Medicaton and prediabetes

They accepted responsibility for her amputation because of gangrene. Her diabetes was under control. She did not have hypos. She got gangrene because a podiatrist nicked her toe when cutting her nails.
I do not care whether you believe me or not.
I cannot be bothered any more.

I'm a bit puzzled dj, why did the Diabetic clinic accept responsibility if her diabetes was under control?

I'm with Anya in that I suspect her diabetes probably wasn't well controlled or the situation would never have escalated to amputation over the two years.

I've nursed dozens of people with diabetes type 1&2 as a DN and only one ever had an amputation (big toe) following a DIY attempt at removing hard skil with a scalpel.

My point being, Jen that if you want to make a believable case, you must try to marshal your facts and present them clearly, logically and without undue emotive language.

Yes, you are sad that your sister's friend suffered and died, that I understand. I lost a close friend to diabetes and I was there for her through the retinopathy, the amputation, the kidney failure and her death from a heart attack at 42.

I was with her when her first child was diagnosed with sacral agenisis.

I injected her when she was went into her hypoglycaemic comas and carted her off to hospital when her blood sugar levels went through the roof.

So you don't have the monopoly on compassion. But I do know that my friend made no effort at all to control her diabetes, though she told the doctors etc she did, but her A1c tests told a different story.

By the way, her diabetes was under control. The diabetic clinic accepted responsibility.

Sorry, I should not feel emotional about someone I know who died after she had had her leg amputated from getting her toe cut by a podiatrist?

I find it hard to be logical about that!!!

I didn't call you a liar Jen did I? What I said is that I doubt that the nicked toe was the cause of gangrene two years later. But I do find it incredible that she sat with her leg up for two years and just watched it grow worse

In fact it's much more likely that the gangrene was the result of poorly managed blood sugar.

Gangrene usually affects diabetics with high and uncontrolled blood sugar levels. High blood sugar damages the nerves of the foot causing peripheral neuropathy and also hardens the walls of the arteries leading to narrowing and obstructed blood supply. These are the main causative factors of a raised risk of gangrene in diabetics.

So while there is an outside chance that this nick led to gangrene two years later there are far more likely explanations. But it's always good to blame another person rather than face the fact that it might have been preventable had the diabetes been under control.

Perhaps you could take a leaf out of Riverwalk's book and present your argument in a logical, reasoned and informative way as she has done, rather than using emotive language and a complete lack of logical thought.

Sorry, that should have said ..... often leads to amputation, because some ulcers are successfully treated but by no means all.

Anya I'm afraid that very small cuts or even pressure from shoes can and do lead to amputation, many years later.

The initial cut/pressure causes a small ulcer which, because of circulation problems due to diabetes, never heals and gradually increases in size, often down to the bone, until the only cure is amputation.

Yes, they could have amputated her foot instead of the whole leg, but they were expecting it to get better or something. Lots of antibiotics, etc. I do not know all the ins and outs of it, as we live in different parts of the country, but basically, that's what happened, just wait and see.

This woman knew what the outcome could be, as well, because she had a brother who had had both legs amputated because he was type one diabetic, and did not look after himself, not caring about diet, and drinking too much. He was in a wheelchair for much of his life.

"watched as it got worse"

Is there no treatment for gangrene in its early stages?

I'd rather you did not call me a liar, Anya. The woman in question had to sit with her foot up after that happened for two years until they decided what to do, and they just watched as it got worse.

Do you really know as much as you say you do about diabetes?
It is well known that gangrene is a problem with diabetics, as granjura says. That's why they are supposed to have their feet inspected annually for any sign of foot problems. You do not expect the podiatrist to cause the problem.

Sadly, people with diabetes can have real problems with their feet, and a small injury can fester and become a huge problem, slowly leading to gangrene and amputation. One of my friends here had both legs amputated due to his diabetes- but he lived for several years. This is a well-known fact, and denying this is the case shows poor knowledge of diabetes and complications.

That's hardly keeping an open mind is it Jen?

Thanks for the CV and family history. I won't bore you with mine

Incidentally I doubt very much that having a toe nicked would result in gangrene two years later but I'm sorry your sister lost her friend.

