Tag Archives: Foot Care

Defining Complications

20 Mar

Oxford English Dictionary definitions:-

1) A circumstance that complicates something; a difficulty

2) An involved or confused condition or state

3) A secondary disease or condition aggravating an already existing one.


An issue, a complexity, intricacy or convolution.


From Latin “complicare” meaning to fold together.

When people speak of complications in the context of diabetes, there is an unspoken, implicit or inferred presumption that the phrase means only a narrow range of specific conditions ( e.g. Neuropathy, Retinopathy), and the the person with diabetes will have brought about these by their actions or inactions.

In my opinion, all of these presumptions are wrong, but not only that, they are very unhelpful.

Synonyms for presumption include:-

Presupposition, an automatic inference, prejudgment and PREJUDICE.

No wonder the conversations about complications in diabetes produce so much judgment and blame!

So, firstly, I would prefer to talk about the issues, complexities and intricacies of living with diabetes, not complications. And secondly, I want to emphasise that they are NEVER caused deliberately by the person living with the condition, but are simply responses to the combination of disease, genetics, physiology and circumstances that people with diabetes may (emphasise that MAY too) encounter during their life.

Having got all the ground rules established, I’ll now tell you what I think of as the intricacies of living with diabetes after having had the condition for 42 years.

The first thing I associate with having diabetes is always feeling a bit tired. It’s a sort of chronic fatigue, and I believe it’s borne of loss of sleep from nighttime hypos, variation in blood sugar levels that results in biochemistry mutating into a physiological effect, and the niggling nag at the back of your mind all the time that you’ve not done something you should have.

The impact of this amorphous haze of weariness that seems to be permanently present is unsurprisingly a degree of grumpiness. This in turn affects relationships, whether at home or work or with friends, who funnily enough get pretty fed up with your always seeming to be in a bad mood and short tempered. Even the most patient or knowledgable about diabetes make it clear at some point that it’s you, person with diabetes, that is in the wrong. It’s your fault.

First strike, as they say. First blame on you. You’ve failed. You must be doing something wrong otherwise why would you feel so tired all the time.

Wrong. You’re not doing anything wrong. You’re coping with a disease that is ever present, so in many ways you could argue they should see you as permanently “unwell” (although we all want to be as well as we can all the time, so I don’t like this way of thinking). The “grumpiness” is caused by the condition, not by you.

Nevertheless, unless you recognise this, it’s pretty easy to become dispirited, demoralized and think that all your efforts at managing your blood sugars are failing. So why bother.

Impact no 2 of tiredness – “burnout”. You give up trying.

Result? Worse blood sugars, you feel worse, you become even grumpier.

A vicious circle develops which becomes a vortex taking you down into depression.

Another “issue” that is not unknown with diabetes, but is also not recognised as a “complication”.

The feeling of being a burden on others can arise even if you’re lucky enough not to feel tired and grumpy, just from all the things you do simply by handling diabetes:-

You’ll be interested in the carb content of food you’re going to eat, and may have other die try requirements that can accompany having diabetes, like being gluten intolerant, you’ll need to do blood sugar tests that involve pricking your finger, you might need to inject insulin or dig a pump out to bolus. Most people will try hard to avoid having a hypo, and will try to look ahead to anticipate what might go wrong and lead to a situation where low sugar is likely. Sometimes this “anticipating” can lead to obsessive planning, which results in extra food being taken, sometimes considered unnecessary by others, or a reluctance to be spontaneous, so you’re thought of as a “drag”.

All of these actions can produce curiosity or frowns faces, but even if the people you’re with are used to you doing these, you’ll know they are aware and you’ll know you are different from them.

By being “apart” or not fitting in or not “belonging”, some people can feel isolated and develop negative self-esteem.

Then there’s the actual capability test – can you stand up to your peers’ scrutiny and do the sums to work out how much insulin you need, just like they can?

In this context, I was told recently that university researchers (at Glasgow I think) determined that on average a person with Type 1 Diabetes makes 100 extra decisions a day, compared to somebody without diabetes. And at a conference last week, it was stated that other research had found the maths ability of many diabetics is equivalent to that of an 11 year old. So, firstly, don’t feel bad – you have to think more that people who don’t have the condition, and secondly, don’t feel different if maths is a struggle – it seems it is for many of us. I shudder to think what the ability is in the population at large too!

