When thinking back on the first year of medical school, one of the things that sticks out in my mind’s health certain conditions or habits seem to be risk factors for just about everything. Being overweight or obese, a smoker, or diabetic immediately come to mind.
Diabetes is a serious chronic medical condition that impairs the body’s use and management of glucose or blood sugar. Type 1 diabetes, which is also sometimes called juvenile onset diabetes, is caused when the pancreas doesn’t produce enough insulin, a significant metabolic hormone. Type II diabetes, which is also known as adult onset diabetes, is the condition where the body either resists insulin or doesn’t produce enough of it.
Doctors, physician assistants (PAs), nurse practitioners (NPs), and registered nurses are well aware that one of the top challenges for diabetics is maintaining skin integrity and wound healing, particularly in the lower extremities. And with this knowledge, these providers have a heightened responsibility under the standard of care to protect diabetic patients from these risks.
It is well known in the medical literature that the problems in regulating blood sugar experienced by diabetics causes skin integrity issues, including development of foot ulcers. Even in non-diabetic patients, lower extremity and foot wounds take longer to heal. Superimposing diabetes makes matters even more difficult.
The diagnosis, treatment, and management of diabetes and its complications is a team effort. Primary care providers, including general and family practice physicians, PAs, and NPs, are responsible for ordering appropriate insulin and medical therapy to control blood glucose/sugar levels. It’s up to the patient following the orders and guidelines, and on the providers and patient for obtaining ongoing care for monitoring.
When a diabetic patient develops a lower extremity wound, it’s a known complication that should capture the attention and focus of both the patient and the healthcare team. The failure to have proper skin and wound care in this situation can lead to infection, sepsis, amputation, and even death.
According to the American Diabetes Association, after decades of decreasing annual numbers of lower limb amputations in the United States, there is a new disturbing upward trend. Based on data from the most recent six-year period, the amputation rate has increased by an astounding 50%, accounting for around 200,000 non-traumatic amputations on an annual basis.
This negative trend is felt to be related to the overall increase in obesity and diabetic diagnosis throughout society, including younger populations. In fact, the sharpest increases in amputation rates were noted among young and middle age adults.
From my experience in handling numerous pressure injury and skin integrity cases, I’m mindful of medical expert testimony that the best way to treat pressure and skin injury cases is to avoid them in the first place. This is particularly true for diabetics.
When patients have uncontrolled diabetes—meaning that their blood sugar is out of whack—it limits proper blood flow to the lower extremities, legs, and toes. This, in turn, leads to nerve damage and a lack of sensation of a skin problem until it is already developed or advanced. This condition is called diabetic neuropathy.
Think about it like this. If you have normal sensation, even a tiny splinter on the bottom of your foot is impossible to overlook. People with diabetic neuropathy don’t notice even larger injuries that disrupt the skin integrity and progress into troublesome wounds.
On top of that problem, impaired blood flow in diabetic patients make it difficult for their lower extremity wounds to heal.
When diabetic patients do their part in seek appropriate medical care, it’s up to their physicians and providers to meet the standard of care in diagnosing and treating skin issues. This is the only way to avoid severe infections and even amputation.
If you’ve been seriously injured because of poor diabetic care in Texas, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help in evaluating your potential case.
