To prevent amputations in patients with peripheral disease it is important to ensure early referral to a vascular surgeon. Early referral to an orthotist for special shoes can prevent amputation in the neuropathic foot.

Nutrition advice: As for anybody, the usual advice for healthy eating is to have at least five pieces of fruit and vegetables a day; to restrict alcohol to fewer than three units a day for women or four units a day for men, and to limit salt intake. Calorie restriction is important if the individual is overweight, and advice should be given about having less fat overall, with proportionately more monosaturated and polyunsaturated fat. If the cholesterol level is above target, a referral should be made to the GP for possible treatment with a statin.

Patients who are having difficulty achieving their targets on nutrition should be given an opportunity to see a dietitian preferably a diabetes specialist dietitian.

Conclusion
When screening for complications and running diabetes clinics, nurses need to be aware that psychological and social issues will have a bearing on how patients view their diabetes and whether they are likely to make lifestyle changes.
The role of the patient with diabetes is as an active decision-maker and the role of the nurse in this case is to provide information, direction and support. The nurse will be assessing risk, so that appropriate interventions can be made at appropriate times. In addition, the nurse should regard every annual review or screening visit as an opportunity to find out what information the patient has and to fill in any gaps, supported by educational materials. Exploring why patients may not feel able to make changes to their lifestyle and to undertake suggested treatments may help the nurse to suggest actions that such patients are likely to follow.

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