In the UK we are exceptionally lucky to have the NHS which means we don’t pay for insulin and other consumables. I saw a photo today of a till receipt for $807 for 3 vials of

Humalog insulin from an American pharmacy (Walgreens, effectively the US version of Boots)! So we’re lucky and grateful.

However, there can be hidden financial costs even here, with food for low carb diets costing more, hypo treatments like dextrose tablets or lucozade, continuous glucose monitor sensors or flash sensors if you buy them, and the tech kit like smart phones or watches to get the benefit of the readings conveniently. I have developed some neuropathy in my feet, and now find it very hard to know whether a pair of shoes fits well. It therefore takes me a long time to be sure I’m getting a pair that will be comfy and won’t rub, and there’s always a risk I’ll buy a pair only to find after a week that they don’t fit and I need to spend the same again to get the next size up!

All this expenditure mounts up, with some things being prohibitively dear, but how many of them either are pretty much essential or make such a difference we would really miss them? We may not have to pay for medical supplies like insulin, but the burden of finding the money for all the other things that are not explicitly diabetes-related can be substantial, leading to worry, etc. etc.

If you haven’t slit your wrists yet, you’ll be relieved to know I think there’s a silver lining to all these negative aspects – effectively they antonyms to the words I prefer to “complication”.

Firstly, you’re managing the condition, you’re coping with it.

Synonyms for these words are “tackling”, “sorting out”, “contending with”, “facing up to”, “handling”.

These all have positive connotations in people’s minds, being good attributes, associated with traits like courage, determination, perseverance. Bear those in mind. You’ve got all of them.

Secondly, you make a lot of decisions every day. If you have Type 1 Diabetes the anecdote about the research is you make an AVERAGE of 100 extra decisions every day (so some days it might be an extra 150!) compared to other people who don’t have diabetes. (I’m afraid

I have no similar anecdote about research relating to Type 2 Diabetes, but it stands to reason, people with that condition will also be making more decisions than people without diabetes).

This decision making involves getting information, weighing up the options and judging which gives the best outcome. It’s not a knee-jerk choice. That “consideration” process is also considered to be a good attribute, so you’ve got that to accompany your ability to decide (another positive).

When you’ve made a decision, you then have to check to see whether your prediction about the outcome was right. This “monitoring” often involves recording stuff (blood sugar readings for example) over time, and analysing it for patterns.

Depending on what your checking finds, you might have to change what you’re doing in some way, adjusting a temporary basal rate for example.

And you have to do these things all the time, every day, in varying amounts depending on how many curve-balls diabetes throws at you that day. Often you’ll have very little time to make each of these considered choices too, so you have an inherent ability to handle pressure, whether you realise it or not.

Making one decision at a time with a break between each one is perhaps not as impressive as I’ve made it sound. However, from my experience, the decision making frequently has to take account of several factors at once. For example:-

I was intending going for a swim today. I usually do about 45 minutes to cover about 1 km in the pool doing front crawl. I had put in the temporary reduced basal rate for about 30 minutes, about an hour before I was planning to go, and I’d eaten 30 g of carbs. then I go to drive to the pool and the battery is flat.

So, I have to decide what to do to take account of the the temporary basal rate and the extra carbs, now I’m not swimming. Do I put in more insulin to correct, only that will take about an hour to start working by which time my sugar will be high, or do I do alternative exercise? If so, what and for how long?

I chose to go for a walk for about 40 minutes and bolus for the extra carb I had eaten.

Two and a half hours later, I’m now sitting at 4.6 mol/l and likely to need a bit more carb to ensure I don’t go lower before dinner. So, nearly, but not quite!

This is a relatively simple example, but it shows how many factors there are to take into account, and plan for, some before starting out when there’s plenty of time to consider, some requiring decisions on the hoof, and how it’s not always possible to get them all right.

I reckon having to make judgements taking into account multiple factors is more common in diabetes than most people think, so everybody with the condition will almost certainly have done this, probably without recognising it.

This waffle is written from the perspective of somebody with Type 1 diabetes, and I confess I know relatively little in comparison about Type 2. However, I am aware that its causes are complex and not particularly well understood yet.

I’d argue there is no benefit in shaming or blaming people with any type of diabetes as all it is likely to do is to reduce their self-esteem which as I’ve explained earlier is likely to be already under pressure from themselves.

So, I would suggest we focus on the achievements people with diabetes realise every day and please let’s not use the word “complications”!

There are so many issues and complexities folded together with a broken pancreas that to label only a small number of traits, (which are effectively identifiable physiologically), is a gross over-simplification.

