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Nail Sugery & the Paediatric Type 1 Diabetic

Discussion in 'Diabetic Foot & Wound Management' started by shepod, Apr 9, 2009.

  1. shepod

    shepod Welcome New Poster

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    I am wondering if anyone has (or can point me in the direction of) information or guidelines for best practice in undertaking nail surgery on a paediatic Type 1 diabetic, particulary upper HbA1c range? I have come across a few local policies where the cut off ranges from 8% to 12% but none of those I have had contact with were able to provide evidence on why they settled on the figure they had. I understand that ours was a decision made by our Consultant Diabetologist. As a result I am keen to know what others are doing, how they arrived there and if they have any evidence to support it.

    I will be hugely appreciative of any information or suggestions you are able to provide.

    Thank you, Shepod

    ps. I am mortified I have spelt surgery wrongly in the title but can't work out how to edit it!
    Last edited: Apr 9, 2009
  2. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Young people with Type 1 DM have surgical procedures without fuss routinely. Yes, a wayward HbA1c is of some interest in terms of risk profile for infection, but beyond that there is little reason not to perform a minor procedure of this nature under local anaesthesia if it is indicated. If the patient has always had trouble containing there HbA1c to the desired target, then that just might be they way it is despite the best (or worst) of care.

    Professional courtesy suggests inform the treating endocrinologist/diabetologist and family doctor of your plans, and why the surgery needs to be done, in case you need their assistance with a postoperative infection.

    Though sometimes multidisciplinary care is sometimes great in theory, but a let-down in reality...

  3. twirly

    twirly Well-Known Member

    Hi Shepod,

    :welcome: to Podiatry Arena.

    :eek: Been there, bought the T-shirt.

    You could try clicking the 'edit' feature at the bottom of your post. (There is only a limited time to edit though). I'm unsure if this will allow you to alter the title.

    If you had just posted & not yet had any replies you could delete the thread as the thread starter & started over.

    Best regards,


    PS. My typos are (usually though not always) reduced by previewing my posts before I submit reply. :empathy:
    Last edited: Apr 11, 2009
  4. Rie

    Rie Guest

    As a Pod working primarily within the NHS, I quite readily provide a nail surgery service to youngsters with IDDM. If there is concern re: HbA1c then I'll discuss it with their Diabetologist but have yet to receive a negative response. Generally by the time they get to us they are in such a state that if we didn't operate they would only get worse anyway. I have been known to remove nails (under local anaesthetic - are you listening Robert) from very poorly controlled, 90+ year old diabetics with extremely iffy circulation. I just make sure that they/family are fully aware of every possible outcome, are fully able to consent and I obtain signed fully informed conset at every stage. I also monitor anyone I consider to be 'higher risk' more closely post surgery than I would do otherwise. It is generally a case of making a fully informed, professionally competent decision. I am comfortable doing so. I have also made the decision (far to many times sadly), athough never yet for a child, to tell the patient that the best I can do is prescribe regular podiatric care (which within the confines of the NHS if far too infrequent for most). I would not however generally feel comfortable making these decisions when working as a private practitioner (although I am in the lucky situation of being able to refer my patients into my own NHS dept where I know the level of care they will get). If you have the opportunity to discuss care with consultants or with peadiatric DSNs, or even district nursing or school nursing teams get them involved- they are an amazing and undervalued resource. And to get back to your original question - I have performed a Both 1st Bilateral PNA on a 13 year old in a diabetic coma on a HDU, kid now ok (3 years on), no regrowth - and that was done outside the NHS because the manager at that time veto'd it so the kids parents went private!

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