Diabetes Mellitus and the Associated Complications.ppt

diabetesmellitusandtheassociatedcomplications,understandingdiabetesmellitusandthecomplicationsrelatingtothediseasecanassistthefittertobetterservepatients.,diabetesmellitus,accordingtotheamericandiabetesassociation:numberofdiabeticsintheunitedstates,allages,diagnosedandundiagnosed:total:23.6millionpeople,or8%ofthepopulationdiagnosed:17.9millionpeopleundiagnosed:5.7millionpeople*2007results;mostrecentavailable,countylevelestimatesofdiagnoseddiabetesstatemaps,diabetesmellitus,diabetesmellitus,mostcostlydiseaseinthemodernworld$132billionmedicalexpense5%ofallhealthcaredollarsspentonunnecessarydiabetescomplicationssignificantlyhigheraverageannualhealthcarecosts$13,243/yeardiabetespatients$2,560/yearnon-diabetespatients,comprehensivefootcareprogramscanreducediabeticfootamputationsbetween45-85%-centersfordiseasecontrol(cdc)theleadingcauseofnon-traumaticlowerlimbamputationsintheunitedstatesisdiabetes.lessthan10%ofthosewhoqualifyfordiabeticshoesareactuallyreceivingthem.,diabetesmellitus,accordingtotheworldhealthorganization(who),thenumberofglobalcasesofdmisexpectedtoincreaseinthenext25yearsfrom135milliontonearly300millionpeople.mostofthesepeoplewillcomefromareasoftheworldwhereunhealthydiets,aging,obesity,andsedentarylifestyleswillcontributetotheonsetofdiabetes.,diabetesmellitus,diabetesisthedecreaseduseoforshortageofinsulin,whichplaysanactivepartinthemetabolismoffatandproteins.sugarisglucoseandusedasfueloranenergysourceforthebody.insulinisahormone.thepancreassecretesinsulintotheblood.theliverstoresglucose.whennotcontrolled,glucoseandfatsremaininthebloodanddamagevitalorgans.,diabetesmellitus,normalblood70-110mg/dl(milligramsperdeciliter)diabeticblood126mg/dlandhigherpre-diabeticblood111-125mg/dl-highriskforacquiringdiabetes(formerly“borderlinediabetic”)a1cglycatedhemoglobintests;reflectstheaveragebloodsugarlevelforthepast2-3months;averageforpeoplewithoutdiabetesis4-6%anddiabeticsgenerallyliketokeepitbelow7%.,diabetesmellitus,somegeneralsecondarypathologiesassociatedwithdiabetesinclude:heartdiseasestrokeblindnesskidneyfailurelowerextremityamputationsdeathrelatedtofluandpneumonia,diabetesmellitus,riskfactorsforprediabetesandtype2diabetesresearchersdontfullyunderstandwhysomepeopledevelopprediabetesandtype2diabetesandothersdont.itsclearthatcertainfactorsincreasetherisk,however,including:weight.themorefattytissueyouhave,themoreresistantyourcellsbecometoinsulin.inactivity.thelessactiveyouare,thegreateryourrisk.physicalactivityhelpsyoucontrolyourweight,usesupglucoseasenergyandmakesyourcellsmoresensitivetoinsulin.,diabetesmellitus,riskfactorsforprediabetesandtype2diabetes(continued)familyhistory.yourriskincreasesifaparentorsiblinghastype2diabetes.race.althoughitsunclearwhy,peopleofcertainracesincludingblacks,hispanics,americanindiansandasian-americansareathigherrisk.age.yourriskincreasesasyougetolder,especiallyafterage45.often,thatsbecauseyoutendtoexerciseless,losemusclemassandgainweightasyouage.buttype2diabetesisincreasingdramaticallyamongchildren,adolescentsandyoungeradults.,diabetesmellitus,undermedicareguidelines,havingdiabetesdoesnotalonequalifyabeneficiarytoreceivefootwear.properdocumentationofoneof6existingorpastconditionsdetermineseligibilityforfootweartobecoveredundermedicare.