DM Cultural + Wound Care Considerations

Question 1

[CULTURE/RACE INFLUENCE]

Genetics/family history:
Asians have ____ risk of developing T2DM compared to Europeans. Why?

Answer 1

Asians have higher risk of developing T2DM
- due to less muscles, more abdominal fats => lead to insulin resistance

Question 2

[CULTURE/RACE INFLUENCE]

How might environment affect diabetes risk?

Answer 2

• Higher stress levels can induce binge eating, less exercise
• Poor health literacy/misconceptions (e.g., carbs more filling than proteins)
• Language barrier

Question 3

[CULTURE/RACE INFLUENCE]

What constitutes asian diet? Why might it contribute to diabetes risk?

Answer 3

Asian diet - carbs heavy, stir fry/deep fry wil oill
=> Carbs broken down into glucose

Question 4

[RAMADAN]

During ramadan, fasting individuals abstain from food, drink, smoking, and even oral medications from dawn to sunset (only have 2 meals - one at predawn, one at sunset)

What effect does this have on DM management?

Answer 4

No food - risk of hypoglycemia, lack of exercise, binge eating at sunset

No water - risk of dehydration and thrombosis, acute diabetes (DKA/HHS)

No medications - risk of hyperglycemia, risk of acute diabetes (DKA/HHS)

=> Unpredictable BG levels due to differing baseline glycemic control
=> Unsafe self-management practices: providers not informed, BG not monitored, fasting despite hypoglycemia symptoms

Question 5

[RAMADAN]

What DM medication adjustments can be made during Ramadan?

Answer 5

1. TDS to BD
2. Reduce medications with high hypoglycemia potential (e.g., SU, insulin - these secrete insulin)
3. Evening dose potency higher than morning (since evening eat more)

=> In general, new potency of meds should be reduced as pt typically eat less overall

Question 6

[RAMADAN]

What to counsel fasting patients?

Answer 6

• When to break fast
• Recognise hypo and hyperglycemic symptoms
• Remove misconceptions
• SMBG
• Fluids, dietary advice
• Physical activity and exercise
• Medication adjustment, and test fasting

Question 7

[RAMADAN]

HCPs may use LEARN to help provide specific diabetes support and address cultural differences.

Answer 7

Listen
Explain
Acknowledge
Recommend
Negotiate

Question 8

[DIABETIC FOOT CARE / WOUND CARE]

What are the common bugs that case DFIs?

Answer 8

Mild: Gram positive (Staph, Strep)

Moderate: Gram positive + Gram negative + Anaerobe

Severe: Gram positive + Gram negative + Anaerobe + Pseudomonas

Question 9

[DIABETIC FOOT CARE / WOUND CARE]

How to assess and treat wounds?
*TIME acronym

Answer 9

Tissue:

• Non-viable or Necrotic (not healing, black, or yellow sloughy) => debride
• Viable (red, pink - granulating, epithelializing) => normal wound healing

Infection:

• Chronic wounds stuck in inflammation phase

Moisture:

• Assess and manage wound exudate (not too moist - maceration, excoriation) (not too dry - need some moisture and nutrients from exudate)

Edge of wound:

• Assess non-advancing wound edges, condition of periwound (ensure that the wound is able to close up)

Question 10

[DIABETIC FOOT CARE / WOUND CARE]

What are some risk factors for DFI?

Answer 10

1. Poor glycemic control - immune function impaired
2. Peripheral artery disease - insufficient blood and nutrients supply
3. Peripheral neuropathy - numbness, loss of sensation
4. Visual impairment - unable to self examine their foot
5. Smoking - damages vascular tissues (cause clotting, decr artery wall thickness, narrowing of arteries => predispose to PAD)

Question 11

[DIABETIC FOOT CARE / WOUND CARE]

How to prevent/educate on prevention of DFI?

Answer 11

1. Maximise BG control, reduce risk factors (smoking cessation, treat other conditions)
2. Self-examination of the foot

• Observe for cracks, wounds, dryness
• Use mirror to view bottom of foot

3. Foot protection

• Avoid being barefoot, wear socks
• Ensure shoes not too tight to prevent reduce blood circulation
• Ensure shoes not too loose to prevent abrasion

4. Nail and foot care and hygiene

• Foot care: wash foot and wash b/w toes (dry properly, prevent fungal growth)
• Foot care: soak in warm water 1-2min a day, not too long to prevent weakening of skin
• Foot care: Use moisturizers to prevent drying, but do not moisturize b/w toes to prevent fungal growth
• Nail care: cut straight across, leave edges sharp rather than rounded to prevent ingrown toenails

5. Annual foot examination

• Visual inspection
• Vascular assessment of pedal pulses (to ensure no PAD)
• Monofilament test (to ensure no neuropathy)