Hi, In UK at present there has been much news regarding the failure of our health service to identify and treat diabetic foot problems leading to amputation. As far as am aware there are no stats as to chances of having an amputation wherever in body it maybe. Have learned two things that in 30 yrs as type 1 have never been told. Possible poor health care or maybe i was told but didnt want to hear. Either way was a big shock with 2 very young daughters. One was to expect a 20 year reduced lifespan (written by chairwoman of UK diabetes who has confirmed this is correct?? other being high risk of amputations. Can anyone shed any light or even better facts on what is correct and whether i better not risk buying green bananas in supermarket today. Many thanks, Chris
According to the most current research the life expectancy of a type 1 diabetics is just 4 years shorter than that of the general population. This knowledge is derived from the studies of Dr. Rachel G. Miller. He analysed the data of hundreds of type 1 diabetics. He then compared the group diagnosed 1950 to 1964 with the group diagnosed 1965 to 1980. His finding was that the life expectancy of those diagnosed after 1964 was in the mean 15 years higher and climbed to 69 years. By interpolation it was concluded that today it is just 4 years shorter - if you are not attacked by a green banana of course.
Here's a link from the BBC concerning amputation in the UK.
According to a United States Centers for Disease Control press release the rate of leg and foot amputations among U.S. adults aged 40 and older with diagnosed diabetes declined by 65 percent between 1996 and 2008. In 2008 the rate of nontraumatic lower–limb amputations was 3.9 per 1,000 people with diagnosed diabetes.
PREVENTION is the key. PREVENTION is by knowing exactly how many grams you're eating and how many units of insulin keep your blood sugar under 140 even after eating green bananas.
Bananas, one 30 grams of mouth watering carbs, send me to 295 mgdL/16.5 mmol. I've had to reduce my carbs so I can use insulin to keep me running in the 90-110 range. Insulin simply doesn't "cover" carbs that spike. And spiking is a precursor of problems.
That being the way to PREVENT problems, my lifespan will probably be the same as my long-lived ancestors, and it will be free from complications.
Yes, 30 years ago, we believed diabetic persons had reduced lifespans. I taught it. TODAY, we know that those who count carbs, know their insulin to carb gram ratios and follow them, and who refuse to eat those carbs that spike, get by without complications. This is simplistic, but you get what I mean. We can all work to update doctors who also need to learn about details of keeping blood sugars in the normal range.
Glycemic control is part of the equation to avoiding complications leading to amputation, but only ONE PART. Proper foot hygiene techniques must be practiced and daily foot inspections are a MUST.
- Inspect feet daily. Inspect for cuts, blisters, hot spots and condition of skin, nail beds and nails.
- Never, ever. not once walk anywhere barefoot.
- Never wear sandals or open toed shoes.
- Only wear properly fitting shoes and inspect for foreign objects before putting them on.
- Always wear clean, dry socks.
- Check to be sure shower or bath water is not too hot with your hand before getting in.
- Check for objects you could accidentally step on.
- Never wear the same pair of shoes or socks two days in a row.
- If shoes or socks get wet, change as soon as possible.
- If you cannot arrange to have a podiatrist trim your nails, have one instruct you how to do it properly.
- Never use foot care products with label warnings that state they are not suitable for diabetics
I call that good educational background, LOL
Someone on these threads recently posted that Dr. Bernstein recommended rubbing mink oil into your feet, especially if they're prone to be dry (cracked) or have rough patches. There are other highly-emolient natural oils that might work well for vegans and vegetarians, such as jojoba. Even just massaging in food-grade almond oil and slipping on a cotton sock until the oil is absorbed is helpful. Just make sure you keep dry between the toes and under the toes at all times, to avoid any cracking or skin compromise from fungal infections. I use clean paper towels after my shower to "floss" gently between and under each toe to ensure that that area is completely dry before I put on my socks and shoes. At the end of the day, I change my socks and put my shoes in front of a small fan to ensure that they dry out completely. I used to have terrible problems with athletes foot and cracked heels, but not any more.
The medical profession is failing diabetics. That's the bottom line. I'll bet you that one diabetic in 10,000 is getting appropriate and necessary care from their medical team. The rest of us either take on the task of learning how to be The Diabetes Expert in our own lives, or else we'll suffer the consequences! The medical profession today just isn't set up to provide the level of care, education and support that diabetics really need, especially in the critical years right after diagnosis.
I can't count how many T2's I have met or heard about through friends/family who are walking around every day in the 300's, 350's, 400's and have NO idea of what to do about it. I've probably invested about two hours (minimum) per day learning about diabetes over the past two years. I've spent maybe a total of four hours (maximum) in the presence of one of my doctors talking about diabetes during the same two year period. That's 730++ hours vs. 4 hours.
