Diabetes foot care and eye screening: the daily check, the yearly appointments and when to act

The signs that the nerves or blood supply are changing come on slowly. Diabetes UK lists tingling or pins and needles, burning pain or a dull ache, numbness, feet that no longer sweat, shiny smooth skin, hair loss on the legs and feet, and cramp in the calves. None of these is an emergency, and all of them are worth mentioning to the GP or diabetes nurse.

If you are new to the condition itself, what diabetes is, and how type 1 and type 2 differ covers the background.

Sit your relative in a chair with good light, sit or kneel in front of them, and take one foot at a time. Look first and then feel: Diabetes UK names a foot that feels much hotter or colder than usual as one of the signs to act on, and a hand on each foot will tell you that faster than your eyes.

If they can do the check themselves, let them. If they cannot see the soles, Diabetes UK suggests a mirror, with the person sitting or lying down. If they cannot see well or bend that far, somebody else needs to look. The Doncaster and Bassetlaw NHS foot leaflet says that a person whose sight is not good should make sure somebody looks at their feet every day.

That somebody can be a partner, a son or daughter, or a carer who comes in each morning or evening to help with washing and dressing. Looking at the feet, washing and drying them carefully and rubbing in a prescribed cream are part of ordinary personal care. If nobody in the family can be there every day, you can search for carers near you and compare their rates, then meet the ones you like and agree the routine with them directly. Every carer on PrimeCarers has had their identity and right to work checked, an enhanced DBS check (or PVG in Scotland, Access NI in Northern Ireland) issued within the last 2 years, and an online interview. Carers are insured while they work. We do not check training, so what a carer says about their experience with diabetes is their own account on their profile, and it is worth asking them about it when you meet.

Whoever does it, write down what they see, such as "small red mark on left little toe, shoes changed", so the next person knows what to look at and the GP or podiatrist has something to go on.

On nails, Diabetes UK's general advice is to cut them regularly with clippers, not too short and not down the sides, then file the corners. The Royal College of Podiatry goes further and says that people who have diabetes should not try to cut an ingrowing nail themselves. In practice, ask at the yearly foot check who should cut your relative's toenails. If their feet are at low risk and the nails are healthy, the answer may be the family or a carer, and our guide to mouth, nail and foot care at home sets out how. If not, the podiatrist does it.

NHS podiatry for people with diabetes is linked to their risk level. NICE says people whose feet are at moderate or high risk should be referred to the foot protection service, a team that assesses the feet, gives and provides skin and nail care, and looks at whether special shoes or insoles are needed. If you pay for a private podiatrist, the NHS foot leaflet advises checking they are registered with the Health and Care Professions Council.

At the check, the nurse or podiatrist looks at the whole of both feet, including between the toes. Diabetes UK describes them feeling for the pulses in the feet or using a small handheld scanner called a doppler, and testing feeling with a tuning fork and a thin nylon filament touched against the skin. They will also ask about pain and how the feet are looked after at home.

Before you leave, make sure you know two things: which risk group your relative is in, and who to ring if something changes. NICE says people should be given their current risk, foot care advice and the details of who to contact in a foot emergency, both spoken and written. If the leaflet does not have a phone number on it, ask for one, and put it somewhere everyone who helps can see. If your relative has kidney disease, note that NICE puts anybody on dialysis in the high-risk group, and kidney disease and dialysis days covers the rest of that week.

While you wait, Diabetes UK says to sit or lie down, take the weight off the foot and raise it if you can. If the GP or foot team cannot be reached, it says to use the out-of-hours service, and its main page on feet says to call 111 for advice if you cannot get through. The NHS foot attack leaflet adds that if nobody is available and there is no sign of healing after a day, go to the out-of-hours service or A&E. A spreading foot infection can lead to sepsis, so the signs of sepsis in an older person are worth knowing too.

1. 1

   The letter arrives

   Every year, or every 2 years

   Everyone with diabetes aged 12 or over is invited by letter. The NHS says the invitation comes when diabetes is diagnosed, then every year, or every 2 years if the last two tests found no changes. If a letter is overdue, ring the GP practice or the local screening service.
2. 2

   Plan the journey home

   Before the day

   The drops blur the sight for a few hours, so the NHS says your relative will not be able to drive afterwards. Arrange a lift or somebody to go with them, and bring glasses and sunglasses, because everything may look bright.
3. 3

   The appointment

   About 30 minutes

   They read some letters on a chart, then drops go in to widen the pupils, which can sting briefly. Once the drops work, photographs of the back of each eye are taken with a flash.
4. 4

   The result

   By letter, usually within 3 weeks

   No changes means screening again in around 1 to 2 years. Some changes means screening again in a year or sooner. Changes that could affect sight mean a referral to a specialist.

Eye screening is not the same as a sight test at an optician, and the NHS says both are needed. Screening looks only for diabetic retinopathy. An optician checks the glasses prescription and looks for other eye conditions, such as glaucoma, that can be linked to diabetes. A sight test is free on the NHS for anybody diagnosed with diabetes, and for anybody aged 60 or over.

Coming home unable to see clearly is harder for an older person, and a carer can go with your relative to appointments if the carer agrees. Under the client contract, any mileage or travel cost is paid only if you and the carer agree it in advance, in writing.

Between screenings, the NHS says to ask for an urgent GP appointment or get help from NHS 111 if somebody with diabetes notices their sight suddenly getting worse or becoming blurred. Floaters, or struggling to see in low light, are for the GP, diabetes team or an optician, without waiting for the next letter.