Diabetic foot problems

Diabetic foot problems stem from a combination of peripheral neuropathy and peripheral arterial disease. Loss of nerve sensation, which usually protects the foot, and sometimes deformity (a condition known as Charcot foot), can lead to abnormal loading of the foot, and minor trauma such as injury or ill-fitting footwear – which may go unnoticed – can precipitate infection and ulceration. 

Diabetes UK says that 70,000-90,000 people with diabetes have a foot ulcer in any given week, and the disease leads to more than 8,500 toe, foot and leg amputations each year.

Annual foot checks are essential and should be brought forward if someone notices symptoms (e.g. swelling, unusual warmth in one foot, or a change in the shape or colour of the foot) or has another issue to do with their feet. 

Autonomic neuropathy

Autonomic neuropathy tends to happen at a later stage of diabetes than other complications and can present in different ways. Some of the more common complications include sweating (due to the skin being compromised), postural hypotension (as a result of damage to blood vessel nerve supply), gastroparesis and diarrhoea (following deterioration of the nerves supplying the gastrointestinal tract), incontinence or other bladder symptoms, and sexual dysfunction, such as difficulty getting or maintaining an erection and vaginal dryness. There can also be impaired awareness of hypoglycaemia.

Reflection exercise

Think of a brief intervention that could take place in your pharmacy to help identify or reduce the risk of damage caused to each of the main organs identified in this module affected by diabetes complications: namely the kidneys, eyes and feet.