By Dan Howarth
Community pharmacists are often a very useful resource of advice and support for people living with and affected by diabetes. Whether it’s by helping people to identify their symptoms, and further advise whether or not to seek specialist help, or by giving vital information such as how to avoid or reduce the risk of complications, pharmacists can bring real benefit to those living with the condition.
One area of care that community pharmacists are well placed to support is in footcare. Having diabetes puts a patient at much greater risk of developing foot problems and, as a result, many thousands of people in the UK undergo a lower limb amputation related to their condition each year.
But there are a number of ways pharmacists can help and, as a trusted voice for people living with diabetes, it’s important that they use every opportunity possible to give advice, support identifying symptoms and, ultimately, try to help people with the condition prevent or reduce their risk of developing serious foot complications.
How problems with feet develop
Serious foot problems can develop very quickly in people with diabetes, but community pharmacists can play a very important role in ensuring that symptoms are caught and treated early.
There are two main reasons diabetes can lead to serious foot problems, both due to the effect of raised blood sugars over a period of time. The first is that high blood sugars can also damage the sensation in the feet. The second is that it can also affect the circulation; which can mean blood can’t flow around your body properly, especially to your feet.
A loss of sensation in the feet can mean small cuts and sores go unnoticed, and therefore untreated. What’s more, without a good blood supply, people living with diabetes may find they have problems with cuts and sores healing.
Unhealed ulcers and foot infections are the leading cause of diabetes-related amputations, with diabetic foot ulcers preceding more than 80 per cent of amputations.
On average, 169 diabetes-related amputations are carried out each week – that’s 24 amputations a day, or one every hour. However, many of these amputations are avoidable – if people are supported to take good care of their feet, and check them regularly, they can significantly reduce their risk of serious problems.
So, where do community pharmacists come in?
How pharmacy can help
There are a number of key ways pharmacists can help people with diabetes take care of their feet. As with much of life with diabetes, the person with the condition will do the lion’s share of their own management. Footcare is no exception.
As someone a person with diabetes sees regularly, pharmacists can play a vital role by reminding their patients with diabetes of the huge importance of checking their feet, and of seeking help if something isn’t quite right. Even this simple step can make a very big difference.
What to look out for
Knowing what to look for when performing a foot check is hugely important, and community pharmacists can support their patients with diabetes by themselves being aware of the tell-tale signs of foot problems, such as hard skin, a change in temperature, change in colour, and cuts and sores that haven’t healed properly.
Pharmacists should also remind their patients with diabetes that any problems should be checked immediately by their GP or a specialist.
But minor problems with their feet could quickly become something very serious, so here’s a full list of what signs patients should look out for:
- tingling sensation or pins and needles (like numbness)
- pain (burning)
- a dull ache
- shiny, smooth skin on the feet hair loss on the legs and feet
- loss of feeling in the feet or legs
- swollen feet
- their feet don’t sweat wounds or sores that don’t heal
- cramp in their calves when resting or walking.
If any of the above symptoms are noticed, it’s really important that patients:
- take the weight off their foot
- contact their GP or foot protection team immediately
- go to their nearest out-of-hours healthcare service if the GP or foot protection team aren’t available.
People should seek urgent medical attention rather than waiting to see their GP, if they experience any of the following symptoms:
- changes in the colour and shape of their feet
- cold or hot feet without any obvious reason for the change in temperature
- blisters and cuts that they can see but don’t feel
- foul smell coming from an open wound.
How to check for sensitivity in feet
Diabetes UK encourages people with diabetes to check their feet every day. Pharmacists can help by encouraging people to check the sensitivity (or feeling) in their feet at home on a regular basis, as sensitivity is one way in which our bodies alerts us to other problems.
But people with diabetes aren’t always confident they’re doing it right. To help, Diabetes UK has developed an easy step by-step guide that pharmacists can run their patients through to help them check the sensitivity in their feet. It can be accessed via our website (diabetes.org.uk).
15 healthcare essentials
Pharmacists hold a trusted position in the lives of their patients, and are seen as an expert source of information. So another way that pharmacists can help is to make sure the people with diabetes they see are aware of the level of care they are entitled to. People with diabetes are entitled to a number of free health checks through the NHS each year – we call these the 15 Healthcare Essentials – and they include an annual foot check from a specialist.
It is important for pharmacists to educate and support people with diabetes to get these thorough annual health checks; doing so could help prevent devastating complications, it could help act quickly in the event of an emergency, and could be the difference between keeping and losing a foot.
Source of knowledge and support
So, to help make that difference and help prevent amputations, pharmacists can use every opportunity not only to help people with diabetes know what they can do to reduce their risk of developing foot problems, but also help advise of appropriate steps when symptoms appear, such as urgently seeing a their GP or their specialist diabetes team.
Ultimately, good diabetes care should be a multidisciplinary team approach, so GPs, specialist diabetes teams and pharmacists alike can all work together to ensure the best care for people with diabetes.
Dan Howarth is Head of Care at Diabetes UK
This article also appears in the December/January issue of Pharmacy Business.