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3 types:

1) Type 1 diabetes
2) Type 2 diabetes
3) Gestational diabetes


Complications :
- Stroke
- Heart attack
- Kidney disease
- Eye Disease
- Nerve Damage
There are three main types of diabetes mellitus:
Type 1 DM results from the body's failure to produce
insulin. This form was previously referred to as "insulin-
dependent diabetes mellitus" (IDDM) or "juvenile
diabetes".
Type 2 DM results from insulin resistance, a condition in
which cells fail to use insulin properly, sometimes also
with an absolute insulin deficiency. This form was
previously referred to as non insulin-dependent
diabetes mellitus (NIDDM) or "adult-onset diabetes".
Gestational diabetes, is the third main form and occurs
when pregnant women without a previous diagnosis
of diabetes develop a high blood glucose level.


Fasting Plasma Glucose Test
(FPG) - (cheap, fast)
*fasting B.G.L. 100-125 mg/dl
signals pre-diabetes
*>126 mg/dl signals diabetes


Oral Glucose Tolerance Test
(OGTT)
*tested for 2 hrs after
glucose-
rich drink
*140-199 mg/dl signals pre-
diabetes
*>200 mg/dl signals diabetes

80 to 90 mg per 100 ml, is the normal fasting blood glucose
concentration in humans and most mammals which is
associated with very low levels of insulin secretion.

A.K.A.: Glycated Hemoglobin tests
A1C
Type 2 diabetes is frequently associated
with obesity. Serum insulin levels are
normal or elevated, so this is a disease of
insulin resistance.
Type 1 diabetes must be managed
with insulin injections.

Type 2 diabetes may be treated with
medications with or without insulin. Insulin
and some oral medications can cause low
blood sugar, which can be dangerous.
Gastric bypass surgery has been successful in
many with severe obesity and type 2 DM
.Gestational diabetes usually resolves after
the birth of the baby.

Type 1 diabetes always requires daily
replacement of insulin and regular blood
glucose testing and monitoring for possible
complications of diabetes
In early stages of type 2, changes in lifestyle
may control the disease. Oral insulin
sensitizing drugs may be given, as well as
antidiabetes medications.

High blood sugars can lead to poor blood flow
and nerve damage. This can lead to slow
healing of sores. You can experience severe
pain, but you can also lose feeling in your feet.
In serious cases, this may lead to amputation of
your toes, foot, or leg.
Symptoms of nerve damage include:
Burning pain
Numbness
Tingling or loss of feeling in the feet or lower legs
Constipation and diarrhea


Diabetic comas
Diabetic hypoglycemia
Diabetic ketoacidosis
Hyperglycemic hyperosmolar state
Diabetic angiopathy
Diabetic foot
ulcer
Neuropathic arthropathy
Diabetic myonecrosis
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy
Diabetic cardiomyopathy
Diabetic dermadrome
Diabetic dermopathy
Diabetic bulla
Neuropathic ulcer

Diabetic Ulcer
Ischemic Neuropathic
Appearance
Glossy skin.
Yellowish stuck-on base.
May be painful.
Erythematous.
Prognosis & Treatment
Poor prognosis without re-vascularization Meticulous
wound care to avoid chance of infection.
No pressure over area.
Vascular Consult / Vasodilators.
Dont debride.
Dont soak.
Appearance
Hyperkeratotic rim.
Beefy red base.
No pain.
Near bony prominence.
Prognosis & Treatment
Good prognosis if pressure decreased.
Control infection.
Debride necrotic tissue.
Custom shoe vs. total contact cast.
patients presents with foot having no
sensation .
Due to neuropathy ,an infection can
spread leading to gas gangrene in
diabetic foot.
When damage to the foot is more
extensive and can not be treated
conservatively, an amputation with or
without reconstructive vascular surgery
may be indicated. These cases will be
treated in order of severity.
diabetic complications may require penile
prosthesis implantation, ulcer debridement,
or limb amputation.
During the postoperative period, diabetic
patients face poor wound healing,
increased incidence of acute renal failure,
and increased infection rates
Gangrene
Remove shoes and socks and
Look for any deformity
Look for inappropriate shoes

10 gram microfilament +2 of 3
Vibrations-using 128 Hz tuning fork
Pin prick sensations
Ankle reflexes













Areas at risk
Foot pulses
Ultra sound Doppler
Angiogram
Management
Metabolic control.
Antibiotics / i/v antibiotics.
Surgical management
(Debridement/Desloughing/Amp
utation)
Plaster cast/Modified rocker
bottom/Boiler iron/Foot wear.
Skin care
Moisturizer
Wear shoes that fit well
FO (muscle imbalance)
AFO (drop foot)
Heel pads (silicon)
The prosthesis are available for amputations and
complications to prosthetic fitting may occur.

The knee joint is maintained for a more energy
efficient gait. The patient is also expected to walk
with a prosthesis in most of these cases.
A temporary, or preparatory, prosthesis may be
provided .The patient may desire to walk as soon as
possible. In these cases, a rigid dressing may be fit
immediately after surgery.
A definitive prosthesis may or may not be
considered depending on a number of factors
including the patient's ability to manage himself on
the prosthesis.

The residual limb also may not have
atrophied enough for a definitive
prosthesis to be fitted.
Stump size may not be well suited for
prosthetic fitting.
Bacterial Infection can occur on
stump due to contionus wearing of
prosthesis.

SKIN PRESSURE PROBLEMS
High shear forces or excess pressure,
positive or negative, are bad for the
amputee and especially so for the diabetic.
Coupled with decreased subcutaneous
tissue, these forces may result in a major
problem for the amputee.
Body positioning, local tissue environment,
and activity levels may also contribute to
the problem and should be distinguished
from breakdown related to direct pressure
from a poorly contoured socket.

Diabetics usually remain active and
ulceration usually comes from repetitive
loading of short duration because of
ateriosclerosis and of skin pressure levels
from 30 to 300 pounds per square inch or
more.
A very tight socket may lead to
continuous pressure problems and will
create edema .


The insensitive diabetic patient at the
start of the day can tolerate loading as
can a normal person, but when tissues
reach their threshold, the patient has no
way of knowing and does not change
his gait to reduce the loading.Due to
repepitive loading ,there is blister
formation or ulceration
Pressure over an infected site was also
more often the cause of ulceration or
abcess
Taking Care of Your Feet
Wash your feet every day with mild soap and warm
water.
Test the water temperature with your hand first.
Don't soak your feet.
When drying them, pat each foot with a towel and
be careful between your toes.
Use quality lotion to keep the skin of your feet soft
and moist -- but don't put any lotion between your
toes.
Trim your toe nails straight across. Avoid cutting the
corners.
Use a nail file or emery board.
Don't use antiseptic solutions, drugstore
medications, heating pads or sharp
instruments on your feet.
Don't put your feet on radiators or in front of
the fireplace.
Always keep your feet warm.
Wear loose socks to bed.
Don't get your feet wet in snow or rain.
Wear warm socks and shoes in winter.
Don't smoke or sit cross-legged for long periods
as both decrease blood supply to your feet.


People with diabetes should be educated
about their foot care

To Educate the
Patient
Never walk bare foot at home or outside, not
even on carpet or grass
X
Dont wear nylon socks
Wear cotton socks.
Change them daily and they shouldnt be too tight
Dry Your Feet with Clean Cotton Towel specially
between Toes where fungus can grow
If your feet are dry,
apply petrolleum jelly
or
olive/coconut/mustard
oil on it except in
between toes.

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