Professional Documents
Culture Documents
Diabetes Mellitus 16-12-14
Diabetes Mellitus 16-12-14
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