Are You A Diabetes Timebomb?

(News Today) - The consultant was an expert in his field, with the air of a man who knew what he was doing.

So when Robert Carew-Hunt was told his grossly swollen legs were a sign of lymphedema - a build up of fluid caused by damage to the lymph system, he accepted the diagnosis and was discharged from hospital with a packet of support stockings to reduce the swelling.

Unfortunately, the specialist was wrong. The swelling was, in fact, a sign of undiagnosed diabetes. and although Robert went on to display other, classic symptoms - such as an ulcer on his big toe that wouldn't heal - a succession of clinicians missed the signs, so that by the time his diabetes was finally diagnosed eight months later, Robert had suffered serious tissue damage.

He has since had two toes amputated on his right foot and has charcot foot in his left - an excruciatingly painful degenerative bone condition caused by high blood-sugar levels damaging blood supply and tissues. It ultimately leads to chronic deformity.

'It has been a long road to be able to walk at all since losing my toes, and I'm still in a lot of pain,' he says.

'I'm not a vengeful person by nature. But I'm frustrated and angry that I was seen by so many medics and yet for months not one suspected diabetes.'

His condition meant that Robert, then in his early 50s, had to take early retirement from his job in the civil service.

This is by no means an isolated case - indeed misdiagnosis and misunderstanding about the signs and risk factors for diabetes mean more people than ever are undergoing amputation.

And the fear is that the numbers are only going to rise, with an estimated one million Britons living with undiagnosed type 2 diabetes, according to a new report just published by the charity Diabetes UK.

This is twice as many as previously thought, and is largely due to obesity and unhealthy lifestyles.

Type 2 diabetes is caused by the body's inability to produce enough of the hormone insulin - or the insulin that is produced is not working properly (known as 'insulin resistance').

This is because abdominal fat is thought to release a protein which prevents insulin from mopping up excess sugar in the blood.

Unlike type 1 diabetes, type 2 can go undetected for up to a decade or longer as symptoms can be gradual - in around half of cases diagnosed, patients are already showing signs of the complications of the condition, such as nerve pain and sight problems, without having any obvious symptoms of the condition itself (such as excess thirst or passing more urine than normal).

Every week in the UK around 100 diabetes patients have a limb amputated because of complications. The problem is that untreated or poorly managed diabetes damages the nerves in the feet - a side-effect known as diabetic neuropathy.

This reduces sensation, so patients are unaware if they cut or damage their foot. and because diabetes also affects blood flow to the extremities (high sugar levels damage small blood vessels), it's harder for sores and wounds to heal. left untreated, within just weeks even a minor foot injury such as a blister can quickly become a serious infection - leading to tissue death (gangrene).

As well as amputation, diabetics are at higher risk of heart disease, stroke, kidney failure, and blindness.

Given the risks, why are so many people going undiagnosed? Part of the problem is that medics sometimes simply overlook the obvious, says Dr Brian Karet, a GP specialising in diabetes and an advisor to Diabetes UK.

'It's a statistical fact that overweight people seem to come to the doctor for one reason or another - coughs, colds, infections - far more frequently. Being overweight can lead to diabetes and doctors should seize on the opportunity to offer these patients a blood glucose test.

'As well as asking these patients about the classic symptoms, they need to question them about subtle signs such as recurrent thrush, poor concentration and lack of libido.

'Doctors and nurses need to be tuned into these symptoms and question patients - but some are not: there simply isn't enough awareness.'

As a result, patients are left to develop unnecessary but life-altering complications.

It seems likely that Robert Carew-Hunt, who lives in Wimbledon, first developed type 2 diabetes three years before his legs started swelling when he began to often feel faint and thirsty. At 6ft 5in and weighing 18 stone he wasn't excessively overweight, though he had a sweet tooth.

'Being a typical man I didn't bother going to the doctor - and diabetes certainly didn't cross my mind.' he says. 'I never ate breakfast and I remember nearly fainting one morning on the way to work - though I felt better after eating something. I was downing endless fizzy drinks but they never seemed to quench my thirst.'

Thirst is a classic symptom of the condition as the excess sugar in the blood leaks into the urine and the kidneys have to work harder, causing dehydration.

