Diabetes

Results from the body’s failure to produce insulin. Insulin is a hormone that controls the level of sugar in a person’s blood. Blood sugar levels rise too high because the body doesn’t produce enough insulin to control it.

Type 1 diabetes is a life long condition that can develop acutely over a short period of time. It is not related to a person’s age or weight. People with Type 1 diabetes need to have regular insulin injections to counteract the body’s failure to produce its own.

Results from the body becoming resistant to insulin. It is associated with being overweight. The insulin resistance causes blood sugar levels to rise which can result in symptoms including, lethargy, urinating more frequently, feeling thirsty and it can make wounds and cuts take longer to heal.

Type 2 diabetes is a lifelong condition, though it can be managed with medication and changes to diet and lifestyle.

If insulin in the body starts to run out, ketoacidosis can develop. Ketones are released into the body as the body breaks down fat for energy. Signs of ketoacidosis include needing to pee more than usual, feeling very thirsty, being sick, deep or fast breathing, confusion and passing out . You may notice that the person’s breath smells sweet, like pear drops.

Ketoacidosis is a medical emergency and if you have signs you need to be admitted to hospital. Failure to diagnose it can result in can result in death within a matter of hours.

Treatment will involve being given insulin into a vein as well as fluids and nutrients.

Diabetes is essentially a vascular disease, increased blood sugars causes narrowing and aging of the blood vessels and this can result in problems in the feet an eyes. Patients with diabetes can loose sensation in their skin and so not notice small cuts and wounds. The poor circulation in arteries cause the wounds to heal more slowly.

If a person with diabetes gets an infection in their foot it can quickly spread and become worse. About 10% of diabetic patients will develop a foot ulcer at some point and if not managed correctly, by doctor and patient, they can lead to gangrene and eventually amputations. If a problem is immediately life or limb threatening a patient should be admitted to hospital but most will be referred to a Diabetic Foot Clinic for specialist advice and care.  NICE Guidelines say that the referral should take place within one working day.

Charcot Arthropathy is a syndrome where diabetic patients with neuropath (loss of sensation) develop weak bones and the bones will change shape, fracture and dislocate. The syndrome is rarely seen by GPs in practice but the first signs are redness and swelling and some deformity in the foot and ankle.

If it’s caught early enough then the foot can be put in plaster case to stabilise it before it changes shape too much. If not, then it can the deformity can lead to increased pressure on the foot and cause ulcers to develop resulting in diabetic foot problems and possible amputations.