URGO MEDICAL

Diabetes

Diabetes is a state of hyperglycaemia (high blood glucose) resulting from both genetic and environmental factors.

DEFINITION OF GLYCEMIA

Glycaemia: level of glucose in the blood.
Normal glycaemia in a healthy subject, on an empty stomach, is between 0.7 and 1.1 g/l.
Hypoglycaemia: below 0.7 g/l.
Hyperglycaemia : above 1.1 g/l.
Diabetes: above 1.26 g/l.

TWO TYPES OF DIABETES

There are two main types of diabetes:

• IDD or Type I Insulin Dependent Diabetes (10% of diabetic patients)
  • This form of diabetes is characterised by the complete or almost complete disappearance of insulin secretion by the pancreas. This lack of insulin is responsible for serious hyperglycaemia and will have a fatal outcome if not treated.
• NIDD or Type II Non-Insulin Dependent Diabetes (90% of diabetic patients)
  • Type II diabetes is characterised by insulin resistance, frequently accompanied with obesity. This type of diabetes is defined by its development over the age of 35 years and there is no need for insulin treatment during the first year after its discovery.

In both types of diabetes, chronic hyperglycaemia is responsible for long-term complications which is why the disease is so serious.

COMPLICATIONS

• 15% of diabetic patients have or have had a wound on their feet.
• The risk of amputation is 15 to 20 times higher in the diabetic population than it is in the general population.
• 5% to 10% of diabetics will at some stage undergo amputation (toe/leg).
• In 30% to 50% of cases, there is a risk of bilateral amputation within 5 years.
• The mortality rate is 50% after amputation within 5 years.
• The extent of this human and financial problem should prompt improvements in preventive care.
• Amputation is the most financially expensive complication of diabetes.

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Perforating diabetic foot ulcer

This condition develops in diabetic patients due to vascular, neurological and metabolic disorders. This wound can frequently lead to an amputation.

Definition

Chronic, painless and clean ulceration, usually located under the head of the 2nd or 3rd metatarsal bone in the foot or on any other point of normal or abnormal pressure on the underside of the foot. It is usually secondary to a reduction or disappearance in sensitivity, within the context of a diabetic angiopathy and neuropathy or deformation of the foot posture. It is readily complicated by infections, abscesses or osteitis.

• Origin : This is a complex response to a sensory and neurovegetative disorder that causes muscular weakness leading to deformation of the foot structure (collapse of the arch of the foot) and reduction or loss of skin sensitivity to pain or friction. All these factors, combined with weakness of the skin and lack of attention by patients, is the starting point for this ulcer called a diabetic Malum Perforans Pedis (MPP) or perforating diabetic foot ulcer.
  

• Characteristics: The MPP originates as small ulcer and is a complication of the erosion of an initial callus by hyperpressure. It takes the form of a wound with well-defined keratinous and sharp edges. It is atonic and is frequently torpid. Secondary infection often occurs in the form of remote purulent fistulae and underlying osteoarthritis.
  

• Prevention: Check the sensitivity of the foot (cold, heat, foreign body, reflexes, etc.). Pay special attention to shoes, toenails, hard skin, fungal infection between the toes, foreign bodies. Careful hygiene is essential.
  

• Aetiology:
  • slight trauma, blister on weight-bearing callus
  • blister, erosive cracking
  • ulceration, gateway for infection
  • swelling in surrounding integuments and establishment of infection, risk of underlying osteoarthritis,
  • complete destruction of metatarsal bones by progressive osteolysis and risk of spread in separation areas (infectious cellulitis)
  • diabetic gangrene
  • if Peripheral Arterial Occlusive Disease: risk of amputation.

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