Diabetes diagnosis and medical negligence
If a person’s diabetes is not diagnosed or managed appropriately then there can be serious and catastrophic consequences. It is not just diagnosis and treatment that has to be timely; adequate monitoring following a patient’s discharge is important to prevent life-changing complications. Within busy, underfunded and understaffed hospitals, GP surgeries and social care units, this is not always the case and omissions and errors can occur.
What is diabetes?
Put simply, diabetes is a condition caused by too much sugar (glucose) in the blood. The high blood sugar (glucose) levels are caused because the person’s body is not producing enough insulin or the body’s cells are not responding to the insulin properly.
Insulin is naturally produced by the body in the pancreas and is a hormone that converts carbohydrates, like sugars and starches, into energy. It is released into the bloodstream when we eat.
Diabetes can be caused by many factors such as lifestyle (e.g. obesity) and genetics. Certain drugs have also been associated with the causes of diabetes.
There are two main types of diabetes. Type 1 diabetes is where the body’s immune system attacks and destroys the cells that produce insulin. Type 2 diabetes is where the body does not produce enough insulin, or the body’s cells do not react to insulin. In the UK, around 90% of all adults with diabetes have type 2 and the number of people with the condition is growing rapidly.
Currently, 4 million people in the UK have type 2 diabetes. That number is expected to reach 5 million within the next 10 years.
What can go wrong?
Some of the most serious consequences of misdiagnosis, delayed treatment or inadequate monitoring and aftercare are:
Recent data released by Diabetes UK and based on figures from Public Health England reveal 7,370 amputations per year are carried out due to diabetes. It is estimated that 80% of those amputations are avoidable.
It can start with something as simple as a toe infection or eczema. Diabetics must keep a watch for changes in feeling to the lower extremities (diabetic neuropathy). Checks should be made and diabetic ulcers or eczema monitored. If diabetic ulcers or nail and toe infections are not treated the patient can end up losing a toe, or worse.
Studies have revealed that 80% of amputations begin as foot ulcers which are usually treatable if diagnosed and treated promptly.
A severe obstruction of the arteries (critical limb ischemia) can also occur. This can cut circulation off to a limb, which can – if left unchecked and untreated – end with the amputation of the affected limb.
Diabetic retinopathy affects blood vessels in the light-sensitive tissue that lines the back of the eye, called the retina. It is the most common cause of vision loss among people with diabetes and the leading cause of vision impairment and blindness among working-age adults.
Controlling diabetes can prevent or delay vision loss but because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should get a comprehensive dilated eye exam at least once a year.
Early detection, timely treatment, and appropriate follow-up care of diabetic eye disease can protect against vision loss.
Diabetic kidney disease (diabetic nephropathy) is a complication that occurs in some people with diabetes. The disease is caused by damage to small blood vessels, which can cause the vessels to become ‘leaky’ – or even to stop working – making the kidneys work less efficiently. Keeping blood glucose levels as near normal as possible can greatly reduce the risk of kidney disease developing as well as other diabetes complications.
A diabetic should have regular blood and urine tests. Urine will be checked for protein particles, called ‘microalbumin’. If these are present then it is an indication of the first stages of kidney disease because the kidneys have become ‘leaky’. Early detection is very important because at this stage the disease is usually treatable.
Urinary Tract Infection
People with poorly controlled diabetes can be more prone to urinary tract infections (UTI) because glucose in the urine provides a breeding ground for bacteria. In some cases, if the infection persists, it can cause serious damage to the kidneys.
Protein in the urine is a sign of a potential UTI and a medical professional should be aware of this. It is important for people with diabetes to have a UTI diagnosed and receive adequate treatment quickly, or risk permanent damage to their kidneys.
Strokes and heart attacks
Diabetic patients are twice as likely to have a heart attack or stroke. This is partly because diabetes increases the chances of a condition called atherosclerosis. The condition is a form of hardening of the blood vessels, caused by fatty deposits and local tissue reaction in the walls of the arteries. Diabetes increases inflammation and slows blood flow, which dramatically accelerates atherosclerosis.