Anyway if you aren't open to new ideas and can't be bothered to do your own research I'm not going to spoon feed you. I accept you are an expert of T2D as well as T1 and all things political and on that note

No, I do not need to. You were the one who told me I was out of date, so I assumed you knew what was up-to-date.
The last thing I did was a BITES course, six years ago. Before that it was Dafne.
My mother had type two. my sister has type two. So did her friend, so I do know a bit about type 2.
Her friend had to have a leg amputated. Not because she did not look after herself properly. She was a nurse, too, and knew about diet. She had one of her toes nicked by a podiatrist. After two years, her leg was amputated because of gangrene. She died five days later.

I'm not telling anyone how to manage their diabetes Granjura and I'm assuming you, or someone close to you, have the condition and have it controlled only by diet? Please correct me if I'm wrong.

But there are many with T2D who struggle to understand what a carbohydrate is let alone understand GI values. And these are the ones who often cannot control their blood glucose levels. Simpler for them to cut out added sugars and cut back on breads, potatoes, pastas, etc. The message needs to be simple to get across.

I know your late DH had T1D jen and that is a very difficult condition to manage. Re the latest research have you tried googling it?

Point is Anya- underxtanding GI values is not just about 'crap carbohydrates' but all carbs and most foods. We can all agree that cutting very sugary foods makes sense, especially for those with pre, or Type I or II diabetes. But you still need to understand carbs in general, and giving up all carbs is NOT necessarily a good idea for most people.

So if you know that a small portion of basmati rice, washed and cooled after cooking and re-heated is low GI- why not have a small portion as part of a low GI diet. Same for a few small boiled NEW potatoes, or a small portion of pasta, again washed and cooled an re-heated- thus drastically cutting the GI content (+ of course the portion size). To follow a low GI diet for life via cutting all carbs is really not easy, and actually not necessary if you understand GI values properly. Educating yourself about such is not 'messing about' really.

So what's the latest research?

Jen I was tired and grumpy last night so didn't mean to sound in any way unsympathetic but Diabetes UK has been criticised for not moving its thinking along to take in recent, and not so recent, research.

GIs were the 'in thing' 10+ years ago and yes, as a rough and ready guide they have their place, but Type 2 diabetes and obesity rates have continued to soar, despite what appeared to be sensible guidelines.

Fresh thinking is casting doubts on research in the 1950s and it is worth taking this into consideration.

I come into contact with a lot of T2 diabetics these days (who doesn't?) and there are those who have their conditioned managed solely through diet, those who have to take pills and those who have to inject. Their different attitude to their condition reflects their medication, or lack of.

You'd better tell that to diabetesuk, then.

www.diabetes.org.uk/Guide-to-diabetes/Enjoy-food/Food-and-diabetes/Glycaemic-index-and-diabetes/

Your thinking is hopelessly out of date Jen and I really CBA to continue discussing this with you any more

'I don't think that wanting to stay alive and out of hospital is over sensitive' ....what on earth are you talking about Jen. Who said anything about that? Your statement is totally illogical, as usual.

Low carb is about the quantity of carbohydrates you eat. Low GI is about quality.If you just miss out carbohydrates, you eat a higher percentage of fat. Eggs and cheese do not have a GI value, but replacing bread with cheese is not healthy. The diabetic diet should be low fat as well.

Actually a low carb diet is usually very low GI one as most of the other food groups eg fats and proteins are very low on the Glycemic Index Jen.

I've had great success lowering DH's blood glucose levels (he has been prediabete twice in the last 8 years) but helping him follow a low caeb diet, with his GP's approval.

If diabetics, especially type 2, cut a lot of tne crap carbs out of their diet then they ought to be able to lower their medication, and of course those with type 2 who are on insulin, have usually progressed to that through not controlling their diet in the first place.

Type 1 is much more complicated I agree.

A low GI diet is not the same as a low carbohydrate diet. Diabetics, like everyone else, need carbohydrates to balance the insulin they need. It's the type of carbohydrates that you eat that matters.
You replace the highly refined carbohydrates with less processed ones.

I do not think that wanting to stay alive and out of hospital is being oversensitive. It's being sensible. Unfortunately it often takes a few hypers and hypos for a diabetic to realise that, particularly a young diabetic.
It must surely be better for those who have been told that they are prediabetic to find out as much as possible about diet to try and head off diabetes, like Iam says.