Chronicles of the Avoidable

Diabetes has been recognized for a number of years as a serious, sometimes fatal condition. However, today, diabetes is thought to be rampant, described by the Centers for Disease Control (CDC) argued as one of the “epidemics of our time” (CDC 2019).

It should be stated that diabetes is delicate, with some ideal conditions that should be met regardless, otherwise, complications are inevitable. This is a story of a young adult, XYZ, who was diagnosed with type 1 diabetes in 2015. He has had to fend for himself in the less remote areas of Zimbabwe, but always got aid from his sister, with regards to insulin drugs and syringes. Now, XYZ got amputated his foot due to a severe foot ulcer.

Some authors argued that the diagnosis of type 1 diabetes in children is usually straightforward and requires little or no specialized testing, (most children present with a several-week history of polyuria, polydipsia, polyphagia, and weight loss, with hyperglycemia, glycosuria, ketonemia, and ketonuria).

Living with any form of diabetes, you are strongly recommended to adhere to medically prescribed regimens. However, socioeconomic factors may be a hindrance for some families to access their optimal medical supplies. XYZ is not an exception, normally he would need at least two vials of insulin but he can only access one; he needs to be visiting the diabetes team at least once in 3months at the Outpatient Department for review, just to mention a few conditions. However, he has been rationing insulin and we cannot start to mention whether he has been monitoring his blood glucose levels at home, as this may seem luxurious but that seems odd.

Diabetes has been nothing but burdensome to some families and it will remain unabated, if access to care has not been made improved as was done for the HIV and AIDS fraternity of Zimbabwe in the 20^th century, through the introduction of the National AIDS Trust Fund or ‘AIDS Levy’.

XYZ was hospitalized in April due to a foot ulcer that had become severe and the medical practitioners thought the natural next step was to amputate the foot otherwise there would risk of losing the leg. Mr. XYZ wished he had much support from his extended family and help to relieve the pressure upon his sister who has been playing much of the mother-figure roles. Now, he blames himself and thinks of himself as a heavy burden on his sister who has to consistently visit him in the hospital and at times supplements the medication that may be required while her brother is still in the hospital. Thus, she is committed to fostering her brother, regardless of her low income and her busy schedule at her workplace.

As it is, XYZ could neither stand nor walk, after his amputation. He can barely support himself to do some of the things he used to do on his own. We can safely say that the amputation has brought about some unforeseen challenges. We learned that XYZ spends all of his time in his bed (fortunately and unfortunately, he's still in the hospital). Foot ulcers and amputation, which are consequences of diabetic neuropathy and/or peripheral arterial disease (PAD), are common and represent major causes of morbidity and mortality in people with diabetes, as postulated by the American Diabetes Association (2022). 

For proper glycemic control, Mr. XYZ needs medication daily as per prescription (just like everyone else living with any form of diabetes) but now on top of that, he will need his hospital bills taken care of, and most importantly, he will either need a wheelchair or crutch and as it is, he does not know who might volunteer to stay with him, at a place closest to the hospital. Sadly, he lost his mother at an extremely tender age and lost his father while in the hospital. Yes, we may decide to donate a glucometer but it will be another story to get access to the suitable test strips, as everything is from out-of-pocket. Hence, Mr. XYZ’s story is like no other but it’s the reality of a 25yr old gentleman, based in less remote areas but greater educational background. However, the support from family has been minimal and if it was not for the love of the aforementioned sister, there would not have been XYZ.

Therefore, there’s a deep need for diabetes bodies that are committed to empowering, educating, and providing aid to those in dire need. Alas, these may have a short-term goal but the permanent solution would be to enact the Health Fund, which is premised on: Universal health coverage (UHC), which “means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship”, in the hope to achieve the once adopted 2030 Sustainable Development Goals (SDGs) in 2015. 

For the benefit of all our readers, below is a list of some recommendations on foot care by the American Diabetes Association:

• Patients with evidence of sensory loss or prior ulceration or amputation should have their feet inspected at every visit;
• Obtain a prior history of ulceration, amputation, Charcot foot, angioplasty or vascular surgery, cigarette smoking, retinopathy, and renal disease and assess current symptoms of neuropathy (pain, burning, numbness) and vascular disease (leg fatigue, claudication);
• Patients with symptoms of claudication or decreased or absent pedal pulses should be referred for ankle-brachial index and for further vascular assessment as appropriate;
• The use of specialized therapeutic footwear is recommended for high-risk patients with diabetes including those with severe neuropathy, foot deformities, ulcers, callous formation, poor peripheral circulation, or history of amputation

in conclusion, foot ulcers and wound care may require care by a podiatrist, orthopedic or vascular surgeon, or rehabilitation specialist experienced in the management of individuals with diabetes.