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however, it is important to note that glucagon receptor activation also stimulates hepatic glucose production, and the net metabolic effect of this component in humans is still being characterised
Patients should be advised to contact their GP or diabetes care team promptly if they experience any of the following: Emergency (999/A&E attendance): Urgent referral indicators (same-day assessment to multidisciplinary foot care service): Ulceration or breaks in skin integrity (any suspected diabetic foot ulcer) Signs of infection : warmth, redness, swelling, discharge, or systemic symptoms (fever, malaise) Severe pain , particularly if sudden in onset or associated with colour changes Suspected acute Charcot foot : red, hot, swollen foot, often with minimal pain in the presence of neuropathy Ischaemic signs : cold feet, absent pulses, pallor, or pain at rest Unilateral, painful swelling (possible deep vein thrombosis) Routine review appropriate for: Persistent foot pain or discomfort affecting mobility or quality of life Gradual onset of tingling or altered sensation Bilateral, mild swelling that resolves with elevation Concerns about foot shape changes or difficulty finding appropriate footwear Development of calluses, corns, or areas of pressure Patients with established diabetic neuropathy or peripheral arterial disease should have enhanced surveillance and may require referral to specialist podiatry or multidisciplinary diabetic foot services, in line with NICE NG19 recommendations
Barker JE, Bolafiosb JP, Land JM, Clark JB
