Diabetic Complications

Question 1

Hormones

Answer 1

Regulate metabolic activity of an organ or tissue.

Question 2

Insulin

Answer 2

Secreted by the pancreas, regulation of carbohydrate metabolism, active part in the metabolism of fat (hydroglycerides) and proteins.

Question 3

Diabetes

Answer 3

Shortage of/ decreased ability to use insulin. When not controlled, glucose and fats remain in blood over time and cause damage to tissues/organs.

Question 4

Secondary Pathologies of Diabetes

Answer 4

Heart Disease
Stroke
Blindness
Kidney Failure
Pregnancy Complications
LE amputations
Death related to flu/pneumonia

Question 5

Secondary Pathologies of the Foot (Diabetes)

Answer 5

Diabetic Neuropathy
Peripheral Vascular Disease
Nail Conditions
Macerations/Infections
Pre-Ulcerative Callusing
Ulcerations
Charcot foot deformity
Amputations

Question 6

Diabetic Neuropathy

Answer 6

Type I & II
Affects ~70% of people w/ diabetes
Destroys the axons/myelin
Damaged nerves do not transmit the proper signal
Loss of sensation/pain/hypersensation

Question 7

Peripheral Neuropathy

Answer 7

Most common form of neuropathy
Numbness, tingling, burning, dull ache, stabbing pain/cramping
Skin sensitivity
Foot ulcers

Question 8

Peripheral Vascular Disease

Answer 8

Similar to coronary artery disease
Fatty deposits build up in inner linings of artery walls
Cramping or fatigue in legs

Question 9

Nail conditions

Answer 9

Toenails should be evaluated for infection / onychomycosis (thick yellow nails that are difficult to cut)
Ingrown toenails / onychomycosis can cause infection at nail border.

Question 10

Maceration

Answer 10

Occurs between the toes and leads to infection.
Very dry skin w/ cracks.

Question 11

Pre-Ulcerative Callusing

Answer 11

Body’s response to unnatural increased pressures on neuropathic foot.
Underlying skin can break down.

Question 12

Ulcerations

Answer 12

Areas most subjected to weight bearing/stress
Most prominent on tips of the toes.

Question 13

Charcot Foot Deformity

Answer 13

Sensory neuropathy involving feet.
Motor neuropathy - intrinsic muscle weakness, splaying of foot on weight bearing compounds trauma.
Convex foot with rocker bottom appearance.

Question 14

Amputations

Answer 14

50% of all non-traumatic amputations.
Of these:
24% digit
5.8% midfoot
38% BK
21.2% AK
10% other sites

Question 15

Type I Diabetes

Answer 15

5-10% of diagnosed cases
Formerly called: Juvenile diabetes or Insulin Dependent Diabetes Mellitus (IDDM)
Onset <25yrs

Immune system attacks and destroys its own insulin producing beta cells.

Question 16

Type II Diabetes

Answer 16

90-95% of diagnosed cases
Formerly called: Adult-onset DM or non-insulin dependent DM (NIDDM)

Body does not make enough insulin or can’t use insulin effectively.

Question 17

Risk Factors for Diabetes

Answer 17

Family history, member of ethnic group, overweight or obese, gestational diabetes, abnormal cholesterol, limited physical activity.

Native Americans: 2.2x more likely to have DM

Question 18

Adolescents

Answer 18

151,000 people below age 20 in the US.

Question 19

Prevention of Diabetes

Answer 19

Early detection, improved deliver of care, education
Nutrition - limit fats/sweets
Glucose levels - reduces risk of eye, kidney, nerve by 40%
Consistent glucose monitoring and A1c levels.

Question 20

A1c

Answer 20

A1c level indicates blood glucose level.
Not influenced by daily fluctuations of blood glucose level.
Reflects average glucose level over the past 6-8 weeks
Glucose is bound to a1c

“good” a1c in non-diabetics = <7%, generally 8%

Question 21

Foot Care

Answer 21

Comprehensive foot care can reduce amputations by 45-85%

Question 22

Therapeutic Shoes

Answer 22

Important to prevent injuries, often deeper/wider than regular shoes.

Medicare B covers 80% cost of 3 pairs of prefab molded inserts per year