Diabetes: Saving legs, saving lives
Many people with diabetes have multiple and complex health problems. Potential delays in treatment or a misdiagnosis can have serious consequences.
A major push for the new licensing regulations for GP's, introduced October 2009, (www.gmc-uk.org/doctors/licensing.asp) was to ensure Doctors keep up to date with training and awareness of the latest treatments for chronic conditions such as diabetes and asthma.
For diabetics, this is crucial because they are at significantly high risk of suffering serious and long term complications as a result of their condition. There are nearly 3 million diabetics in the UK and numbers are ever increasing. They are 24 times more likely than the general population to suffer an amputation as a result of the common long-term complication of peripheral artery disease. These figures translate into 100 diabetics every week having lower limbs amputated. Yet a recent audit presented at a conference this month for Britain's leading vascular surgeons found that 1 in 3 diabetics in hospital did not have their feet examined.
There seems to be a "lottery postcode" of provision, as in some areas of the country, well organised NHS multi disciplinary teams of specialists which include a podiatrist, dietician, diabetic physician and vascular surgeons carrying out regular and thorough reviews of diabetes patients and checking for peripheral artery disease. Research shows such teams can reduce the numbers suffering leg amputations by at least 50% in 3 years.
The statistics for Britain led the surgeons to label the nation's amputation rate as 'shameful' and 'scandalous'.
It is clear that there is a lack of "joined up" health care provision, which has led to the amputation rate being the highest in Europe.
What is diabetes?
Diabetes is a common life long condition when either: the pancreas does not produce insulin (Type1 diabetes) or not enough or insulin that doesn't work properly (Type2). Insulin is required to help the body accumulate glucose from the foods we eat for energy.
Type1 diabetes is treated by insulin injections. Type 1 diabetes is life threatening. The injections are vital in keeping the patient alive and must be taken everyday together with frequent and regular blood sugar level tests.
A healthy diet and exercise can also help patients keep their insulin levels balanced.
Type2 diabetes is treated with lifestyle changes for example a healthier diet, weight loss and increased physical activity. Tablets and or insulin may be required to achieve normal glucose levels.
Short term complications include;-
Hypoglycaemia (when the blood glucose levels fall too low and can result in unconsciousness).
Ketoacidosis (DKA) which happens because of a lack of glucose entering the cells where it can be used as energy. The body begins to use stores of fat as an alternative source of energy, and this in turn produces an acidic by-product known as ketones.
Ketones are very harmful and the body will immediately try to get rid of them by excreting them in urine. Consequently, when ketones are present and blood glucose levels are rising, people often become increasingly thirsty as the body tries to flush them out.
If the level of ketones in the body continues to rise, ketoacidosis develops (ketoacidosis means acidity of the blood, due to an excess of ketones in the body). Their harmful effect becomes more apparent, and nausea or vomiting may start. In addition, the skin may become dry, eyesight blurred and breathing deep and rapid. Eventually, if untreated, the level of ketones will continue to rise and, combined with high blood glucose levels, a coma will develop which can be fatal.
Hyperglycaemia, or Hyperosmolar Hyperglycaemic State (HHS) which occurs in people with Type 2 diabetes, who may be experiencing very high blood glucose levels (often over 40mmol/l). It can develop over a course of weeks through a combination of illness, dehydration and an inability to take normal diabetes medication due to the effect of illness. Symptoms can include frequent urination and great thirst, nausea, dry skin, disorientation and, in later stages, drowsiness and a gradual loss of consciousness.
It is a potentially life-threatening emergency
Long term complications are more serious and include heart disease and stroke, peripheral vascular disease, retinopathy (eye damage) and neuropathy.
Diabetes remains one of the biggest health challenges in the UK today.
We are still seeing a huge increase in the numbers of people diagnosed. In the last 15 years the numbers of people diagnosed with diabetes have risen from 1.4 million to 2.6 million which is 4% of the population. It is thought that many people could be suffering early onset Type2 diabetes without realising it.
What can be done?
The charity, Diabetes UK is campaigning for early identification of diabetic patients; to improve the gaps in services for diabetic patients, in particular podiatry: to improve the support required for self management and to improve, in particular the services for children. Type 1 diabetes is also known as juvenile diabetes (particularly in the USA) as it's onset, which is acute (the pancreas very suddenly fails) most often occurs in childhood.
Experts point out that unless services are better organised (and the health teams referred to are not expensive even in an age of potential cutbacks) then we will see more and more amputations in younger people because of the rates of obesity and diabetes are on the rise.
It is self evident that the loss of a limb is a devastating loss for the patient. Many experts are clear that in a lot of cases the loss could have been avoided. The increased cost to the NHS and the state in providing care to those with amputated limbs is huge compared to the modest cost of providing well trained, multidisciplinary teams of diabetic experts which would significantly reduce that risk.
Examples of compensation claims following loss of a limb
Thompsons recently acted for a client with long standing diabetes and known peripheral artery disease. Although the patient was seen regularly at a hospital Trust , due to a lack of training and a breakdown in communication, a foot ulcer was not treated adequately and there was a failure to refer the client at the appropriate time to vascular surgeons resulting in the loss if a limb. All the independent medical experts commissioned by Thompsons to report in this case were clear that this loss was avoidable had our client been appropriately treated at the correct time. Thompsons were able to secure a substantial sum in compensation for not only the pain and suffering and loss of mobility but for the additional care our client required and adaptations to the home needed to assist in activities of daily living.
We also recently acted for a 65 year old man who was a long standing diabetic, who suffered a below amputation of his left leg as a result of a failure to appropriately treat an infection which had developed in his left little toe There was a failure to prescribe an appropriate course of antibiotics and a failure to investigate his left lower leg circulation. The doctors also failed to administer insulin and to consider surgical debridement of the ulcer which had then developed.
As a result of the amputation, our client was unable to continue working as a Butcher and required considerable care and support from his wife. We obtained reports from experts in accommodation, prosthetics, occupational therapy, and care amongst others, to identify his ongoing needs and value the claim. The claim had been defended vigorously by the Hospital's solicitors, and was listed for a 5 day trial in July 2010. However, shortly after the meeting between the vascular surgery experts, the Hospital's solicitors agreed to attend a settlement meeting at which a favorable settlement was secured for our client.
If you wish to donate to Diabetes UK to assist their valuable research, campaigning and support for people with this chronic, lifelong condition, please go to their website www.diabetes.org.uk.
You can also find out more information about Type 1 diabetes and the search for a cure by logging on to the website of the charity, Juvenile Diabetes Research Foundation www.jdrf.org.uk
If you think that you have suffered damage by reason of a delay or misdiagnosis of diabetes or complications from diabetes please contact Thompsons Solicitors on 08000 224 224 or complete one of our online personal injury compensation claim forms.
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