Thursday, 26 November 2015

Walk Your Diabetic Feet To The Pathway of Good Foot Care

Our guest speaker at our November diabetes get-together in Co. Clare is a podiatrist from the local health centre (Thank you, Doireann). And I know that most people with diabetes know the basics of taking care of your feet, especially if you have been around diabetes for a couple of decades.

The reason I decided to post about our meeting is that the pathway to podiatry has changed a little in recent years and that is worth sharing this information (IMO).

But I have included an article which, coincidently, was published online this week, and contains some of the basics to lead up to the local information.

So, why do healthcare professionals stress the importance of good foot care?

“In almost all high-income countries, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation.” (from International Diabetes Federation). But a simple annual foot check can prevent or reduce your risk of developing serious problems with your feet.

“People with diabetes have special reason to take good care of their feet. High blood glucose levels may make feet susceptible to injury and infection. This is because the protective sensation in the toes or feet – your “pain alarm system” ­may slowly disappear with long term high blood glucose levels.” (from Diabetes Ireland)

The Foot "Issues".

The two feet problems that podiatrists (and people with diabetes) are on the lookout for are;

Nerve Damage

Nerve damage can cause you to lose feeling in your feet. You may not feel pain, heat, or cold in your legs and feet. You may not feel a pebble inside your sock that is causing a sore. You may not feel a blister caused by poorly fitting shoes.

Sores on your feet can become infected. If your blood glucose is high, the extra glucose feeds the infection in those sores and the infection gets worse. Nerve damage can also cause pain and lead to foot deformities, or changes in the muscles, bones, and shape of your feet.

Poor Blood Flow

Poor blood flow means not enough blood flows to your legs and feet through your blood vessels. Poor blood flow makes it hard for a sore or an infection to heal. This problem is called peripheral artery disease, also called PAD.

Sometimes, a bad infection never heals. The infection might cause gangrene. If you have gangrene, the skin and tissue around the sore die. The area becomes black and smelly.

Too much glucose in your blood from diabetes can cause nerve damage and poor blood flow, which can lead to serious foot problems.” (from the American National Institute of Diabetes and Digestive and Kidney Diseases)

Everybody with diabetes in Ireland should have a foot check by a podiatrist, children included, every year.

I know that some doctors and consultants might perform a brief foot check at your clinic appointment but our podiatrist (and lots of other reputable websites) state that if your foot check does not include a test using a tuning fork and a Monofilament tool.
Monofilament Tool

At your annual foot exam your healthcare professional will;

  • Look at your feet for signs of problems, especially if you have nerve damage
  • Test the sense of feeling in your feet using a Monofilament tool.
  • Test how well blood is flowing to your legs and feet
  • Show you how to care for your feet

How do access Diabetic Foot Care?

Referrals to your local podiatry service for people with diabetes are available from your GP, Public Health Nurse, Community Nurse, or Diabetes Clinic.

In Co. Clare, you can avail of a self referral form which is available at the Health Centre on Bindon Street in Ennis. It’s not available online. And we believe that this option is only available in Co. Clare.

Your very first foot screening with your podiatrist will assess you and place your feet in one of three categories; Low, Moderate or High risk.

If you are low risk, you may be referred back to your GP’s surgery for your annual foot exam. If this is the case then it will be your responsibility to schedule this. If you are referred to your GP, it’s really important that you keep a record of when your last foot check was and when to schedule your next one.

If you are Moderate or high risk of diabetes foot disease then you will probably continue to be seen in the Diabetic Foot Clinic, where they will send out your appointment to you in the post.

However, there are instances where the clinics fall behind in their appointments and it would be wise if you kept a record of when your last foot exam was and when your next one should be.

You can find more information from the HSE's Model of Care for the Diabetic Foot document, which was revised in October 2014.

Thursday, 19 November 2015

Explaining Type 1 Diabetes to Non Diabetics

I spend a lot of my time "hanging" and communicating with other people with diabetes. I realise that I'm very lucky to have that when I have come across so many people who have never met anyone else with diabetes.

So, when I find myself in a situation where I have to explain type 1 diabetes to someone who is not a member of that community, I actually find it extremely difficult. Even when I know it's coming!

Two such encounters have prompted me to try harder in this and I sat down to considered the following;
- when I want to share my diabetes story where is the best place to start (without turning it into a rambling, never-ending tale)?
- And, how do I connect with people who have no connection to diabetes? How do I explain it so that they ask me good questions?

Here is what I came up with! And I did decide to try to keep it simple and specific to my diabetes, which means I know a lot of you will have lots more to add to it. But this is my starting point.

What is type 1 diabetes?

Type 1 diabetes happened to me when my body, for no apparent reason, decided to destroy the part of me that makes insulin.

What the heck is insulin?

Everybody needs insulin to be able to turn the food they eat, namely carbohydrates, into energy. If I don't have insulin, I will die of malnutrition, even though I eat.

