SUMMARY: Diabetes mellitus is a common chronic disease that frequently features in medical malpractice Actions. Both duration of diabetes and effectiveness of treatment may be factors in the development of complications. Trivial injury to a diabetic foot may result in amputation of the leg. Diabetics have materially impaired healing capabilities.
Diabetes Mellitus that develops during, and is caused by, pregnancy increases the probability and severity of a number of risks to the fetus. Depending on severity of the mother's Diabetes Mellitus, the fetus may be at increased risk of spontaneous abortion, stillbirth, birth defects and macrosomia. The newborn infant is at increased risk of Idiopathic Respiratory Distress Syndrome, hypoglycemia and jaundice.
Non Insulin Dependent Diabetes Mellitus (NIDDM, Type II Diabetes) may become unstable and life-threatening when other acute illnesses supervene1. In general, diabetic oral medication should be discontinued during hospitalisation in favour of administration of insulin 2.
Both duration of diabetes and effectiveness of treatment may be factors in the development of complications.
Severe hypoglycemia is a medical emergency because permanent brain damage can occur within minutes. Accidental or intentional over-dosage of insulin or oral diabetic medications requires immediate administration of sugar, intravenously if necessary. Such administration is part of the empirical resuscitation of anyone found unconscious for no evident reason3. there are no medical conditions that will be harmed by an intravenous infusion of 50 ml of 50% glucose.
Practice PointFailure to administer intravenous glucose in undiagnosed coma may be Actionable |
Complications of diabetes include injury to the kidney (nephropathy) and eye (retinopathy) and injury to nerves (neuropathy). Diabetes causes both blockage of the smallest blood-vessels, capillaries (microangiopathy) and accelerated peripheral vascular disease that results in severe blockage of large arteries.
Trivial injury to a diabetic foot may result in amputation of the leg.
Neuropathy and arterial disease combine to make foot problems commonplace. 20% of all diabetics are hospitalised for foot problems, and diabetes accounts for about half the 100,000 non-traumatic lower extremity amputations in the US each year4. It is commonplace for a relatively minor injury to a vulnerable diabetic foot to trigger a sequence of events that ends with below-knee or above-knee amputation of the leg.
Earlier diagnosis and control of diabetes can slow or prevent injury to the kidney (nephropathy) and eye (retinopathy) but not injury to nerves (neuropathy)5. Many drugs have been investigated for prevention of diabetic neuropathy, but none has yet proved successful6.
Practice PointDelayed diagnosis and treatment of diabetes mellitus may or may not be Causally related to adverse outcome |
Diabetes contributes significantly to MVAs in the elderly.
Wound healing generally is impaired by diabetes. As well as neuropathy and microangiopathy, immune factors7 and biochemical abnormalities contribute to the impairment8. In skin, bowel and other tissues that have undergone accidental injury or surgery, scars of diabetics remain weak9.
Most Type II Diabetics are obese, and obesity is probably an additional and independent risk factor for impaired healing10.
Practice PointSurgeons may fail to disclose to diabetic patients the materially worse prognosis for healing |
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