By the time we are 50 years old, most of us will have worked hard, studied, maybe raised children and our responsibilities may be lessening and hopefully we have saved money to fund our bucket list of adventures. So what might stop you in your tracks from enjoying the second half of your life?
Most commonly, poor health and more specifically Type 2 diabetes, BUT ONLY if you are in denial about it or Type 2 is not detected. There are 854,165 adults over 40 years of age in the Republic of Ireland at increased risk of developing (or have) Type 2 diabetes 1 and over 1.1 million adults in Ireland that need to change their diet and exercise habits in order to avoid chronic disease.
Many of us prefer not to know our health risks, cross our fingers and hope for the best. Detecting diabetes is a simple, pain-free, finger prick test at your GP surgery or at a free diabetes screening event. Good blood glucose control maintains glucose levels in the blood between 4 and 7mmol/L. When Paul Kenny, who appeared in Celebrity Operation Transformation, was initially tested at a Diabetes Ireland public screening in Tesco, Bray on April 12, 2008, his glucose reading was 27 and he was advised to immediately attend a hospital. Two days later he attended Loughlinstown hospital and got a diagnosis of Type 2 diabetes. Paul had been experiencing “insatiable” thirst for a long time, he had been carrying excess weight and after a long day of hard work he came home and fell into a deep sleep for 1 to 2 hours. He was constantly going to the toilet but he did not know that these were the symptoms of Type 2 diabetes. Paul urges everyone to learn the symptoms and is annoyed that he did not know the symptoms at the time. He encourages everyone who feels they may be at risk to get tested.
Even after diagnosis, Paul was in denial about the condition and admits to “taking the tablets and testing his bloods on and off”. He states “I did not look after myself”. As a result in December 2014, Paul lost his big toe but was back to work after 6 weeks. His work ethic was and remains strong. His blood glucose readings at that stage were around 23 (remember normal range is 4-7mmol/L). He changed his behaviour for 3 months, taking his medications and eating healthily and his blood glucose readings fell to 10/11 mmol/L, a big improvement on 27. At this point he was doing less damage to his body but then reverted to his old ways. In December 2015, Paul lost his lower limb. Finally, the reality hit home. Paul was always an active man but needed to change his diet, adhere to medication and monitor his bloods to help him maintain those dietary changes that would keep his blood glucose readings down. He is a realistic man and accepts full responsibility for his loss. He gained a stone in weight due to enforced inactivity after his limb-loss but is determined to return to work and activity as soon as possible and will shed the extra stone. Paul is coping well, enjoying life but has regrets about his diabetes. Paul comments “I am doing this media campaign so that others will not make the mistakes I made. I am urging everyone to know the risk factors, know the symptoms, get tested if you are at risk and take diabetes seriously.” Type 2 diabetes that is well managed will allow you to live a full and happy life.
In 2015, 451 people with Diabetes lost a lower limb because of damage caused by diabetes. One person goes blind every week in Ireland because of Diabetes. One third of kidney disease is diabetes related. Diabetes is a condition you just cannot afford to ignore if want to enjoy life post 50 years.
References
- Healthy Ireland Survey by the Department of Health
Diabetes Podiatry
- Diabetes related amputations continue to rise in 2015
- 60% of all amputations are diabetes related
- 1,948 people with diabetes hospitalised for foot ulcer treatment, up 250 year on year
- 9 HSE Community based Podiatry posts left unfilled
- “Not Good Enough” says Diabetes Ireland
Latest data shows that 2,400 people were hospitalised in 2015 as a result of diabetes related footcare complications, with 451 of those requiring lower limb amputation surgery.
Recent HSE figures released to Deputy Roisin Shortall TD, showed that the number of people with diabetes receiving lower limb amputation surgery increased from 443 people in 2014 to 451 in 2015, with a further 1,948 (up from 1,697 in 2014) people with diabetes requiring hospital in-patient treatment for foot ulceration spending on average 14.5 days in hospital. More worryingly, around 950 of these patients were under 65 years of age and of working age.
Roisin Shortall TD said “it is frightening to see the number of diabetes patients requiring hospitalisation for foot ulceration treatment as research has shown that foot complications are almost completely preventable by regular screening of diabetes patients and by early intervention by podiatrists in those requiring urgent in-depth treatment”.
Lower limb amputation is one of the preventable potential complications of long term poorly controlled diabetes. However, due to continued under-resourcing of podiatry services, there is inadequate specialised early screening and thus the lack of early intervention in patients who require it.
Despite the introduction of a National Diabetes Footcare programme by the HSE in 2010, a service that today employs 22 podiatrists, numbers of amputations continue to rise. “We are not even stemming the number of diabetes related amputations and in-patient foot ulceration treatment year on year. The 2016 HSE Service plan provided funding for 9 further community podiatrists to be employed this year. Not one of those posts have been filled to date and it’s simply not good enough” said Professor Hilary Hoey, Chairperson, Diabetes Ireland.
RTE’s Celebrity Operation Transformation programme highlighted Paul Kenny, a patient who has undergone a diabetes related lower limb amputation. Paul’s message to all people with diabetes is “don’t pretend it’s not there. I ignored my diabetes and did not take it seriously, I now regret that and I am urging people not to make the same mistake I did. Make sure you manage your condition as best you can”.
Dr Ronan Canavan, Consultant Endocrinologist, St Vincent’s & Loughlinstown Hospital said “Ireland still has one of the lowest manpower levels of specialist podiatrists working in diabetes in Europe. There are significant parts of the country which do not have this service despite an urgent need. We need around 120 podiatrists around the country providing local screening and early intervention to the diabetes community.
An Irish Study showed that the average inpatient hospital treatment of a diabetes related foot ulcer is €30,000 and based on this, the cost to the HSE of treating 451 diabetes related lower limb amputations was over €13.5m in 2015. Add that to the cost of treating a further 1,948 diabetes patients admitted to hospital for foot ulceration treatment and we are looking at a total cost to the HSE of over €71m in 2015.
A 10% reduction of diabetes patients requiring inpatient foot ulceration treatment would save the HSE around €7m per annum. Other costs savings such as long term social welfare costs, housing alteration costs etc also need to be added to this figure making further cost savings for the Exchequer.
“We have basic grade podiatrists qualifying out of college every year looking for employment and further investment in community based diabetes foot care will go a long way to reducing the hospital treatment cost. If we can identify at community level those at moderate risk of developing foot ulceration and ensure they are put under active surveillance by a podiatrist we can reduce these costly diabetes complications. It makes economic sense to expand the programme as the foot complications of diabetes and the associated risk of amputation are preventable with regular foot examination, regular podiatry screening and rapid access to footcare specialists for the urgent cases” added Professor Hilary Hoey.