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CONTINUING PROFESSIONAL DEVELOPMENT
What else can Christina
do to reduce risks of
To reduce the risks of developing
diabetes‐related foot complications,
Christina should see a podiatrist on a
regular basis to assess the health of her
feet. She may require the assistance
of her podiatrist to select appropriate
footwear that supports her foot and fits
properly, to reduce her risk of tripping
and minimise shear on the skin of
It is important for pharmacists to
remember that, while peripheral
neuropathy is the leading risk factor for
foot ulceration, injury or trauma from
an external insult is often the initiating
cause of an ulcer. The Royal Prince
Alfred Hospital Diabetes Centre (NSW,
Australia) followed up 472 patients and
identified that trauma from footwear
initiated 50% of all foot ulcers that
developed in this group.3
A dietician and a diabetes educator will
also be invaluable for Christina, to help
her manage her diabetes to the best of
her abilities. Controlling blood glucose
levels can prevent further damage to the
vasculature and neurological anatomy
of her feet and other organs.
Where can Christina find
Education and support can
help Christina reduce her risk of
complications from diabetes. She can
receive important information and
advice from her diabetes educator,
pharmacist, GP, practice nurses,
Further information about foot care
and diabetes can be found through
the Diabetes Australia (www.
diabetesaustralia.com.au) and National
Diabetes Service Scheme (www.ndss.
com.au) websites, which have a wealth
of resources on diabetes with regard to
foot health, diet, treatments, and the
annual cycle of care.
1. Overview of diabetic foot ulcers (November 2011). In:eTG
complete. Melbourne: Therapeutic Guidelines; 2016.
2. Boulton AJM, Kirsner RS, Vileikyte L. Neuropathic diabetic
foot ulcers. N Eng J Med 2004;351(1):48–55 .
3. National evidence-based guideline on prevention,
identification and management of foot complications
in diabetes (part of the Guidelines on management of
type 2 diabetes) 2011. At: www.nhmrc.gov.au/guidelines-
4. Diabetes Australia. Foot care. 2015. At: www.
5. Greenaway T. The diabetic foot. Australian Wound
Management Association; 2006.
6. Edmonds M. Diabetic foot ulcers: practical treatment
recommendations. Drugs. 2006;66(7):913–29.
7. World Union of Wound Healing Society. Wound infection
in clinical practice. An international consensus. London:
MEP Ltd, 2008. At: www.woundsinternational.com/media/
8. NPS MedicineWise. Annual cycle of care for type 2
diabetes. 2016. At: www.nps.org.au/conditions/hormones-
9. Bergin SM, Gurr JM, Allard BP, et al. Australian diabetes foot
network: management of diabetes-related foot ulceration
— a clinical update. Med J Aust 2012;197(4):226–9 . At:
10. NDSS. Your feet. 2015. At: www.ndss.com.au/your-feet-
COUNSELLING IN PRACTICE
1. Damage to the autonomic nervous
system caused by diabetes may
a) Alterations to sweat production in the
b) Changes to foot shape through muscle
c) Loss of spatial awareness of the foot.
d) Burning and tingling of the shins.
2. Strategies to help prevent diabetic
foot complications include:
a) Changing to low-tar cigarettes for
b) Ensuring that footwear fits correctly
without rubbing or slipping.
c) Treating all corns and plantar warts with
salicylic acid preparations as soon as
they are identified.
d) All of the above.
3. A patient with diabetes presents to
the pharmacy seeking advice about
their cold, pale toes that feel numb.
These symptoms are most likely a
a) Motor neuropathy.
c) Sensory neuropathy.
4. Which of the following signs
and symptoms should prompt
pharmacists to refer a patient with
diabetes to a GP?
a) A swollen area on the foot.
b) A painful area on the foot.
c) A foot with splits in the skin.
d) All of the above.
Diabetes is a complex condition that causes many and varied symptoms, and leads
to progressive damage to various organs and body systems. When a patient with
diabetes presents to the pharmacy, it is important to:
• assess the possible involvement of diabetes in the current presentation
consider that this presentation may be a sign that diabetes management is not optimal
• remember that diabetes management requires a multidisciplinary team, to ensure
that issues don’t escalate.
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