As the hardening of the arteries develops is can lead to poor circulation in the legs, and stroke and heart conditions such as angina and heart attack. Coronary heart disease is recognised to be the cause of death for 80% of people with diabetes
If a diabetic patient complains of pain in the chest, discomfort in arms, back or shoulders, shortness of breath, irregular heartbeat, swelling of ankles or other signs of a heart condition, it is unacceptable for a doctor or nurse to send a patient home without appropriate tests and treatment.
Degeneration of the nerves
Diabetic neuropathies are a collection of nerve disorders caused by diabetes. People with diabetes can develop nerve damage throughout the body and in every organ system, including the digestive tract, heart, and sex organs. Diabetic neuropathies are caused by many of the abnormalities common to diabetes, such as high blood glucose.
Some people with nerve damage will have no symptoms but others can suffer from pain, tingling, or numbness—loss of feeling—in the hands, arms, feet, and legs.
Healthy lifestyle choices with good care and monitoring can prevent or delay the onset of these nerve conditions. The alternative can lead to a diverse range of problems, including gastroparesis, dizziness, incontinence and sexual problems.
Foot care is particularly important. Diabetics should have a comprehensive foot exam each year to check for neuropathy. People diagnosed with neuropathy need more frequent foot exams to assess the skin, muscles, bones, circulation, and sensation of the feet. Loss of feeling in the feet means that sores or injuries may not be noticed and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers. If these conditions go undiagnosed and untreated then ultimately it can lead to amputation.
Diabetes UK has called for the NHS and the government to improve treatment for diabetics in order to reduce the number of amputations required after it was revealed that over 20 amputations per day were being performed in England.
The symptoms of diabetes
Some of the common signs of diabetes are excessive thirst, frequent urination, hunger, weight loss, fatigue, irritability, and blurred vision.
If a person’s diabetes is not managed appropriately then low blood sugar levels (hypoglycaemia) can lead to a loss of consciousness. Symptoms of hypoglycaemia include trembling, sweating, anxiety, blurred vision, tingling lips, paleness, mood change, vagueness or confusion.
Diabetes is a growing medical problem in England and Wales, and it is a difficult condition to diagnose, treat and monitor. The issue of diabetes is further complicated by an underfunded, understaffed and undertrained NHS struggling to cope with growing demand and an aging population. Under these circumstances omissions and errors can occur.
Delay in diagnosis
If doctors and nurses do not heed signs and symptoms of diabetes, this can lead to a delay in diagnosis and the condition going unchecked and therefore untreated. Any delay in diagnosing diabetes, or any misdiagnosis, can lead to a patient developing complications, which can be life-changing.
Poor care and management
Quick diagnosis of diabetes is crucial, but adequate care and management of the condition can make the difference between remaining healthy and developing serious side-effects. Medical professionals must provide advice and treatment that allows diabetic sufferers to stay safe in order to prevent injury.
And if complications develop, such as problems with their feet caused by the blood being restricted, then medical professionals must provide a good standard of care to avoid an amputation.
Inadequate care in the community
Some diabetic patients require care in the community to manage their diabetes and any related conditions.
Vulnerable adults may need regular visits from district nurses in their own home in order to keep them safe. Elderly people within a care home environment will need a good standard of care to manage their diabetes. It is a complicated condition that requires the measuring of blood sugar levels, administering the correct amount of insulin, providing the right diet, and monitoring for infections. Diabetes management is further complicated if the elderly person also has dementia and other medical conditions.
Care homes and community health services are widely regarded as underfunded and understaffed. These pressures will impact on care quality. Temporary or undertrained staff will be used to plug the gap, which is when errors, omissions and neglect can occur.
If the worst does happen
Medical (or clinical) negligence is a serious breach of the duty of care that doctors, nurses and medical professionals ethically and legally owe to their patients.
It happens when serious errors in a person’s medical diagnosis or treatment are made. The breach of care will have caused, or materially contributed to, a person’s injury.
It is important to seek expert legal advice as quickly as possible to check a person’s legal rights and whether they have been a victim of medical negligence. A successful claim for compensation, if the person has been injured, can be important to the future quality of their life. Settlements can help fund private medical treatment, speed up rehabilitation, pay for extra care, changes to the home and car, replace earnings of a family carer, and help with the practical everyday expenses that inevitably come with illness.