Diabetes: symptoms, diagnosis and the risk of amputation
Real Stories Clinical Negligence lawyer Marianne Walker considers how a friend’s diagnosis led to an increasing interest in the condition and explains legal cases where delays in treatment have led to devastating injuries.
Symptoms, diagnosis, and our lack of awareness
Diabetes can be such an insidious condition and the symptoms can creep up slowly. Current thinking estimates that 1 in 2 people living with diabetes are undiagnosed and most of these cases are type 2 diabetes.
Two of my close friends from university were diagnosed with delayed onset type 1 diabetes not long into their twenties, within about six months of each other. It all felt rather bizarre and unreal at the time, a consequence of our youthful ignorance of the condition was that we simply could not understand how either one of them had developed it.
"They were young, healthy, and active; their diagnosis flew in the face of our preconceptions of the condition."
One friend was travelling through Australia when he noticed the first symptoms of extreme thirst, frequent urination and weight loss. Finally, unexplained and slow healing wounds sent him to the doctor and a diagnosis. On return to us in London he would make his condition as palatable as possible and instigated a game on nights out where we would place bets (“high or low”) on his blood sugar level before he would take a test, pronounce the winner, and inject accordingly.
Levity aside, he certainly takes his condition seriously. He has become a veritable textbook on the condition and manages it very carefully. Consequently, he has suffered no episodes of hypoglycaemia or hyperglycaemia and has managed to avoid hospitalisation with the condition.
One thing that was clear from my friends’ experience was how little we as a friendship group knew about Diabetes having never been effected by it before. When I consider this, it does not surprise me that people could be living with the condition without a diagnosis or access to proper treatment.
Diabetic foot problems
As a Clinical Negligence Solicitor, I now have a much greater understanding of diabetes and the devastating impact of this condition through my contact with the experiences of some of my clients.
"...specialists including Podiatrists, Vascular Surgeons, Orthopaedic Surgeons, Microbiologists and Diabetic Nurses."
The most severe injuries suffered by my clients have arisen as a result of diabetic peripheral neuropathy. This is where damage is caused to the nerves and leads to numbness and a loss of sensation in extremities, most commonly the feet. This lack of sensation can lead to injuries and the development of blisters and ulcers.
The National Institute for Health and Care Excellence (NICE) Guidance to medical professionals recommends patients with diabetic foot problems have access to a multidisciplinary foot care service with specialists including Podiatrists, Vascular Surgeons, Orthopaedic Surgeons, Microbiologists and Diabetic Nurses. Prevention and early intervention are key and the NICE guidance prioritises swift assessment of problems such as ulceration and infection and immediate referral to acute services.
The issue with delay
I have represented clients who have suffered injury in circumstances where a quick referral has not taken place or the extent of the issue has not been appreciated and managed correctly, with devastating results.
"From a blister on the foot... to a bone infection... to a below-the-knee amputation."
In one of my cases my client developed a blister on the heel of his foot. He was assessed by his GP and they attempted to manage the wound at home with District Nurses attending to regularly dress the wound to encourage healing. He developed a bone infection. By the time he was referred and his condition assessed his treating doctors strongly recommended below the knee amputation to control the bone infection which was not responding to IV antibiotics.
An earlier referral and swifter treatment would likely have avoided this outcome. This client was unsuitable for a prosthetic leg and needed adjustments to his house to fit a wheelchair. The impact on him was massive and touched on all of the areas of his life.
"From a stubbed toe... to cellulitis... to a half-foot amputation."
Another client stubbed his big toe and developed a wound. He was referred on a non-urgent basis for Podiatric assessment. While waiting for an appointment he became very unwell with an infection in the wound and went to accident and emergency where he was admitted with cellulitis. The wound was debrided and microbiology identified the strain of pathogen causing the infection but by the time appropriate antibiotics were administered they could not bring the infection under control. This client underwent a half foot amputation, and later when the infection re-emerged a below knee amputation.
These life-changing complications of diabetic foot problems are not as rare as one would hope, and this likely goes some way to explain the NICE Guidance insistence on detecting at risk patients early and referring issues immediately to an experienced and multidisciplinary team for management.
World Diabetes Day
This World Diabetes Day we can all do a little to educate ourselves on this condition which affects more and more people every year.
Knowing the most common symptoms of undiagnosed diabetes can help:
- Going to the toilet a lot, especially at night
- Being really thirsty
- Feeling more tired than usual
- Losing weight without trying to
- Genital itching or thrush
- Cuts and wounds take longer to heal
- Blurred vision
As always, it’s best to talk to a medical professional, and particularly your GP if you have any specific concerns. They can not only test for the condition if you are worried but can also provide advice about reducing your individual lifestyle risks.