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    Diabetes Mellitus 16-12-14

    Uploaded by

    smritiraj2001

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pptx, pdf, or txt
    of 18

    DIABETES MALLITUS

    Smriti Chauhan.
    Diabetes mellitus (DM), also known as simply diabetes, is a
    group of metabolic diseases in which there are high
    blood sugar levels over a prolonged period
    any one of the following-
    •
    Fasting plasma glucose level ≥ 7.0 mmol/l
    (126 mg/dl)
    •
    Plasma glucose ≥ 11.1 mmol/l (200 mg/dl) two
    hours after a 75 g oral glucose load as in a
    glucose tolerance test
    •
    Symptoms of hyperglycemia and casual
    plasma glucose ≥ 11.1 mmol/l (200 mg/dl)
    •
    Glycated hemoglobin (Hb A1C) ≥ 6.5%.
    •
    Serious long-term complications include heart
    disease,
    •
    stroke,
    •
    kidney failure,
    •
    foot ulcers and
    •
    damage to the eyes.
    •
    Type 1 DM results from the body's failure to
    produce enough insulin. This form was
    previously referred to as "insulin-dependent
    diabetes mellitus" (IDDM) or "juvenile
    diabetes". The cause is unknown.
    •
    Type 2 DM begins with insulin resistance, a
    condition in which cells fail to respond to
    insulin properly. As the disease progresses a
    lack of insulin may also develop. This form was
    previously referred to as "non insulin-
    dependent diabetes mellitus" (NIDDM) or
    "adult-onset diabetes". The primary cause is
    excessive body weight and not enough
    exercise.
    •
    Gestational diabetes, is the third main form
    and occurs when pregnant women without a
    previous history of diabetes develop a high
    blood glucose level.
    •
    Type 1 diabetes must be managed with insulin
    injections.
    •
    Type 2 diabetes may be treated with
    medications with or without insulin.
    Surgical complications of Diabetes are due to
    1) Micro vascular changes involving the
    capillaries of retina, kidneys, and peripheral
    nerves.
    2) Macro vascular changes characterized by
    atherosclerotic lesions of the coronary and
    peripheral arterial circulation.
    3) Diabetic neuropathy.
    4) Infection in glucose loaded tissue.
    Surgical complications in Diabetic
    Patient
    • Bacterial infections like abscesses, carbuncles,
    chronic balanitis, and diabetic foot.
    Emphysematous Cholecystitis,
    Emphysematous Pyelonephritis, Necrotising
    fasciitis and
    Fournier’s gangrene
    Fungal infections like candidiasis, Mucormycosis.
    • Sexual dysfunctions
    Diabetic foot
    • Most feared and devastating complication of
    diabetes
    • Most common cause for leg amputations
    • The classic pathological triad of the diabetic
    foot is vascular disease, neuropathy and infection
    Wagner’s classification for diabetic
    foot
    • Grade 0 : High risk foot. No ulceration
    • Grade 1 : Superficial ulceration
    • Grade 2 : Deep ulceration penetrating up to
    tendon, bone or joint
    • Grade 3 : Osteomyelitis or deep abscess
    • Grade 4 : Localized gangrene (Toes or fore
    foot)
    • Grade 5 : Extensive gangrene (mid foot or hind
    foot) requiring major amputation
    Neuropathic foot
    • Sensory, autonomic and motor neuropathy contribute
    to the pathogenesis of Neuropathic foot.
    • Motor weakness leads to atrophy of the small
    muscles of the foot with an imbalance between the
    flexors and extensors. This results in clawing of the
    toes and prominent metatarsal heads.
    High foot pressure develops under the metatarsal
    heads.
    • Dry, brittle skin (as a result of autonomic neuropathy)
    and high foot pressure lead to callus formation. The
    callus can cause tissue damage and ulceration.
    Diagnosis and assessment of
    diabetic foot
    Thorough neurological examination to detect
    sensory, motor or autonomic nerve deficit.
    H/o rest pain, intermittent claudication. Examination
    of peripheral pulses, capillary filling.
    Doppler study.
    Estimation of blood glucose, Hb.TLC,DLC, urea,
    creatinine
    and lipids.
    • X‐ray to detect osteomyelitis
    Management of diabetic foot
    •
    Infections are treated by wound debridement,
    proper antibiotic, multiple insulin injections to
    achieve good control of blood glucose.
    •
    Exercise, cessation of smoking. Use drugs like
    pentoxyphylline, aspirin, and thrombolytic agents to
    improve blood supply.
    •
    Angioplasty, bypass, stenting, atherectomy and laser
    ablation of atherosclrotic plaque
    •
    Attempt to convert wet gangrene to a dry one
    by repeated dressings and proper antibiotics.
    •
    Once gangrene sets in, decide for amputation.
    Surgery in diabetic patients

    • Diabetic patients are prone to develop sudden


    hyperglycemia or hypoglycemia during
    surgery. So, frequent monitoring of blood
    glucose is necessary.
    • Short acting insulin is given during surgery and
    in the immediate postoperative period.
    • They are admitted a few days ahead of
    surgery.

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