Intelligent care for diabetic foot dr,qutaiba abdullah aldori
Intelligent care for
Dr. Qutaiba Abdullah Aldori
Burn & Reconstructive Surgeon at
Azadi –Hospital –Kerkuk/Iraq .
•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
abnormalities and various
degrees of peripheral
vascular disease in the
• 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
• Did you know that every 20
seconds an amputation caused by
diabetes occurs somewhere in the
• 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 pathologies
• The concept of Many research
• People with high blood
glucose levels have
increased risks of
•increased risks of DM
Predictable Causes of
• 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.
Unpredictable Causes of
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
averages 3 liters
are 12 liters
• Disturbances in
• Hemorheological picture of
• Copeptin level ,a surrogate
marker for vasopressin (AVP)
A measurement of the thickness and
of an individual's blood.
Dr. Ajay Kumar
• Abnormal high blood viscosity in diabetes mellitus
• 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
• 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 ).
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
• 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
Several studies show
• Water intake inversely independently
associated with Hyperglycemia
• Water intake affect (Copeptin)
• 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.
• Insulin resistance was associated with
higher copeptin levels.
• Copeptin, a surrogate marker for
vasopressin, is associated with chronic
kidney disease progression in patients with
• 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
• Jessica M Sontrop, Nephrology,
• Department of Medicine,
• London Health Sciences
• Centre, London, Ontario,
• Change in water intake and change in plasma
• At the end of 6 weeks we conclude
that ,the increase in water intake
was associated with a significant
decrease in the concentration of
• 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
Multidisciplinary Foot care
The only difference is
the additional item
increase of water
intake to 1.5-2 liters per
9 1 2016 20 1 2016 14 3 2016
AFTER 11 DAY
AFTER 9 Week