How do we convince our patients of their risks from poorly controlled type 2 diabetes?
Earlier this week, it was announced by Diabetes UK that now 20 people/day in the UK have some kind of lower limb amputation as a result of diabetes. How should we try to get this message across to our patients, many of whom say they feel fine, and just don’t seem to understand how serious the issues are?
Sadly, but not surprisingly, a man who I had been working with to try and improve diabetes control following a partial foot amputation 15 months ago, died recently. The first amputation wound eventually healed, albeit very slowly due to his poor control, but then another infection developed in his other foot, and quickly got out of control. He was admitted with sepsis originating from this foot infection, and died as a result of this, as his general health meant he was not fit for further surgery.
I’m sure many of you have patients you have known to whom similar things may have happened, it may not necessarily be amputations, but dying from a heart attack or being crippled by a stroke. How can we prevent all this from happening? It is so hard to understand what is going inside the body as a result of blood sugars being too high, people don’t feel any different, they can’t see anything going on and before they know it, their life is rapidly going downhill.
We must make it a priority to inform our patients about what is happening, and educate them about diabetes at every possible opportunity. When they come in for a review and a blood test shows things are not going well, we have a duty of care to try and convey to them what is happening and what they might try to do.
At the end of the day, we cannot be responsible for what happens to every one of our patients, because after all each of us has freedom of choice, and none of us make all the right decisions all the time, do we? If we were not constantly under time pressures, we might have greater opportunities to spend time explaining things better. Some people refuse to take on board what they are being told, and wrongly assume that as healthcare professionals, we have a medication that will rectifiy the problem, whatever it is.
I have a patient who fits this picture, and his hba1c is 13.6% or 125 mmol/mol; he is on multiple oral medications for his diabetes and twice daily novomix insulin, which he expects the district nurses to administer or prepare for him. His total cholesterol is 10.8mmol/l and his triglycerides are 22mmol/l. He has experienced four heart attacks so far and is only 61 years of age. He refuses to come to the surgery, always expecting healthcare staff to come to him, because he says he can’t leave his disabled wife. How can we prevent a further heart attack or other complication?
When I recently went to visit him at home in support of my district nurse colleagues, I discovered that he keeps very little food in the house, the fridge only contained yoghurts and milk and there was no evidence of fresh fruit or vegetables anywhere. He can often be spotted in the early evening going to get a takeaway, although he is apparently unable to get to the surgery. What is the answer, certainly not the ever-decreasing resources we have in the NHS?
Please let me know your experiences, and anything that works in getting the seriousness of diabetes across to those who need to know?