Where is all my education/support coming from? From people like YOU, Alan, and all my TuD heroes, from books, from on-line resources like PubMed and Diabetes 101. Without YOU and the on-line diabetes community, I'd be walking around with a double-digit A1C, too, and I'd have no idea what to do about it, either. I'd be told to "eat more carbs" and I'd be checking my glucose maybe five times per week and seeing my doctor for a ten minute drive-by visit and labs four times per year and...it doesn't bear thinking of where I'd be with complications. It's sickening to even consider it.
A time tested solution for drying out wet or damp shoes is to wad up some newspaper and stuff them inside. It absorbs the moisture and helps them to retain their shape as they dry. Another good idea is to keep leather soft and supple with a periodic application of saddle soap on the outside. It cleans well and helps to keep the leather soft.
Over the last few years the responsibility for diabetes here has gone back and forth between the GP and the diabetes clinic. Over this time the foot checks that used to happen just stopped.
The UK NHS leaves a lot to be desired. There’s no point having lots of well meaning nurses etc and supposed free care if the care you get is no good and you get left on your own. For the money the NHS costs, I find the diabetes care to be poor.
I definitely think theres been a failing here with the NHS rather than the usual bashing of people for not completley managing their complex health issues themselves along with their job and family life.
I think too that a lot of people don't take foot injuries seriously enough? The first time I ran > 30 miles in a week (had week off, cleared decks, decided to see how it went...) it went well but it was December and 1) I was wearing shoes that were perhaps a wee bit small and 2) was wearing 2 pairs of socks. My toenail turned black and I freaked out and went to the doctor, just in case and, sure enough, there was pink around the outside and she said "that could be cellulitis" and said something to the effect that "ANY time anything like this happens, get it checked out..." because when that stuff goes south I think it increases the potential for an infection that can become more serious than you think quickly.
I also had a wierd ankle sprain, like in the middle of my ankle (hit lane bowling and slipped out, doing splits w/ bowling ball, felt *pop* in front center of ankle...) and the doc said "if it's broken in there, and you have problems healing, it could lead to bone death and being in a wheelchair". Perhaps she was a bit carried away but the CT was negative and it was just a sprain.
I think that people get so used to endos being remote or inaccessable, except through "staff" that they don't think "oh, a ____ on my foot could be an emergency and they'd get me in" but both times, I said "I have diabetes and [a wierd foot injury] and the docs got me in right away and praised me for having gotten them checked out. My doc always checks my feet but I think that it's these "minor traumas" that aren't taken seriously enough by people that may cause a lot of these situations.
That's true! I think the hazard for PWD are exponentially higher, although I'm not totally a math person?
It's a dangerous prospect indeed. One not too many people want to talk about. It's important we stay as healthy as we can...but with so many diabetics out there, and with that number rising on a global basis, it's hard for everyone to avoid these problems. That is why we really need to continue the fight for the cure, in my opinion.
well, it could be a SMALL exponent or a slow-ridin' algorithim but yeah, if we want to be precise, it's a hellofalot more risky!
Hi, Many thanks to all who responded. In UK yes healthcare is free but quality generally poor despite the politicians trying to tell us how lucky we are to have it. I much prefer American system and would be happy to pay for quality care. Latest reports in UK are that Amputation can be up to 8 x greater depending on where in UK you are. Have spent 30 years not really thinking about my feet or lifespan, hearing the reduction is 4 years reduced lifespan i can live with, 20 yrs had been told from head of Diabetes UK appears outdated misleading information. Re footcare I appreciate other messages coming from all responses stating footcare is something i should be taking seriously. Thanks again, its great website!
All depends if you could afford private insurance in the US. Most can't. It's staggeringly expensive. Friends of mine with a pre-existing condition pay over $22,000 annually. The husband is self-employed & the wife's employer doesn't provide health coverage. They still have high deductibles & pay a lot out of pocket.
With private health insurance, US insurance companies decide what procedures are covered & at what reimbursement rates, what meds are covered & how much time doctors spend with patients. Having insurance is far from a guarantee of being provided good medical care. Some insurance policies have caps. Once you've reached the limit, you're out of luck. If they decide they'll no longer cover a med, you're out of luck. Insurance companies, in short, dictate whether you live or die. Want a business deciding your fate?
In 2009 there were 50.7 million people in the US (16.7% of the population)without health insurance, according the US Census data.
Medical insurance provided by employers are what people hope for. It's getting increasingly difficult for small companies to offer this given the current economy & constantly rising insurance premiums. Insurance through an employer is a lot less expensive (employees have to pay for it), but it may not be the type of health coverage you need. Of course, not all jobs have health insurance benefits.
I knew zilch about insurance before being diagnosed. The past month has been a whirlwind for more reasons than just insurance, but the insurance information and concepts alone are enough to make my head spin.
I am lucky in that I will be able to obtain insurance on graduation.. including life and disability and that I will not have to undergo medical underwriting (which would be marked up 50% otherwise)..
Free health care would be nice, but I think our situation could be rectified somewhat in the US if insurance companies weren't allowed to take such large paychecks out of the profits for themselves..