diabetes and amputations

osteoporosis

Damage to blood vessels supplying bone, related to high levels of blood sugar, reduce nutrients to bone causing osteoporosis

chopart amputation

amputation that is a disarticulation at the chopart jt. (tarsals and talus)

lisfranc/mid-foot amputation

amputation that is disarticulation at the lisfranc jt (metatarsal and tarsal bones)

fasting

diagnostic criteria for both type 1 and 2 DM -fasting __________◦glucose test >126mg/dL ◦Random blood glucose test >200mg/dL ◦HgA1c >6.5%

pancreas

when high levels of glucose build up in the blood stream, __________ produces insulin ◦Insulin promotes transport of glucose to the liver to be stored as glycogen. ◦Insulin plays a role in carbohydrate metabolism, protein synthesis, and lipid metabolism.

fasting plasma glucose

◦Blood glucose testing that happens at least 8 hours after eating/drinking ◦Normal <100 mg/dL ◦Positive for DM if >125 mg/dL

oral glucose tolerance testing

◦Blood glucose testing two hours after ingestion of sugary drink ◦Normal <140 mg/dL ◦Positive for DM if >200 mg/dL

A1C testing

◦Blood test based on the attachment of glucose to hemoglobin ◦Measures the average blood glucose of the last 2-3 months ◦Normal <5.7% ◦Positive for DM if >6.5%

blood glucose testing

◦Casual blood glucose test ◦70-130 mg/dL before meals ◦<180 mg/dL 1-2 hours after meals

type 2 DM

Etiology: Body's tissues become resistant to insulin and do not use it properly; the pancreas tries to create more insulin to address rising blood sugar levels. Over time pancreas cannot keep up with blood sugar levels and stops making insulin, causing blood sugar levels to continue to rise. Typically diagnosed >45 years old (due to rising obesity rates, seeing in younger populations)

type 1 DM

Etiology: Unknown- possibly autoimmune condition with genetic and environmental components, may be related to viral exposure causing autoimmune response. ◦Body destroys the Islet of Langerhan beta cells, pancreas produces little to no insulin. S/S: episodes of hyperglycemia and hypoglycemia, polyphagia , weight loss, ketoacidosis, polyuria, polydipsia, blurred vision, fatigue.

type 1 DM

Failure of pancreas to produce insulin. ◦Insulin-dependent- require injected insulin to maintain healthy blood glucose levels. Normally diagnosed in childhood, symptoms most often develop suddenly.

type 2 DM

Risk Factors: genetics (strong hereditary component), sedentary lifestyle, HTN, hypercholesterolemia, poor diet, obesity- all contritube to insulin resistance. S/S: like Type I ◦EXCEPT ketoacidosis does not typically occur Treatment: Diet, exercise, weight management, oral medications, may require insulin injections.

Ray

Toe and _____ amputations -often performed in hopes of "salvaging" the limb -toes may be disarticulated with skin/plantar mm used to close -Ray amputation involves removal of toe and part of metatarsal

80-120 mg/dL

What is the normal blood glucose level?

PT

____ for DM: Be aware of signs and symptoms of hyper/hypoglycemia *** Monitor and adjust exercise to avoid exercise induced hypoglycemia. Be aware of sensory changes in skin when using thermal modalities. Most individuals with DM have other underlying health conditions that may affect exercise tolerance. Monitory vital signs regularly.

Ray

_____ amputation involves removal of toe and part of metatarsal bone

PT

_______ for amputations: things to consider: ◦Pain ◦Phantom pain ◦Skin integrity ◦Dehisence, hematoma, seroma, wound infection, necrosis.. ◦Often amputations require delayed healing or healing by secondary intention. Why? oPsychological Trauma oEnergy Expenditure oAKA energy expenditure may be up to 49% more than individual with complete limbs. oNumber of amputations oMany Diabetic patients may have amputations on both lower limbs oArterial Disease may affect both LE's, in severe cases resulting in bilateral AKA's. oAlterations in Function oContracture development oGait without/without prosthetic oWeight bearing status oBalance

trauma

________/damage to tissues can be too severe to surgically correct or despite surgical correction pain/loss of function would be worse when compared to amputation

HgA1c

_____________=A1c= glycohemoglobin = average measure of blood sugar over 2-3 month period. ◦Glucose binds to hemoglobin, the more glucose in the blood the more that binds to hemoglobin. ◦The % correlates with an average blood sugar. For Ex. 6% = 126mg/dL ◦Normal HgA1c less than 6%.

