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Diabetes & Wound Management > Diabetes > Flashcards

Diabetes Flashcards

0
Q

Fatigue, micro & macro vascular complications and autonomic neuropathy are indications of?

A

Hyper-glycaemia

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1
Q

What is the fuel for CNS?

A

Glucose

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2
Q

What is the prevalence rate of diabetes mellitus?

A

7.4%

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3
Q

High blood sugar’s affect on the pancreas

A

Release of beta cells (insulin)

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4
Q

Three cardinal signs of diabetes mellitus

A

Polyuria
Polydipsia
Polyphagia

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5
Q

Gold standard in measuring insulin sensitivity and glucose metabolisation

A

Euglycemic clamp

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6
Q

Two types of euglycemic clamps

A

Hyperglycemic clamp

Hyperinsulinemic clamp

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7
Q

HOMA-IR

A

Homeostatic model assessment-insulin resistance

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8
Q

Diabetes mellitus has a fasting plasma glucose concentration of

A

Greater than 7

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9
Q

A 2h post glucose load plasma glucose concentration of someone with pre-diabetes

A

> 7.8-<11.1

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10
Q

IGT

A

Impaired glucose tolerance

7.8-11.1 PGC

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11
Q

IFG

A

Impaired fasting glycaemia

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12
Q

Impaired fasting glycaemia plasma glucose concentration

A

> 6.1-<7

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13
Q

Diabetic autonomic neuropathy

A 
Stealthy complication (maybe 100%)
Decreased sensation and decrease functions
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14
Q

Upstroke represents diastole or systole?

A

Systole

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15
Q

Polydipsia

A

Excessive Thirst

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16
Q

Polyuria

A

Excessive urination

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17
Q

Sudomotor dysfunction

A

Affects the activity of the sweat glands & often manifests as anhidrosis of the extremities

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18
Q

‘Head rush’ due to blood pressure falls suddenly as a result of standing up quickly

A

Orthostatic hypotension

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19
Q

Mechanism of atherosclerosis

A 
LDL build up
Plaque
Decreased BF
Rupture
Thrombus
Blocked flow
Tissue ischemia
Myocardial infarction
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20
Q

Intimal thickening is caused by

A

Smooth muscle cell proliferation

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21
Q

At herons or plaque formation

A

Intimal thickening & lipid accumulation

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22
Q

Fatty streak

A

Excess LDL accumulates between the endothelium and connective tissue.
There it is oxidised and phagocytosed.
Macrophages produce paracrines that attract smooth muscle cells.

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23
Q

Normal cell wall consists of

A

Smooth muscle and connective tissue with an endothelial cell lining

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24
Q

Stable plaque/ fibrous plaque

A

A fibrous scar forms around the cholesterol build up, migrating smooth muscle cells divide, thickening the arterial wall and narrowing the lumen of the artery.

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25
Q

Vulnerable plaque/thrombus

A

Calcified scar tissue will form, if the endothelium is damaged and collagen is exposed, platelets stick to the damaged area and a thrombus forms

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26
Q

Atherosclerosis Stage I

A

Monocytes adhesion/migration

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27
Q

Atherosclerosis mechanism Stage II

A

Foam cells in intima

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28
Q

Foam cells

A

Lipid containing macrophages

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29
Q

Atherosclerosis stage III

A

Appearance of extra cellular lipid

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30
Q

Atherosclerosis stage IV

A

Core formation

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31
Q

Atherosclerosis stage VI

A

Thrombosis

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32
Q

Atherosclerosis stage V

A

Fibrous cap and core formation

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33
Q

Extra cellular lipid coalescing into the centre of the plaque

A

Core formation in stage IV of the development of atherosclerosis

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34
Q

Fully formed lipid core and and well developed cap of fibrous tissue separating the core from the lumen

A

Stage V of the atherosclerosis development of a fibrous cap and core

35
Q

Glycosylation of the plantar fascia

A

Stiffer tissues = reduced shock absorption

Hypothesis to cause pes cavus foot type

36
Q

Pes cavus foot type

A

Increased forefoot & rearfoot plantar pressures

37
Q

Unperceived injury, breakdown & infection –> ulceration can result from

A

Sensory neuropathy

38
Q

Key diabetic changes to gait

A

Reduced heel contact phase

39
Q

Preventing complications

A

Prevent hyperglycaemia
Prevent neuropathy & PAD
Prophylactic Intervention

40
Q

Prophylactic intervention

A
  • diabetes education
  • footwear
  • podiatrist assessments
  • plantar pressure reduction
41
Q

Non enzymatic glucosylation

A

Proteins combine with free glucose & form ketoamines
Ketoamines form AGES - haphazard process that impairs the function of biomolecules
Causes a decrease on nerve function as atonal transport is disrupted and myelin sheaths damaged - changes to the collagen fibres