Type 1 diabetes is kindof like an allergy to carbohydrate. I cannot eat carbs without taking insulin. And if I don't take insulin, what the carbs become once I have digested them, the sugar/glucose builds up in my blood and starts to do bad things to my organs.

What if, every time you ate any of these foods you had
stick a needle into yourself?

If I just didn't eat carbohydrate would that not make life easier?

A person without diabetes might respond to this with "What if you just didn't eat carbohydrate would that not make life easier?"

Not really, our liver, also, releases glucose and we can't turn that into fuel either. So, we actually have to take insulin to deal with that sugar/glucose that is being continuously released in the background.

So either way, we need to inject/infuse insulin or we die.

What if you just measure how many carbs you are eating against how much insulin you are taking?

One of the ways people manage their with type 1 diabetes is to measure how much insulin they take and measure how much carbohydrate they eat.

This is where I know I am going to lose you.

Type 1 diabetes is more complex than that. There are other factors that influence blood sugar/glucose (BS). Sure;
  • Food brings BS up, but all foods raise BS differently. 
  • Insulin brings it down.
  • ANY physical activity has the potential to bring it up or down.

But there are things that influence BS that are not easy to measure.
  • Hormones such as adrenaline, the stress hormone cortisol, menstrual hormones can raise or lower your BS. 
  • Illness raises BS.

These are just a few, here's a list of 22 other factors that commonly influence BS.

Living with type 1 diabetes is tracking all of this and more. It's exhausting!

So all I need now is a guinea pig volunteer to try it out on? Oh and here's some more helpful tips to help explain type 1 diabetes to people.

Thursday, 12 November 2015

The HbA1c and how does it fit into Diabetes Management.

Our HbA1c is just one piece of information in the picture of our diabetes management.

It is really important to our healthcare providers because that's how they measure how well THEY are doing in keeping people with diabetes healthy. It's a global measurement and so they can use it to compare their service to services in other countries.

For us, the individual with diabetes, it really doesn't have that much value. You might feel differently but for me, it's just another number, one of many that I use to manage my type 1 diabetes.

I have had a good HbA1c for a number of years now. But there was a period of time a couple of years ago when I had an excellent HbA1c of 48 mmol/mol (6.5% NGSP unit). However, both myself and my endo were confused because my blood glucose readings told a very different story. They were ALL OVER THE SHOP!!! Not one of my BG readings was within any of my targets!

They were so bad that while my meter was counting down from 5, I would close my eyes tight, cross my fingers and hope for a single digit, as in less than 10

We figured out that I was having more than the occasional hypo during the night and not waking up (Flipping scary). These lows were offsetting the highs during the day, making my HbA1c appear excellent.

These days, I look up my average blood glucose reading over 30 and 90 days on my meter. Plus, I look at my "standard deviation". The Standard Deviation SD is a measure of how spread out my numbers are and it's measured in a percentage. 

"Say your average blood glucose reading is made up from a 13.9mmol (250mg/dl) and a 2.8mmol (50mg/dl) giving you an average of 8.3mmol (150mg/dl). The 8.3mmol (150mg/dl) average is not bad, but the 2.8mmol (50mg/dl) is too low and the 13.9mmol (250mg/dl) is too high. So if you only look at the average, you might think you are doing well, when in fact you are not doing so well.Source; Diabetes Daily

The SD from the example above is +/-7 which is quite a spread.

Ultimately, I want to smooth out the peaks and troughs of my blood sugars and that's why I would like my average blood glucose reading to be between 8 and 9 mmols and my standard deviation to be a small as possible.

I was always tempted to brag a little about having reasonable HbA1c results. But once I learned about SD it removed all temptation.

Thursday, 5 November 2015

Diabetes Interruptus

Let me count the ways that diabetes interrupt my life.

Wednesday evening I attended a business women's network event. I know I eventually have to leave my career of stay at home mother because, well, they grow up, don't they! So I'm trying to get my head around the fact that I NEED to go back to work in the next year or two!!!

Anyway, half way through this event we had a much valued break where we could, you know, network. We had moved around the room and I had left my bag at another table. Once I assessed that the finger food was worthy of insulin and filled my plate, a very nice lady started a conversation as I was filling my cup with tea. I had to excuse myself to return to my bag because I needed to test my blood sugars and work out a SWAG (Scientific, Wild Assed Guess Bolus).

When I'd finished she was surrounded by 4 others ladies, clearly, she was a person that I would have liked the opportunity to talk to. But the opportunity was lost because of my diabetes.

Thursday evening, I over estimated my carb count at dinner and about one hour after dinner I began to descend into a low when my phone rang. I didn't recognise the number but I still had a hard time deciding that I should not answer it and deal with my hypo instead.

Turns out it was the Mum of one of my children's new friends wanting to arrange a play date. I didn't get to call her back for a couple of days.

I try to make sure that diabetes doesn't interrupt our family life or my life by planning ahead as much as possible.

But sometimes, it just doesn't work.