'I became aware of a loss of sensation in my feet - just a sort of numbness, but nothing drastic. I thought it was one of those things, possibly from having a sedentary job.' About two years later he was admitted to hospital when his legs suddenly swelled considerably - 'which was uncomfortable and a little alarming', he recalls.

'I was taken first to the fracture clinic and then my X-ray was passed to the specialist who diagnosed lymphoedema.' The correct diagnosis was made a year later after Robert developed the ulcer on his right big toe which wouldn't heal and became increasingly infected.

He saw a succession of nurses at his local health centre as they dressed the wound. But it wasn't until three months later that one, concerned by how long the ulcer was taking to heal, tested his blood glucose levels.

In healthy people the reading is around four to eight; Robert's was 27 - dangerously high.

'I was staggered since I knew nothing about diabetes,' says Robert. 'I immediately saw my GP, who put me on a regimen of healthy eating - no sugar and limited carbohydrate.'

He was also referred to the local hospital diabetes clinic. When the doctors saw his toe, they told Robert the damage was so extensive, it would have to be amputated.

'All I could think of was, would I be able to walk again,' he says. 'although they reassured me I would, they then said my diabetes had started to damage other tissues, and a few months later I lost another toe on the same foot.'

Diabetes UK estimates that up to 85 per cent of all diabetic amputations could be prevented by keeping blood glucose levels under control.

But it's not simply that medics are not spotting the signs. Sometimes there are no signs, as Gail Wellings discovered, when she fell on a kerb, cutting the big toe on her right foot.

Although she wasn't in pain, the toe became increasingly red and the cut failed to heel.

After three weeks, she decided to see her doctor. 'I'll never forget the expression on his face,' says Gail. 'He took one look at my toe and said: "Oh no, Gail, you are going to lose your foot." I couldn't believe it.'

Gail, a secretary from High Wycombe, Bucks, was sent to A&E where, after a day of blood tests and X-rays, she was a told that even though it was just her toe that had been injured, she had no circulation in her lower leg and before long those tissues would become gangrenous, too.

There was no real choice but for her to have a below- knee amputation.

'It was a nightmare,' she says. 'One moment it was my foot. Now it was my lower leg. I was absolutely stunned because everything happened so quickly.

'I kept thinking, my life is over, I won't be able to play tennis, to run, to get around. But what amazed me was that when I came round from the operation I was told the cause was Type 2 diabetes.'

What so perplexed her was that she'd had no other symptoms. 'But now, with the benefit of hindsight I can see why I might have been a candidate for the condition,' she says. 'I was 56 at the time [the risks increase with age] and 2st overweight. Doctors guessed I'd been diabetic for around four or five years, which is why the damage was so great. It was the most horrible, horrible time of my life.'

Gail was discharged from hospital-after eight days and now has a prosthetic lower leg. She spent a year on insulin injections until her blood sugar was stable enough to be controlled through diet and medication.

Her shocking story highlights the need for doctors and patients to know the risk factors as well as the symptoms, says Dr Brian Karet. These include being overweight or having a large waist measurement (more than 31.5in for women and 37in for men). Being over 40 is another risk factor.

Meanwhile, Diabetes UK wants better access to diabetes specialist care. As Cathy Moulton of the charity explains: ' Specialist nurses play a vital role in diabetes care and management and unfortunately, this kind of care is patchy in the UK.

'NHS providers must prioritise the delivery of effective and efficient integrated care, where competent primary and specialist teams can work together to support people with diabetes to self-manage their condition.

'Diabetes is one of the biggest health challenges facing the UK today and it is getting bigger.'

And Gail says: 'I wouldn't want anyone to go through what I've been through. Early action and awareness are critical.'

Robert Carew- Hunt adds: 'Doctors need to consider not only the obvious, but also the subtle side-effects.

'I suppose that I lost "only" two toes, though I have terrible pain from the bone deformity in my other leg. I had diabetes for over two years before it was diagnosed and I've no idea what those lost years could yet do in terms of other potential complications.

'It's just not necessary for anyone else to go through this.'

Source : kompas

Posted in: