a healthcare professional and say 'why can't you have your feet checked?' rather than 'what is stopping you – do you need help?'."
New guidance on managing Type 1 diabetes (NG17, July 2016), from the National Institute for Clinical Excellence (NICE) aims to do just that, and advises healthcare professionals to help people self-manage.
"Everyone needs access to support and information, so that their condition can be managed successfully," said Sir Andrew Dillon, NICE Chief Executive, adding that standards of diabetes care varied across the NHS.
Mike Kendall, who has lived with Type 1 for more than 25 years, helped develop the guidance. It includes a version specifically for people with diabetes with a list of questions to ask healthcare teams.
"It acknowledges how infuriatingly fickle Type 1 can be and how important it is for people to be empowered in their own self-management," he said.
All adults with Type 1 should be offered a structured education programme, such as DAFNE, within 12 months of diagnosis, and be supported to aim for a target HbA1c level of 48 mmol/mol (6.5%) or lower, NICE recommends.
"Life gets in the way"
Busy lives and a lack of engagement can get in the way of checks and reviews.
"The eight healthcare check ups are a fairly big commitment. People feel they have too much to juggle, or can simply forget," said Reach editorial advisor Kristy Haywood, pointing out that most people under 40 worked or studied full time. Kristy, a mental health nurse student, was diagnosed aged nine, and admits to missing scheduled appointments in the past.
"I always felt guilty for my blood sugar levels being unstable. I was worried they would think I was not taking my diabetes seriously if I were to 'sneak' a chocolate or piece of cake."
Kristy said GPs and hospitals should embrace social media to send out reminders and engage people in their own care.
Best foot forwards
Around 10% of people with diabetes will develop a diabetic foot ulcer, yet a quarter of those with Type 1 missed their annual foot check in 2015.
Small injuries such as cuts can go unnoticed because nerve damage (diabetic neuropathy) means the person with the injury doesn't feel the pain that would otherwise prompt them to take action. Put simply, an ulcer is damage to the skin and underlying tissue of the foot which, if left untreated, can develop into open sores and become infected.
“Diabetic foot problems are serious and can lead to amputations,” said Rachel Berrington, a Diabetes Specialist Nurse who has been working on new NICE guidelines on foot care.
“Mortality rates are high, with up to 70% of people dying within five years of an amputation." Having foot checks is simple and painless and helps you prevent problems before they start.
What happens at a foot check
Sharon Steele, diabetes lead podiatrist, Solent NHS, explains…
"You may be unaware of early nerve damage and poor blood flow to the feet, so it's important to attend regular foot screening."
"It involves removing shoes and socks to allow for full examination, during which your healthcare professional will look for breaks in the skin or signs of infection, as well as any callus and deformity."
"The sensitivity of nerves is tested using a plastic filament and blood flow is assessed using the fingertips. This is quick and painless and should be done every year".
"Shoes should be checked for appropriateness and support, and you can ask where to seek treatment should you notice a problem. Ask your level of risk (low, moderate, high risk or active foot problem/ulceration) so you can take appropriate steps to reduce your chances of developing foot complications."
Top tips for healthy feet
- Have your annual foot check
- If you are at increased risk, ask to be referred to a foot protection service or specialist podiatrist
- Moisturise your feet and check for redness, pain, build-up of hard skin or changes in their shape everyday
- Look after your toenails
- Do not use corn-removing plasters or blades
- Wear well-fitting shoes
- Avoid stockings or socks with elastic tops and never wear socks with darned areas or holes
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