metabolic syn & diabetic foot Flashcards
Define metabolic syn
cluster of metabolic RF that factors the development of diabetes and CV dz
diagnostic criteria for metabolic syn
3 of:
waist circumference >37 men (35 in asians); >31 women
Tg > 150 or Rx (fibrate or niacin)
HDL <40 in men < 50 in women or Rx (fibrate or niacin)
BP >130/85 or Rx
Fasting glucose >100 or Rx
is metabolic syn a cardiac-risk equivalent?
No
but there is a 2 fold risk of developing CD w/in 5 to 10 years
etiology of metabolic syn
insulin resistance driven by visceral adiposity
visceral fat contributes to HTN, low HDL
relationship between visceral fat, inflammation and insulin resistance
visceral fat causes systemic inflammation and insulin resistance
5 predispositions to metabolic syndrome
diet
physical activity
socioeconomic status
genetics
birth size/childhood growth
treatment of metabolic syndrome
aggressive lifestyle mod– reduce onset Dm by 60%
wt loss and aerobic exercise improves insulin sensitivity, BP, lipid levels
medications and surgery
with who should you not use the framingham risk calc.
in patients w/ known heart dz or diabetes
medications used in treating metabolic syndrome
metformin
fibrate/niacin
statin
antihypertensive
surgery like gastric bypass
components of framingham risk calculator
age and gender
smoker
total and HDL cholesterol
systolic BP
tx for HTN/antihypertensive
which medical therapy for obesity inhibits fat absorption? what are its ADRs?
orlistat
ADR: diarrhea and GI upset
which medical therapy for obesity suppresses appetite? whats weird about this medication being taught? ADR?
phentermine/topiramate XR
its no longer on the market
ADR- suicidal behavior, increased HR, etc
which medical therapy for obesity targets serotonin receptors to increase satiety & decrease food consumption? ADR?
lorcaserin
ADR: dizziness, dry mouth, nausea, constipation, suicidal thoughts, euphoria, etc
which medical therapy also used for DM treatment is used to treat obesity?
GLP-1 agonist
SGLT-2 inhibitors
what is the most common cause of hospital admission for diabetics
foot ulcers
blood glucose limit for ulcers to heal
200+ mg/dL will not heal ulcers or anything
factors contributing to diabetic foot
neuropathy + deformity + trauma & delayed healing= ulcer
what disease is 30x more prevalent in diabetics? how it affects diabetic foot?
peripheral arterial disease
no blood flow to the foot means no antibiotics can get to it
types of trauma contributing to ulcers
mechanical including footwear
thermal
chemical
Risk factors for DM foot
DM > 10 yrs
peripheral neuropathy
abnormal foot structure
PAD
tobacco
poor glycemic control
hx of ulcer or amputation
treatment for ulcers
offloading shoes
debridement
wound care
Abx
surgery
what is the process of debridement?
remove biofilm and stimulate capillary growth-bleeding to turn a chronic wound into acute wound
what is the wound care for large exudate ulcer?
foam, alginates= debridement
what is the wound care for light to moderate exudate?
hydrocolloid= not w/ infection, collagen