(seestatementofcertifyingphysician),diabetesmellitus,lessertoeamputation,amputation:theremovalofabodyextremityeitherbysurgeryortrauma.asasurgicalmeasure,itisusedtocontrolpainoradiseaseprocessintheaffectedlimb.,diabetesmellitus,amputationsarenotcausedbyanyonespecificproblem.diabetesalonealsodoesnotensuresomeoneofanydegreeofamputation.diabetesandperipheralneuropathyleadstolossofprotectivesensationanddevelopsawoundorulcerinconjunctionwithpoorcirculationandleadstothewoundbecominginfectedandwithadecreasedabilitytofightinfectionitbecomesosteomyelitismedicaltermforinfectionofthebone,diabetesmellitus,diabetesduration:thelongerapersonhashaddiabetes,thegreatertheriskofamputation.followingalowerextremityamputation,apatientisatincreasedriskforbothlossoftheotherlimbanddeath.theratesfortheoccurrenceofeithermortalityorlossofthesecondlimbfollowinganamputationare:o1year:15%o3years:38%o5years:68%thegoalfordiabeteshealthcareprovidersmustthereforebetohelppatientsavoidthefirstamputation.useofproperfootwearandappropriatefootcaretechniquescanhelppreventmanyamputations.,diabetesmellitus,ulcerations(malperforans):abreakorholeintheskin;opensoresorwoundsthatmostoftenoccuronthebottomofthefoot.untreatedulcerscanoftenbecomeinfectedandmayeventuallyleadtoamputation.,morethan800,000diabeticpatientsexperiencefootulcerseachyear.,ulcers(cont.):visitingaphysicianregularlyfordebridementandtheuseofcustomorthosesandisthekeytothemanagement.,mostcommonsitesareplantartothemetheadsandhallux.,riskfactorsforfootulcerspreviousamputationpastfootulcerhistoryperipheralneuropathyfootdeformityperipheralvasculardiseasevisualimpairmentdiabeticnephropathy(especiallypatientsondialysis)poorglycemiccontrolcigarettesmoking,diabetesmellitus,diabeticneuropathy:afamilyofnervedisorderscausedbydiabetes.peripheralneuropathyaffectstheextremityincludingthefeet.feetandlegsaremorelikelytobecomeaffectedbeforethehandsandarms.nervesnotsendingthepropermessagestothebrain.symptomsinclude:numbnessorinsensitivitytopainortemperature;tinglingorburning;sharppainsorcramps;extremesensitivitytotouch;lossofbalance.,diabetesmellitus,diabeticneuropathy(cont.):peripheralneuropathycancausemuscleweaknesses,whichmayleadtochangeingaitandfootdeformities.riskofoccurrence:roughlyhalfthepeoplewithdiabetesdevelopsometypeofneuropathy.,diabetesmellitus,callusformation(plantarkeratoma):hardareasofskinontheplantarsurfaceofthefoot.causedbyincreasedpressure.verycommonoccurrenceeveninnon-diabetics.usuallypainfulwithdirectpressure.,footdeformityhammertoe:atoethatisbentattheproximalinterphalangealjoint.acornmaydevelopatthebonyprominence.verycommon,especiallyindiabeticsduetoweakenedmusclesatthetendonscausingtoestocurlunderfeet.,diabetesmellitus,footdeformityamallettoeisbentatthedistalinterphalangeal(dip)joint.acornmaydevelopatthedorsalbonyprominence.aclawtoeisbent(orcontracted)atboththeproximalanddistalitpj.,diabetesmellitus,footdeformityabunionisastructuraldeformityofthebonesandthejointbetweenthefootandbigtoe,andmaybepainful.abunionisanenlargementofboneortissuearoundthejointatthebaseofthebigtoe(mtpj).thebigtoemayturnintowardthesecondtoe,andthetissuessurroundingthejointmaybeswollenandtender.,footdeformityacrossovertoeisaconditioninwhichthe2ndtoedriftstothegreattoeandeventuallyliesontopofthebigtoe.itisaprogressivedisorderandistheresultofabnormalfootbiomechanics.theballofthefootbeneaththesecondtoejointtakesanexcessiveamountofweight-bearingpressure.thispressureeventuallyleadstoweakeningofthesupportiveligamentsandafailureofthejointtostabilizethetoe,resultinginthetoecrossingover.,diabetesmellitus,footdeformitycorn(heloma):hardareaofskinofthetoes.usuallycausedbyill-fittingshoes,bonyprominenceorpositionofajointwithinthetoes;ahardcorniscalledahelomadurum,whileasoftcorniscalledahelomamolle.,thelocationofsoftcornstendstodifferfromthatofhardcorns.hardcornsoccurondry,flatsurfacesofskin.softcorns(frequentlyfoundbetweenadjacenttoes)staymoist,keepingthesurroundingskinsoft.softcornsarealsosometimesreferredtoas“kissingcorns.”,diabetesmellitus,footdeformitycharcotarthropathyisaprogressivemusculoskeletalconditioncharacterizedbyjointdislocation,fracturesanddeformities.itresultsinprogressivedestructionofboneandsofttissueofweight-bearingjoints,mostcommonlyinthefootandankle.itismostcommonlysecondarytodiabetes.,treatmentisusuallynon-operative,consistingofreductionofstressonthejointbycasting,avoidingweightbearingwherepossible,andelevationto