Dishum Dishum 2022

An innovative patient centric initiative held yearly to
diabetes and its complications!


November is a diabetes month. Kauvery Hospital has always managed to observe this month in a very special, innovative, simple and interactive way. To reconnect and recollect the yearly effort, this year I would like to share also the knowledge experienced over the last two years during COVID-19. COVID gave us a chance to rethink the way we practiced diabetic foot and its complications in some extraordinary situations. Financial, physical, emotional challenges were tackled in some equally extraordinary ways.

Everything was fine tuned with patient centric education, patient friendly clinical medicine and providing efficient, cost conscious, timely treatment. Any problem was no problem for the Dishum Dishum fight with diabetes and its complications @ Kauvery. A lot has been learnt and reflected upon. With the multiple avenues provided at Kauvery for dissemination of knowledge, the experience gained by every department has been successfully shared. Dishum Dishum is yet another successfully run programme where the patient has the chance to physically interact with all aspects of diabetes and benefit enormously. This helps fight diabetes and its dreaded complications. We welcome all for this year’s Dishum Dishum for a united fight against diabetes. This article once again is to share a patient centric chart to easily and effectively be educated about diabetic foot and its complications.

Diabetic foot is a huge burden but a proper knowledge is valuable for looking after it. Disease burden and the foot at various stages of diabetes foot complications are shown clearly in this chart. The number of patients with diabetes and complications are said to rise exponentially with chance of losing the limb staring dangerously at our faces.


I am sharing our practice of diabetic foot care. This starts with a patient friendly, simple chart, which is colour-coded and helps understand diabetic foot and its complications as they might arise while at home. It is the patient, close relatives or the caregivers who can spot the changes in a foot. They can spot the red flags and refer to the chart, which gives a quick and simple guide to look at any evolving complications.

Now let us look at the chart below.

The chart takes into account the spectrum of patients presenting as diabetic foot and its complications. The chart also emphasizes the need and urgency for seeking medical help (i.e., time since noticing a change in the foot) and more importantly the need to go to the right venue containing all the facilities and expert knowledge. That is why the chart is titled “Venue Time Based Notion in Management of Diabetic Foot”. The chart helps the patient to localize his condition in the chart and act accordingly.


There could be three categories of patients. Our own old patients, who have no ulcers. These could be recently diagnosed and are concerned patients. They need to be reassured and educated. Those who have been treated and have booted the diabetic foot out Dishum Dishum. This second category is worried if they could be victims again. The next category is one who have existing ulcers, those who are healing and well on the way to kicking Dishum Dishum to the ulcer complications. The category falling into the yellow column are those who need to be very wary and be aware of the danger signs in the foot in existing ulcers or a recent ulcer which needs to be observed by the patient or the care givers. This is an emergency limb or life critical situation. Those patients who fall in the red column are those who are very critical and may or may not be able to save the limb or life. Concomitant COVID made this group very vulnerable and very critical. Hesitancy, late referrals, financial, social, mobility issues or just fear of coming to hospital were some of the causes of increased limb loss and death.

Time of occurrence and time taken to seek medical help is represented in the horizontal rows. Delay will push a patient from the white or blue column to the red column. Similarly, the vertical column guides us on where to go for help and how we could be treated.

Diabetic foot is very simple to understand by the public if this chart is followed. Simple and basic knowledge helps in sensitizing the patient and the health care workers. It only remains to be seen if the patient is moving from right to left and well on the way to recovery. Very critical patients with COVID or with other comorbid conditions may dishum dishum us and we lose a limb or the patient. Always ask your doctor to see if danger signs are appearing or on way to recovery. Right time, appropriate venue for treatment by doctors who have the expertise and passion to treat diabetic foot is invaluable to kick Dishum Dishum. For more information, please visit the Diabetic Foot Society of India also.


Prof V. B. Narayanamurthy
Senior Consultant Plastic and Diabetic Foot Surgeon
Kauvery Hospital Chennai

President Diabetic Foot Society of India