ischemia

______________ from critical illness: vasopressor meds used to maintain BP/preserve life. Vasopressors cause vasoconstriction of arteries; over prolonged period can lead to ischemia/necrosis of distal tissues

mid-femur

above knee amputations (AKA) -amutation performed at the _______-_______ removing the lower leg and knee jt -portions of the quadriceps and hamstrings are used to create mm flap for closure -length of residual limb is important for prosthetic fit and function

tibia/fibula

below the knee amputation (BKA) is amputation of the lower limb performed mid-_______/________, preserving the knee. -gastroc and soleus are used to create a flap for closure and cushion bone ends. -length of residual limb is important for prosthetic fit/function

insulin

beta cells produce ____________

transmetatarsal amputation

what type of amputation is when forefoot is removed to the mid-metatarsal bones? -mm and skin on plantar surface of foot are used to create flap closure

diabetes mellitus

disorder of the pancreas causing lack of production of insulin or inability of the body to use insulin that is produced

hyperglycemia

elevated levels of blood glucose, caused by reduction in insulin or inability to use insulin -blood glucose of >180mg/dl

hyperglycemia

high blood glucose ◦>180-200 mg/dL ◦Thirst, frequent urination, irritation ◦Result in ketoacidosis or 'diabetic coma' - dyspnea, fruity breath, dry mouth, confusion, nausea, vomiting, loss of consciousness ◦Causes include medications (ex steriods), stress, not taking insulin, alcohol intake.

35

in the US, more than ____million ppl have DM, 1 in 5 don't know they have it. o90% have Type 2 diabetes. o88 million have pre-diabetes. oDiabetes is the 7th leading cause of death in the US. Medical costs for individuals with diabetes is twice that of someone without DM

arterial wounds

ischemia--> tissue necrosis--> gangrene --> amputation -goal is to provide vascular intervention bf tissue necrosis begins. Sometimes artherosclerosis is too severe for intervention to be performed

hypoglycemia

low blood glucose ◦<70 mg/dL ◦Hunger, sweating, shaking, dizziness, clumsiness, headache, loss of consciousness ◦Causes include activity, not eating enough, taking too much insulin. Exercise Response ◦Increased blood glucose uptake by the muscles - regulates blood glucose ◦May result in exercise-induced hypoglycemia

hypoglycemia

low levels of glucose, caused by excess release of insulin -blood glucose of <70mg/dl

6

normal HgA1c is less than ___%

langerhans, beta

normal pancreas function: -pancreas contains islet of ____________ which contains _______cells.

30

people with DM have a ___X greater potential for amputation in their lifetime than someone without it.

diabetic ketoacidosis (AKA, Ketoacidosis)

serious and life threatening complication. ◦May occur with Blood glucose levels >260mg/dL ◦Caused by too little insulin preventing body from using available glucose for enery. ◦Body begins to break down fat instead producing ketones that build up on the bloodstream. ◦Ketones increase blood acidity. ◦Requires medical intervention

amputation

the most common cause for lower extremity _______________ in the US is complications to DM, followed by PVD, infection, trauma, ischemic injury from critical illness.

toe, ray

the most common type of amputation is of a _______ followed by below________ amputations

neuropathic wound

this wound has high incidence of infection--> infection of deep tissues and bone (osteomyelitis)--> life threatening sepsis - if infection/wound is not responding to antibiotic treatment --> amputation to remove infected tissue.

type 1 DM

treatment of __________ ____ ____ ◦Insulin injections or continuous insulin pump ◦Nutritional Management ◦Regular/consistent blood glucose testing

polydypsia

type 1 DM: excessive thirst

polyuria

type 1 DM: excessive urine production

polyphagia

type 1 DM: excessive eating

1

type ____DM: insulin dependent (old term: juvenile DM)

2

type ____DM: non-insulin dependent (old term: adult onset DM-seeing more in younger population)

autonomic neuropathy

◦Chronic high blood sugars damage nerves of the autonomic nervous system. ◦Cause issues including difficulty regulating heart rate, blood pressure, constipation, gastroparesis, neurogenic bladder, erectile dysfunction.

peripheral neuropathy

◦Chronic high blood sugars damages the nerves as well as the vascular supply to the nerves. ◦Damage mostly to the peripheral nerves causing stocking/glove pattern of sensory loss. ◦Loss of sensitivity to pain, pressure, heat/cold, vibration. ◦Most common in foot and lower leg, fingers/hand and lower arm. ◦Often experience chronic pain and paraesthesias (tingling sensation). ◦Foot drop- damage to anterior tibialis nerve causing loss of dorsiflexion. ◦Increased risk of injury due to loss of sensation. ◦High risk of wound formation.

cardiovascular disease

◦Chronically elevated blood glucose levels are associated with development of atherosclerosis. Individuals with DM (esp. Type 2) often have other risk factors for ____________ ____________ (HTN, Obesity, Hypercholestremia

diabetic retinopathy

◦Elevated blood glucose levesl cause swelling of arteries around the retina, arteries may hemorrhage causing blood build-up. ◦May develop abnormal blood vessel growth at retina. ◦Both contribute to gradual loss of vision

renal disease

◦Renal artery stenosis reduces blood flow to kidneys ◦Small arterial vessels that make up the glomeruli are damaged by chronically high blood sugar reducing kidney function.