42
Q

What happens to the proteins in non enzymatic glucosylation

A

They combine with free glucose and form ketoamines

43
Q

What are AGEs

A

Advanced glycated end products

Byproduct of the ketoamines formed when the proteins and free glucose combine

44
Q

Changes in the cross linkage of the collagen fibres has what effect of the nerve

A

Disrupted axonal transport and damaged myelin sheaths

- decrease in nerve function

45
Q

The biomechanics of the diabetic foot have one common denominator which is

A

Increased plantar pressure

46
Q

Soft tissue alterations

A 
Glucosylation of tissues
Limited joint mobility
Changes to foot architecture
Changes to skin and soft tissue
(Distal) migration of tissue
This tissue
47
Q

Limited joint mobility affects gait?

A

Reducedpnility of joints reduces shock absorbing capacity and so increases plantar pressures

48
Q

Aldose reductase

A

Converts glucose into sorbitol

49
Q

Poly sorbitol pathway

A

Sorbitol is accumulated in neurons and supporting tissue
Osmotic effect -> H2O moves into the neural tissue
Neural and peri neural oedema
Demyelination of the Schwann cell

50
Q

Thickening of the basement membrane

A

Result of osmotic stress due to sorbitol accumulation in cells

51
Q

Highest plantar pressure areas in a diabetic foot

A

Lateral forefoot

52
Q

Diabetes mellitus

A

Is a metabolic disease in which there is chronic hyperglycaemia

53
Q

T2DM

A

Pancreas can’t make enough insulin OR insulin is not affective

54
Q

T1DM

A

Pancreas does not make insulin

55
Q

Charcot neuropathy

A

Neurogenic athroropathy aka neuroarthropathy

Rapidly progressive non infectious degenerative arthritis affecting single/multiple joints

56
Q

CN

A

Charcot neuroarthropathy

57
Q

Four probable pathogenesis of CN

A

Peripheral neuropathy
Unrecognised injury
Continued repetitive stress on injured structures
Increased local BF

67
Q

DDx Charcot foot

A

DVT

Osteomyelitis

68
Q

How do you differentiate DVT from Charcot?

A

Doppler

69
Q

How do you differentiate osteomyelitis from Charcot?

A

Bone probe

84
Q

What is the BMI of an obese individual

A

> 30.0

85
Q

What is the BMI of a overweight individual?

A

25.0- 30.0

86
Q

What grade is the diabetic risk category assessment for a minimal pathology?

A

Grade 1

87
Q

What grade is the diabetic foot risk category assessment for insensate with deformity?

A

Grade 2

88
Q

What grade is the diabetic foot risk category assessment for - demonstrated pathology

A

Grade 3

89
Q

What grade is the diabetic foot risk category assessment for - neuropathic ulceration

A

Grade 4a

90
Q

What grade is the diabetic foot risk category assessment for - acute chariot joint deformity

A

Grade 4b

91
Q

What grade is the diabetic foot risk category assessment for - infected diabetic foot?

A

Grade 5

92
Q

What grade is the diabetic foot risk category assessment for - days vascular foot

A

Grade 6

93
Q

Chelation therapy

A

Mobilisation of calcium within atherosclerotic lesion (?lesion regression)
Side effects hypoglycaemia & renal failure

94
Q

CN 4 factors

A

Peripheral neuropathy
Increased trauma
Increased bf
Unrecognised injury

95
Q

Ineffective agents in IC treatment

A

Purely vasodilators

96
Q

Treatment for osteomyelitis

A

Long course of antibiotics

8 weeks of ciprocloxacin

97
Q

What is Slough

A

Glutinous yellow covering comprised of fibrin, deoxyribonucleo-protein, serous exudate, leukocytes and bacteria. It may build up rapidly on the surface of a previously clean wound and predispose a wound to infection

98
Q

What nutritional components are necessary for wound healing

A

Carbs, vitamins and proteins

99
Q

Nitric oxide is a vasodilator or vasoconstrictor?

A

Potent vasodilator

100
Q

Tulle e.g

A

Shallow flat wound
Jelonet
Paranet

101
Q

Semipermeable film

A

shallow wound with low/minimum exudate

Onsite tegaderm

102
Q

Hydrocolloids

A

Light to heavy exudate, sloughing or granulating wounds

DuoDERM, tegasorb

103
Q

Hydrogel a

A

Necrotic or sloughy wound beds

Regardless, intrasite

104
Q

Alginates

A

Exudating & sloughy wounds

E.g kaltostat, sorbsan

105
Q

Foam

A

Absorb and protect (do not out on dry wound)

Allevyn, lyofoam, biatain

106
Q

Hydro fibre

A

Deep wound with heavy level of drainage

107
Q

Antimicrobial

A

Reduce bacterial load to improve healing

Silver, iodine

Diabetes & Wound Management (1 decks)

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