Nick Howsam, 28th April 2016

Nick Howsam, 28th April 2016

Nick Howsam MChS, BSc(Hons) Pod, BSc Hons.

Podiatrist and Chiropodist

Nick’s great personal knowledge of diabetes and mine of experience with foot care ensured a packed audience for his return talk to the Group. He started by reminding everyone that the 130 limb amputations each week cost The NHS £252 million each year (and rising) with some 20% of NHS funds now being spent on treating foot problems whilst so much of this cost and suffering is avoidable with good diabetes management.

Of all diabetes management aims the key to avoiding this and other following outcomes is the control of blood sugars. Poor foot care leads to reduced mobility, loss of independence and consequent depression with disfigurement and mortality as possible outcomes.

All this derives from poor control of blood sugars and cholesterol leading to the loss of vital capillaries and nerves. Because a good blood supply to both feet is thus essential an important foot check for diabetics involves scanning the flow in each foot’s main arteries (one on the top of the foot and one on the bottom). Nick demonstrated two types of scanner that amplify the pulse, a triphasic pulse will be heard in young and healthy feet, this reduces to a biphasic pulse in still healthy though older feet where arteries are less flexible, but drops to monophasic where atherosclerosis and blocking have occurred.

He encouraged diabetics to check their feet daily (a floor mirror helps with this for older people) looking for any changes to skin colour, redness, soreness, swelling, shiny skin (= infection) breaks or any discharge. He explained the processes involved with arterial damage and high blood pressure and detailed the different types of neuropathy (nerve damage) and their consequences.

In caring for feet Nick advised that choosing the right style and fit of shoes is important. Shoes should accommodate the shape of each foot; have a good fitting heel cup, good fastening and a toe area deep enough to accommodate all toes. He also recommended poron insoles for cushioning when needed. The major problem of ulceration usually relates to peripheral neuropathy and of course for diabetics with high blood sugars bacterial infections follow.

For diabetics, lifestyle, that is plenty of exercise and healthy food, is a very important part of blood sugar management, as is avoiding dry skin by using skin creams containing 10% urea.

To conclude diabetics in the audience were delighted that Nick, who is a Type 1 diabetic, was willing show them and explain the advantages and costs of the new FreeStyle Libre system of checking the body’s sugar levels. This avoids constant finger pricking and with the sensing patch in place on the skin it gives a constant measure of the interstitial glucose level which can be read simply by passing a meter over it, moreover it indicates whether the level is rising or falling allowing much greater awareness and thus control of blood sugars.

As ever with a well-informed speaker there was a long and valued question and answer session.

Nick Howsam’s contact number is 07717 124 907