2. 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
3. In diabetes pt have 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%.
4. Complications
• Serious long-term complications include heart
disease,
• stroke,
• kidney failure,
• foot ulcers and
• damage to the eyes.
5. Types
• 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.
6. Continue..
• 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.
7. • 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.
8. 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
9. 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
10.
11. 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
12. 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
13. • Attempt to convert wet gangrene to a dry one
by repeated dressings and proper antibiotics.
• Once gangrene sets in, decide for amputation.
14. 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.
15. • Oral hypoglycemic drugs are stopped a few
days before major surgery and insulin is
started, to bring about better control of blood
sugar. Insulin is continued for a few days in the
postoperative period also.
• Wound healing is likely to be delayed
