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Diabetic Complications and Frostbite

Diabetes, and more specifically, diabetic complications such as neuropathy and poor circulation, made headline news last week when the 68-year old British explorer, Sir Ranulph Fiennes, had to pull out of a grueling expedition to cross Antarctica.

An earlier medical check-up before the journey, had indicated that the noted explorer, “was on the verge… of type 2 diabetes” according to an interview with BBC News in Cape Town, SA. Although the explorer’s theory that a recent deterioration in circulation caused by diabetes may have led to severe frostbite and the subsequent potentially permanent loss of the use of his left hand has not yet been confirmed, there are lessons to be learned from Sir Ranulph’s near disaster.

The explorer described the moment he realised that five years of meticulous preparation for a staggeringly dangerous journey had just ended for him.

He was skiing alone, just over two hours from his colleagues, on a flat but rutted track in a white-out – meaning zero-visibility – and testing some new equipment, when he noticed the snow had loosened the bindings on his skis and “one was slipping all over the damned place.

“I had to tighten them up. I tried with the outer gloves and couldn’t do it. I had to take the [outer and] inner gloves off – no alternative – and use my hands. But that’s OK. Minus 30 or warmer – that’s the norm.”

It took less than 20 minutes for him to secure the bindings, but then “I suddenly realised that one of [my hands] had gone… the other one which also had the mitts off was perfectly alright.

“Once you see that it’s like wood when you tap the skis I knew that I was in trouble and would have to get back.”

With his left hand useless, he struggled slowly back to his team-mates in their vehicles, already aware that “the situation had suddenly, unexpectedly and with a high degree of frustration reached a situation where that hand wasn’t going to be any good for -40C let along -80”.

Excerpted from BBC News 

Lessons Learned:

Our publisher, Steve Freed, found the following article from Frostbite and Diabetic Neuropathy, Wounds. 2003;15(12) :

Diabetes and Prediabetes Increases the Risk of Frostbite

When the body is exposed to cold, the blood vessels close to the skin begin to narrow in order to preserve core body temperature. While this is perfectly normal, people with the following medical conditions, or who are taking the following medications, have a much higher risk of frostbite. You should be particularly alert to the signs of frostbite in seniors who:

Have Diabetes:
While diabetes, the inability to break down glucose, does not in and of itself increase the risk of frostbite, diabetes causes damage to the nerve endings. This damage, particularly in the feet, legs, arms and hands (peripheral neuropathy), can impair the ability to feel the pain associated with too much cold. Individuals with peripheral neuropathy may experience frostbite before they are aware that their hands and feet are too cold.

Have Had Frostbite in the Past:
Skin which has suffered frostbite in the past is more susceptible to re-injury. Although an older man may not have mentioned it, soldiers who served in cold conditions during WWII and in Korea may well have suffered frostbite.

First Aid For Frostbite
If, in spite of precautions, someone you are with suffers frostbite, here are the immediate steps to take:

  1. Move the individual indoors to a warm place. Remove any jewelery that may restrict circulation (rings in particular), tight clothing such as boots, and any wet clothing.
  2. If possible, take the individual for professional medical attention immediately.
  3. Do not rub the affected skin to re-warm. Friction can do serious damage to frozen skin.
  4. Do not use “direct heat” such as from a fire, radiator, heating pad or hair dryer to warm the affected skin. This kind of heat can further damage tissues.
  5. Do not offer alcohol.
  6. If you cannot get immediate medical attention, warm the affected area by immersing it in warm (not hot) water or with warm, wet cloths. Water should be no more than warm (104 degrees is pleasantly warm). This may cause severe, burning pain and swelling. Use dry, sterile dressings on the affected areas, including between fingers or toes to keep them apart.
  7. Seek medical attention as soon as possible.

 

Report Medication Errors to ISMP:

Diabetes in Control is partnered with the Institute for Safe Medication Practices (ISMP) to help ensure errors and near-miss events get reported and shared with millions of health care practitioners. The ISMP is a Patient Safety Organization obligated by law to maintain the anonymity of anyone involved, as well as omitting or changing contextual details for that purpose. Help save lives and protect patients and colleagues by confidentially reporting errors to the ISMP.

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