Diabetics get more Legoff

by Matt Wardman on March 7, 2012

Do not cut

Latvia has its one-legged lesbians, according to Mr Webcameron.

Bristol has its one-legged diabetics, according to the journal Diabetologia, or – rather – makes more of them than elsewhere in the country:

Amputation rates for diabetes patients are 10 times higher in some parts of England than in others, according to a study.

Researchers say the figures highlight the importance of ensuring the right specialist care.

The findings coincide with an NHS report putting the annual cost of diabetes-related amputations at £120m.

Amputation rates in some areas are too high, says the Department of Health.

The study, published in the journal Diabetologia, compared lower-leg amputation rates for local health trusts (PCTs) across England over three years.

In one way, it is not a surprise that there should be more Long John Silvers being madein Bristol, of all places, and I’m restraining  myself from seeking a correlation with the parrot population.

It gets worse, though:

The paper concluded that, compared with the general population, people with diabetes were over 20 times more likely to have an amputation.

That’s the first number I’ve seen put on diabetic amputations compared to everyone else. The heart attack risk is perhaps 4x greater for diabetics. Ditto kidney problems. Ditto eye trouble or blindness, loss of feeling or obesity. Ditto many other things you could think of. We also, as reported, get help with legoff, especially in Bristol, and legover; if they need it, diabetics can get a quota of viagra on the NHS.

The last NICE estimate I saw was that people with Type I diabetes had a life expectancy reduced by 15 years.

So at least one benefit is that you get a better pension annuity, and also I get tickled by a nurse twice a year to check whether I have any diabetic neuropathy (nerve damage) yet.

And by looking after the condition carefully, which is very difficult, particularly the need to maintain motivation for self-treatment which changes several times a day over decades, that can be much improved.

For once, I’m going to congratulate the media on reporting of this. I have yet to see one story about ‘unhealthy Bristol diabetics’ or ‘Bristol diabetic hospital scandal’. I don’t think the Daily Mail has covered it yet, though.

It’s not quite as simple as being a matter of geography and postcode lotteries, though; and that won’t be the case here.

The capital of meeting one-legged people outside a hospital used to be the area around the Royal London Hospital – not because services were bad, or because locals had bad diets and made their condition worse, but because that is where the specialists operated and patients were referred from elsewhere.

As ever, there’s a balance to be struck between big regional centres chopping off a lot of legs who do it well, and smaller centres which will be closer to home but less effective.

There’s a need to get the NHS away from MIMBYs (Must be in My Backyard) who want a small hospital close by, and to take a more strategic approach which – according to most research which I have seen – kills fewer people with difficult conditions.

And there’s a need to continue to invest in prevention, such as training diabetics to self-manage effectively which means that there will be a far smaller need for leg amputations in the first place. And a battle with those GPs who can make it more difficult for people with diabetes to look after themselves, by sometimes refusing supplies.

For a serious discussion of diabetic amputations, and why some changes are need to help, and to save the NHS money in the long term, try the Diabetes UK Putting Feet First web pages.

Now, can anyone explain why there has never been a character in the Asterix books called Diabetix, to go with Anticlimax the climate change skeptic and Fulliautomatix, who presumably does the washing?

 Photo Credit. New York Daily News via Oddee.

{ 10 comments… read them below or add one }


1
Stabledoor
March 7, 2012 at 12:02

It’s quite hard to find humour in amputation – I never like doing it much, especially the moment when the leg is dropped into a bin bag held out by the nurse. As you say good control is hard and not everyone who achieves good control is rewarded by a long life and 2 functioning legs at the end of it. Aren’t most amputations in type 2 diabetes anyway?

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2
Matt Wardman
March 7, 2012 at 12:45

>It’s quite hard to find humour in amputation – I never like doing it much, especially the moment when the leg is dropped into a bin bag held out by the nurse. As you say good control is hard and not everyone who achieves good control is rewarded by a long life and 2 functioning legs at the end of it.

Generally I say no limits to humour. There’s some very black humour at the ‘amputee tattoo’ photoset:

http://www.oddee.com/item_96857.aspx

But I have yet to see a leg on a mantlepiece as some keep kidney stones.

>Aren’t most amputations in type 2 diabetes anyway?>

Numerically, I’d expect so since Type II is about 90% of Diabetes now. Proportionally, I’m not sure, as people who have D as children have that much longer for complications to develop.

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3
JuliaM
March 7, 2012 at 16:51

A leg’s a bit too bit to fit on the mantelpiece – and, sadly, too thin to have hollowed out to serve as an umbrella stand, as with so many elephants.. :(

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4
Scrobs…
March 8, 2012 at 05:47

In the South East, for some years nw, the diabetic clinics have been wound down with specialists seemingly unavailable for regular appointments on progress.

It seems that Type 2 diabetics are becoming lumped with smokers and excessive drinkers etc these days. Much easier to pigeon hole I suppose.

Type ones never had a choice anyway.

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5
Matt
March 8, 2012 at 10:25

@Scrobs

Thanks for the comment.

I was in London treated at the Royal Free from about 2001 to 2003.

Since then – around here anyway – there was a ‘shift ‘em all to the GPs’ move, even for Type Is, then a more recent move back the other way.

Our local hospital D Clinic has lost about 1/6 of staff in the current austerity.

I can’t comment on the real detail of Type II, except there seems to be a lot more insulin therapy in use now. Though that may be affected by the way everyone with insulin – including I think Type IIs – is now categorised under the new driving license regulations.

I can see a lot of Type II people choosing to go for worse D control rather than have a higher risk of having their license revoked.

Matt

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6
Scrobs…
March 8, 2012 at 20:52

It’s more than the GPs here Matt – thanks for replying BTW!

The Nurse (Chum) is in charge of the notes, and although our GP is also a chum, he leaves it to the staff to do the biz.

It takes so much more when you’re Type 1, and it’s still a problem for ‘Type 2s’, because there’s a fair chance that they’re that way as I said earlier; “wrong ‘everything’…”

But also, Type 1s are superb at getting it right – and it’s not rocket science! But I wish there was a better system for people who do look after themselves, but get sidelined at every turn…

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7
Matt
March 9, 2012 at 17:41

The other issue with Type 2s is you tend to get 5-10 years of damage before anyone notices the D – which doesn’t help.

I lasted about 5 days then had the ambulance.

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8
Matt
March 8, 2012 at 10:55

We’ve had some ‘feedback’ offline on this post, so just to note that I’m Type I myself, and the aim of the post was not to laugh at amputees, rather to bring out some of the black humour that comes in diabetic circles and point out a few issues that the wider public usually misses.

If anyone wants to debate, then the best place is in the comments here.

Pseudonyms are fine.

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9
Stabledoor
March 8, 2012 at 16:55

Presumably that’s why the post disappeared for a while yesterday. I wasn’t criticising you, just a little taken aback at the subject matter and I realised you must have diabetes from the post – I don’t envy you that.

I agree that there should be no limits to humour – there is some pretty black humour in operating theatres!

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10
Matt Wardman
March 8, 2012 at 17:13

No. It disappeared because two of us hit publish within minutes :-) , and I backed off for Gildas’ Afghanstan post.

No plots here, just cockups.

My last comment does not refer to your comment.

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11 replies on “Diabetics get more Legoff”