diabetic foot

1. Intelligent care for
diabetic foot
Dr. Qutaiba Abdullah Aldori
Burn & Reconstructive Surgeon at
Azadi –Hospital –Kerkuk/Iraq .

2. Diabetic foot
•According to the World
Health Organization and to
the International Working
Group on the Diabetic Foot

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. • 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. • 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. 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. 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. Pathogenesis
still hidden

9. • The concept of Many research
• People with high blood
glucose levels have
increased risks of
•increased risks of DM
Complications

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. Unpredictable Causes of
in diabetics
(Condensation) Reactions
•&
•

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. Dehydration Synthesis
(Condensation) Reactions &
Hydrolysis Reactions
Hydrolysis
Reactions
Dehydration
Synthesis

14. Dehydration Synthesis
(Condensation) Reactions &
Hydrolysis Reactions
Hydrolysis
Reactions
Dehydration
Synthesis
Glycogen
polymer
Glucose monomer
ATP
insulin

15. • Disturbances in
• Hemorheological picture of
blood
•&
• Copeptin level ,a surrogate
marker for vasopressin (AVP)

17. Viscosity
A measurement of the thickness and
stickiness
of an individual's blood.

18. 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.

19. • 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 ).

20. Diabetic Peripheral Neuropathy

21. 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.

22. B
Viscosity
B
Glucose

24. Several studies show
• Water intake inversely independently
associated with Hyperglycemia
• Water intake affect (Copeptin)
vasopressin secretion
•
• Copeptin directly associated with
increase Risk of DM

25. • 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.

26. • 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

28. • 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.

29. VISCOSITY
Copeptin
MICROANGIOPATHY
DFU
CVD
RENAL AP
RETINOPATHY

30. Normal
VISCOSITY
LESS
MICROANGIOPATHY
DFU
CVD
RENAL AP
RETINOPATHY
Copeptin

31. 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

32. National Institute for Health and Clinical
Excellence
Admission &
Evaluation
Multidisciplinary Foot care
Team
Management pt.
EDUCATE Pt

33. The only difference is
the additional item
increase of water
intake to 1.5-2 liters per
day.

34. case no.1
G3s1
9 1 2016 20 1 2016 14 3 2016
AFTER 11 DAY
AFTER 9 Week

35. • case no.2
• G3s4
AFTER 12 Week

36. • case no.3
• G2s2
AFTER 6 Week

37. • case no.4
• G2sb
AFTER 6 Week

38. • case no.5
• G2s1
AFTER 6 Week

39. • case no.6
• G3s4

40. • case no.6
• G3s4

41. • case no.6
• G3sd

42. • case no.6
• G3s4
•
12 weeks after
StSg

43. • case no.7
• G2sb
After 16 week

44. • case no.9
• G1s2

45. • case no.9
• G1sb
•
AFTER 2 Week

46. • case no.10
• G3s4
After 16 week

47. • case no.11
• G1s2
After 2 week