by Hannah Farrell
Our expert witnesses in diabetes medicine specialise in the care of individuals with type I diabetes, type II diabetes, gestational diabetes, and pre-diabetes. Through their finesse at optimising blood glucose control, our expert witnesses in diabetes help reduce disease progression and avoid the development of diabetic nephropathy (kidney disease), diabetic neuropathy (nerve disease), diabetic retinopathy (eye disease), diabetic foot disease, and diabetic ulcers. Our experts in diabetes have a profound knowledge of managing complex patients with multifactorial disease and psychosocial difficulties.
With a strong understanding of appropriate standards of care and NICE Guidelines, in addition to a thorough knowledge of treatment pathways, our expert witnesses in diabetes medicine can advise on causation, breach of duty, current condition, and prognosis in individuals with diabetes.
See below for a brief overview on diabetes. Alternatively, contact an expert witness in diabetes medicine to see how they can help.
What is Diabetes?
Diabetes is a condition whereby there is insufficient, or a total absence of, insulin in the body or the body does not respond appropriately to the insulin produced. This leads to the improper metabolism of glucose and high circulating blood sugars. Individuals commonly present with increased thirst (polydipsia) and increased urination (polyuria).
Insulin is produced by the pancreas in the body. This converts the sugar in our diet into glycogen, which can be stored in our body for energy.
Type I diabetes is an autoimmune condition that develops in childhood, where no insulin is produced by the pancreas; these individuals are insulin-dependent.
Type II diabetes develops later in life; there is insufficient insulin produced by the pancreas and the body does not respond well to the insulin that is produced. Individuals with Type II diabetes can manage their condition with lifestyle changes and a strict diet; however, they do sometimes require medication and insulin therapy.
Both type I diabetes and type II diabetes result in high levels of blood glucose, which has a detrimental effect on numerous areas of the body. Diabetes can result in the following complications:
- Diabetic vascular disease;
- Diabetic nephropathy;
- Diabetic neuropathy;
- Diabetic retinopathy;
- Diabetic foot disease; and
- Diabetic ulcers.
Diabetic Vascular Disease
High levels of blood glucose damages blood vessel walls, leading to the narrowing, hardening, and total occlusion of the small blood vessels that supply organs and tissues. This presents as cardiac disease, kidney disease, peripheral nerve disease, eye disease, and poor healing.
Diabetic Nephropathy
Individuals with diabetes are susceptible to developing renal atherosclerosis (hardening and narrowing of the blood vessels supplying the kidneys), urinary tract infections, and glomerulosclerosis (hard and fibrosed kidneys). The kidneys become more “leaky” and protein is excreted in the urine (proteinuria).
Diabetic Neuropathy
The blood vessels supplying the nerves become damaged by the high circulating blood sugars. The nerves no longer receive a supply of nutrients and die. This commonly affects the smaller, more peripheral nerves, leading to numbness and paraesthesia in the hands and feet (peripheral neuropathy).
Diabetic Retinopathy
High blood sugar levels result in damage to the back of the eye (retina) which leads to blurred vision, floating spots, and may eventually result in total loss of vision. Diabetic retinopathy has four stages: mild non-proliferative, moderate non-proliferative, severe non-proliferative, proliferative. Diabetic macular oedema and neovascular glaucoma can also develop. People with diabetic eye disease are also at a higher risk of developing retinal detachment.
Common signs on examination of the diabetic eye include:
- Cataracts;
- Microaneurysms;
- Hard exudates;
- Flame haemorrhages;
- Cotton wool spots;
- Neovascularisation; and
- Macular oedema.
Diabetic Foot Disease
The combination of peripheral neuropathy and poor circulation creates a recipe for feet at risk of complications. The loss of sensation, in addition to the poor blood supply to the soft tissue, means that even slight trauma to the foot from something as small as pebble in the shoe can go undetected and lead to breakdown of the skin and development of a foot ulcer.
Diabetic Ulcers
Reduced blood supply to the lower limbs leads to ischaemic changes and tissue death. As the skin breaks down, ulcers develop. In combination with the susceptibility to infection, these ulcers are at risk of becoming infected and require specialist management.