Far better to encourage and value the positive attributes from coping with the condition, like the endurance, stamina, and strength of will required to get up each day and every day to deal with it. Any other approach in my opinion is prejudicial to helping the person with diabetes.


Brian’s Story

28 Feb

Let me introduce myself, I’m Brian Black I live in Arizona, United States. So my journey with my Type 1 Diabetes started real late in my life. So it all began about this time eight years ago. My health seemed to Plummet into this terrible abyss. My body began to ache, had no energy to make it through the day. Then one morning when I woke up my foot was swollen and when I step out of bed to walk, I felt something just burst and blood and fluid covered my left foot. I was scared for what had just occurred. So off to the Emergency Room I went. Upon arriving at the hospital. The Triage Nurse ask me why I was there. I showed her my foot. The first words out her mouth was I a Diabetic. My answer to her was no, that I had never been diagnosed. At that point everything seemed be happening very quick. I was taken to a bed and many blood draws began. I was put on a I.V. and Oxygen. Things seemed to getting worse. I started Vomiting fiercely. Then the E.R. Doctor arrived. He began to explain to me, my body was in DKA. My response what was that. So he explained and told I was very sick man with life threatening illness. So I was off to ICU to be monitored continuously throughout the night. The next morning I was moved to a regular room. They had stabilized from Blood Sugars and Oxygen Levels. So this when I meet this Female Doctor of Podiatry. She came to my room to examine my feet. As the examination continued, she began tell me that it wasn’t going to be a good outcome. That most likely I was going to loose several of my toes or even my whole left foot. So the first surgery would be later that day, to debrief the Infection in my foot. The outcome from this surgery was some what encouraging. That there would an Amputation of The Small Toe and the Removal of The Metatarus. I would spend the next 21 days in the Hospital going through two more surgery’s. And countless Blood Test to formulate a Antibiotic Cocktail to kill the Infection that was still causing me problems. So I went home with one less toe and a broken ego and Type One Diabetes’s It took over me several years to come terms and not to blame myself for the Complications that this Disease of Diabetes brings upon us. Everyday I work hard to take care of myself with my Diabetes. So I leave you with this No Blame and No Shame.

Sliding Doors

8 Nov

Have you ever watched the film “Sliding Doors”?

Is about one person’s life as it is, and in parallel, how it could have been if one thing had happened differently.


How it is…..

Currently my left foot looks like this (yep, gross, but it will be fine).


I have Type1 Diabetes and as a result I do my daily foot checks.

I notice a blister and keep an eye on it.

It starts to look a bit rough, so I go to the practice nurse.

She cleans and dresses it.

She refers me to the Podiatrist.

Podiatrist rings same day with an appointment (that I couldn’t make but that’s not their fault).

Great care for an amazing NHS!


How it could have been…..

For whatever reason I didn’t get T1D.

I get a blister on my foot.

I don’t do daily foot checks, why would I?

The blister turns bad so I stick a plaster over it.

It gets worse.

I’m a typical bloke so I leave it as I’m too busy to go to the GP.

It’s agony now so I go to the GP finally.

Foot is cleaned and dressed.

Time goes on but it gets no better.

Back to GP I go.

To cut a short story long I get diagnosed with Type2 Diabetes.

My foot issue was the first physical indication I was aware of that I had T2D

I wish I’d know that I was at risk of T2D. I can’t guarantee that I would have acted if I had, but at least Id have had a chance to………


Know Your Risk!….

So help yourself, your friends and family but getting them to Know Your (their) Risk of T2D, and if needed, acting on it. Please!


Live Long and Bolus


Finding My Feet

21 Jan



For the last 47 years I’ve been in a relationship.

A threesome……..


My relationship with my feet has changed over the years

We share the same birthday

We used to be close

We played together

I used to touch them a lot

They looked good naked!

I’d even give them a gentle suck…….


Slowly we grew apart (I’m 6 feet 2 inches tall they are a long way away)

We lost touch (I can’t touch my knees let alone my bloody toes)

Things got in the way (beer gut…..)

I paid them little attention

Even when they were naked

Just a passing glance

But I could still depend on them

They never let me down (except when I’m drunk and fall over)


As I said I’m my last blog post they took a bit of a battering

It’s rekindled out relationship

Every night I slowly undress them

My eyes cover every inch

I explore them with a gentle touch

I lovingly rub them with lotion

Then we slide under the covers for the night…..


Remember you daily foot checks!


Live Long and Bolus