Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Intelligent care for diabetic foot dr,qutaiba abdullah aldori

242 views

Published on

diabetic foot

Published in: Health & Medicine
  • Be the first to comment

Intelligent care for diabetic foot dr,qutaiba abdullah aldori

  1. 1. Intelligent care for diabetic foot Dr. Qutaiba Abdullah Aldori Burn & Reconstructive Surgeon at Azadi –Hospital –Kerkuk/Iraq .
  2. 2. Diabetic foot •According to the World Health Organization and to the International Working Group on the Diabetic Foot
  3. 3. • 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
  4. 4. • 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.
  5. 5. • 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?
  6. 6. 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.
  7. 7. Diabetic foot pathologies Internal Trauma (calluses, ingrown nails and foot deformiti es) External Trauma, (from ill- fitting shoes In soles, burns and foreign bodies),
  8. 8. Pathogenesis still hidden
  9. 9. • The concept of Many research • People with high blood glucose levels have increased risks of •increased risks of DM Complications
  10. 10. Predictable Causes of 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 • bCongestive Heart Failure ,heart attack ,stroke. • cImpaired thirst sensation . • d Limited access to water (especially in patients with dementia or who are bedbound or living lonely) • e Older age.
  11. 11. Unpredictable Causes of in diabetics (Condensation) Reactions •& •
  12. 12. for 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
  13. 13. Dehydration Synthesis (Condensation) Reactions & Hydrolysis Reactions Hydrolysis Reactions Dehydration Synthesis
  14. 14. Dehydration Synthesis (Condensation) Reactions & Hydrolysis Reactions Hydrolysis Reactions Dehydration Synthesis Glycogen polymer Glucose monomer ATP insulin
  15. 15. • Disturbances in • Hemorheological picture of blood •& • Copeptin level ,a surrogate marker for vasopressin (AVP)
  16. 16. Viscosity A measurement of the thickness and stickiness of an individual's blood.
  17. 17. 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.
  18. 18. • 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 ).
  19. 19. Diabetic Peripheral Neuropathy
  20. 20. 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.
  21. 21. B Viscosity B Glucose
  22. 22. Several studies show • Water intake inversely independently associated with Hyperglycemia • Water intake affect (Copeptin) vasopressin secretion • • Copeptin directly associated with increase Risk of DM
  23. 23. • 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.
  24. 24. • 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
  25. 25. • 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.
  26. 26. VISCOSITY Copeptin MICROANGIOPATHY DFU CVD RENAL AP RETINOPATHY
  27. 27. Normal VISCOSITY LESS MICROANGIOPATHY DFU CVD RENAL AP RETINOPATHY Copeptin
  28. 28. 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
  29. 29. National Institute for Health and Clinical Excellence Admission & Evaluation Multidisciplinary Foot care Team Management pt. EDUCATE Pt
  30. 30. The only difference is the additional item increase of water intake to 1.5-2 liters per day.
  31. 31. case no.1 G3s1 9 1 2016 20 1 2016 14 3 2016 AFTER 11 DAY AFTER 9 Week
  32. 32. • case no.2 • G3s4 AFTER 12 Week
  33. 33. • case no.3 • G2s2 AFTER 6 Week
  34. 34. • case no.4 • G2sb AFTER 6 Week
  35. 35. • case no.5 • G2s1 AFTER 6 Week
  36. 36. • case no.6 • G3s4
  37. 37. • case no.6 • G3s4
  38. 38. • case no.6 • G3sd
  39. 39. • case no.6 • G3s4 • 12 weeks after StSg
  40. 40. • case no.7 • G2sb After 16 week
  41. 41. • case no.9 • G1s2
  42. 42. • case no.9 • G1sb • AFTER 2 Week
  43. 43. • case no.10 • G3s4 After 16 week
  44. 44. • case no.11 • G1s2 After 2 week

×