Intelligent care for diabetic foot dr,qutaiba abdullah aldori
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Transcript of Intelligent care for diabetic foot dr,qutaiba abdullah aldori
Intelligent care for diabetic footDr. Qutaiba Abdullah AldoriBurn & Reconstructive Surgeon at Azadi –Hospital –Kerkuk/Iraq .
Diabetic foot•According to the World
Health Organization and to the International Working
Group on the Diabetic Foot
• defined as The foot of diabetic pt with ulceration, infection and/or destruction of the
deep tissues, associated with neurological abnormalities
and various degrees of peripheral vascular disease in
the lower limb
• DM is now thought to be in excess of 200 million• Pt. is affected .
• This figure is predicted to reach 333 million by 2025• The current population of the United States of
America is 323,668,578 • 15% of all diabetics with Diabetic foot ulcers
• almost 85% of foot ulcers proceed to amputations.
• Submitted by Lorenzo.Piemonte on Wed, 07/01/2015 - 14:00
• Did you know that every 20 seconds an amputation caused by diabetes occurs somewhere in the world?
objective• If we keep the diabetic foot patient in well hydrated state for two weeks the response of healing is dramatically increase in a positive way.
Diabetic foot pathologiesInternal
Trauma
(calluses,
ingrown nails
and foot
deformities)
External
Trauma,
(from ill-
fitting shoes
In soles,burns and
foreign bodies),
Pathogenesis still hidden
• The concept of Many research
•People with high blood glucose levels have increased risks of
dehydration and dehydration
• increased risks of DM Complications
Predictable Causes of dehydration in
diabetics• 1 / Glycosuria , each glucose molecule
surrounded by 6 water molecules taken out of body with urine .
• 2/ Poor water intake• a\ A stressful event such as infection, or recent
surgery• b\Congestive Heart Failure ,heart attack ,stroke.• c\Impaired thirst sensation .• d\ Limited access to water (especially in patients
with dementia or who are bedbound or living lonely)
• e\ Older age.
Unpredictable Causes of dehydration in
diabetics • Dehydration Synthesis (Condensation) Reactions
• &• Hydrolysis Reactions
Just to remind pleasefor 72 kg human weight containing 40
liters • (2/3 of body water 25 liters is
Intracellular fluid )• (1/3 of body water) about 15
liters is Extracellular fluid,(1/5 of
extracellular fluid) averages
3 liters Plasma
(4/5 of extracellular fluid) are 12
liters Interstitial fluid
Dehydration Synthesis (Condensation) Reactions & Hydrolysis Reactions
Hydrolysis Reactions
Dehydration Synthesis
Dehydration Synthesis (Condensation) Reactions & Hydrolysis Reactions
Hydrolysis Reactions
Dehydration SynthesisGlycog
en polyme
r
Glucose monomer
ATP
H2O
insulin
Hidden Pathogenesis of DFU
• Disturbances in• Hemorheological picture
of blood• &
• Copeptin level ,a surrogate marker for
vasopressin (AVP)
Viscosity A measurement of the thickness
and stickiness of an individual's blood.
Dr. Ajay Kumar• Abnormal high blood viscosity in diabetes
mellitus• Conclusion• The causes of rise of whole blood viscosity are• 1- Rise in haematocrit: due to increase in capillary
permeability in Diabetes Mellitus. • 2- Decrease in RBC deformability: it is found that the
elevated glucose level causes stiffness in red cell membrane in Diabetes Mellitus.
• 3- Increase in Red Cell Aggregation.• 4- Plasma Fibrinogen Level Rises which is one of the causes
for rise in plasma viscosity.
• Red blood cells at rest have an average diameter• of 7.8 micro meter and must deform markedly to
pass• the smallest capillaries of the microcirculation• (3–7 micro meter ).
Diabetic Peripheral Neuropathy
Rheological Picture in pt.T1D &T2D
• Maya Mantskava Microcirculation Research Center Georgia
• . Therefore we conclude that blood rheological disorders are similar in both types of diabetes mellitus.
• The disturbed blood fluidity related to the increased RBC aggregability in the microcirculation promotes, in particular, the development of the gangrene in both types of diabetes mellitus.
B Viscosit
y B
Glucose
Several studies show
• Water intake inversely independently associated with
Hyperglycemia
• Water intake affect (Copeptin) vasopressin
secretion•
• Copeptin directly associated with increase Risk of DM
• PLASMA COPEPTIN IS ASSOCIATED WITH INSULIN
RESISTANCE IN A SWISS POPULATION-BASED STUDY.
• Canivell, S.; Ponte, B.; Pruijm, M.; Ackermann, D.; Guessous, I.; Ehret, G.; Paccaud, F.; Pechere-Bertschi, A.; Mohaupt, M.; Vogt, B.; Burnier, M.; Devuyst, O.; Martin, P.Y.; Bochud, M.
• Conclusions: • Insulin resistance was associated
with higher copeptin levels.
• Copeptin, a surrogate marker for vasopressin, is associated with
chronic kidney disease progression in patients with diabetes mellitus
• W.E. Boertien1, I.J. Riphagen1, I. Drion2, A. Alkhalaf2, S.J.L. Bakker1,• K.H. Groenier3, J. Struck4, H.J.G. Bilo2,5, N. Kleefstra2,5, R.T. Gansevoort1;• 1Nephrology, UMCG, Groningen, Netherlands, 2Diabetes Centre, Isala• Clinics, Zwolle, Netherlands, 3General practice, UMCG, Groningen,• Netherlands, 4BRAHMS GmbH, Thermo Fisher Scientific, Hennigsdorf,• Germany, 5Internal Medicine, UMCG, Groningen, Netherlands.
• . Conclusion: • It would be interesting to study the effect of
lowering vasopressin levels (e.g. by drinking more water) on the progression of chronic kidney disease in diabetic patients
• Jessica M Sontrop, Nephrology,• Department of Medicine,• London Health Sciences• Centre, London, Ontario,
• Change in water intake and change in plasma copeptin,
• At the end of 6 weeks we conclude that ,the increase in water intake was associated with a significant decrease in the concentration of plasma copeptin.
VISCOSITY
Copeptin
MICROANGIOPATHYDFUCVD
RENAL APRETINOPATHY
DEHYDRATION
NormalVISCOSITY
LESSMICROANGIOPATHY
DFUCVD
RENAL APRETINOPATHY
HYDRATION
Copeptin
Our study • 11 pt with Diabetic foot submitted
for same guide lines of management (NICE clinical guideline 119 )
•
• NICE =National Institute for• Health and Clinical Excellence
National Institute for Health and Clinical
Excellence
Admission &
EvaluationMultidisciplinary Foot care
Team Management
pt.
EDUCATE Pt
The only difference is the additional
item increase of water intake to 1.5-2 liters per
day.
case no.1G3s1
9 1 2016 20 1 2016 14 3 2016
AFTER 11 DAYAFTER 9 Week
• case no.2• G3s4
AFTER 12 Week
• case no.3• G2s2
AFTER 6 Week
• case no.4• G2sb
AFTER 6 Week
• case no.5• G2s1
AFTER 6 Week
• case no.6• G3s4
• case no.6• G3s4
• case no.6• G3sd
• case no.6• G3s4 •
12 weeks after StSg
• case no.7• G2sb
After 16 week
• case no.9• G1s2
• case no.9• G1sb •
AFTER 2 Week
• case no.10• G3s4
After 16 week
• case no.11• G1s2
After 2 week