Diabetes and endocrine emergencies

2019 ◽  
pp. 545-606
Author(s):  
Punit S. Ramrakha ◽  
Kevin P. Moore ◽  
Amir H. Sam
Keyword(s):  
Malignant Hyperthermia ◽  
Diabetic Ketoacidosis ◽  
Neuroleptic Malignant Syndrome ◽  
Diabetic Foot ◽  
Pituitary Apoplexy ◽  
Urgent Surgery ◽  
Foot Complications ◽  
Patients With Diabetes ◽  
Thyrotoxic Crisis ◽  
Hypoglycaemic Coma

This chapter describes diabetes and endocrine emergencies, including diabetic ketoacidosis (DKA; assessment, management, complications), hyperosmolar non-ketotic coma (HONK), hypoglycaemic coma, urgent surgery in patients with diabetes, diabetic foot complications, hyponatraemia, hypernatraemia, acute hypocalcaemia, hypercalcaemia, hypophosphataemia, Addisonian crisis, myxoedema coma, thyrotoxic crisis, pituitary apoplexy, hypopituitary coma, phaeochromocytomas, polyuria, malignant hyperthermia, and neuroleptic malignant syndrome.

Endocrine emergencies

2010 ◽  
pp. 515-572
Author(s):  
Punit S. Ramrakha ◽  
Kevin P. Moore ◽  
Amir Sam
Keyword(s):  
Diabetic Ketoacidosis ◽  
Urgent Surgery ◽  
Patients With Diabetes ◽  
Hypoglycaemic Coma

Diabetic ketoacidosis (DKA): assessment 516 DKA: management 1 518 DKA: management 2 520 DKA: complications 522 Hyperosmolar non-ketotic coma (HONK) 1 524 HONK 2 526 Hypoglycaemic coma: assessment 528 Hypoglycaemic coma: management 530 Urgent surgery in patients with diabetes 532 Hyponatraemia: assessment 534 Hyponatraemia: causes ...

scholarly journals Causation Research on Diabetic Foot Complications—What I Learned From Roger Pecoraro: The 2021 Roger E. Pecoraro Award Lecture

2021 ◽  
Author(s):  
Edward J. Boyko
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Past History ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Clinical Information ◽  
Arterial Perfusion ◽  
Primary Care Population ◽  
Foot Complications ◽  
Patients With Diabetes

Roger Pecoraro made important contribution to diabetic foot research and is primarily responsible for instilling in me an interest in these complications. Our collaboration in the final years of his life led to the development of the Seattle Diabetic Foot Study. At the time it began, the Seattle Diabetic Foot Study was perhaps unique in being a prospective study of diabetic foot ulcer conducted in a non-specialty primary care population of patients with diabetes and without foot ulcer. Important findings from this research include the demonstration that neurovascular measurements, diabetes characteristics, past history of ulcer or amputation, body weight, and poor vision all significantly and independently predict foot ulcer risk. A prediction model from this research that included only readily available clinical information showed excellent ability to discriminate between patients who did and did not develop ulcer during follow-up (area under ROC curve=0.81 at one year). Identification of limb-specific amputation risk factors showed considerable overlap with those risk factors identified for foot ulcer, but suggested arterial perfusion as playing a more important role. Risk of foot ulcer in relation to peak plantar pressure estimated at the site of the pressure measurement showed a significant association over the metatarsal heads, but not other foot locations, suggesting that the association between pressure and this outcome may differ by foot location. The Seattle Diabetic Foot Study has helped to expand our knowledge base on risk factors and potential causes of foot complications. Translating this information into preventive interventions remains a continuing challenge.

scholarly journals Causation Research on Diabetic Foot Complications—What I Learned From Roger Pecoraro: The 2021 Roger E. Pecoraro Award Lecture

2021 ◽  
Author(s):  
Edward J. Boyko
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Past History ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Clinical Information ◽  
Arterial Perfusion ◽  
Primary Care Population ◽  
Foot Complications ◽  
Patients With Diabetes

Roger Pecoraro made important contribution to diabetic foot research and is primarily responsible for instilling in me an interest in these complications. Our collaboration in the final years of his life led to the development of the Seattle Diabetic Foot Study. At the time it began, the Seattle Diabetic Foot Study was perhaps unique in being a prospective study of diabetic foot ulcer conducted in a non-specialty primary care population of patients with diabetes and without foot ulcer. Important findings from this research include the demonstration that neurovascular measurements, diabetes characteristics, past history of ulcer or amputation, body weight, and poor vision all significantly and independently predict foot ulcer risk. A prediction model from this research that included only readily available clinical information showed excellent ability to discriminate between patients who did and did not develop ulcer during follow-up (area under ROC curve=0.81 at one year). Identification of limb-specific amputation risk factors showed considerable overlap with those risk factors identified for foot ulcer, but suggested arterial perfusion as playing a more important role. Risk of foot ulcer in relation to peak plantar pressure estimated at the site of the pressure measurement showed a significant association over the metatarsal heads, but not other foot locations, suggesting that the association between pressure and this outcome may differ by foot location. The Seattle Diabetic Foot Study has helped to expand our knowledge base on risk factors and potential causes of foot complications. Translating this information into preventive interventions remains a continuing challenge.

scholarly journals Diabetic Foot Self Care Pada Diabetisi

2022 ◽  
Vol 1 (1) ◽  
pp. 124-130
Author(s):  
Defrima Oka Surya ◽  
Zulham Efendi ◽  
Afrizal Afrizal ◽  
Ria Desnita
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Quantitative Research ◽  
Self Care ◽  
Foot Care ◽  
Consecutive Sampling ◽  
Foot Complications ◽  
Patients With Diabetes ◽  
Leg Amputation ◽  
Diabetes Melitus

ABSTRACT: DIABETIC FOOT SELF CARE ON DIABETES PATIENTS Background: Diabetes Mellitus (DM) can cause complications in various body systems. One of the complications of DM is complications in the feet which can cause diabetic foot ulcers and lead to leg amputation. Diabetic foot complications can be prevented by performing routine foot care or diabetic foot care. Objective: The purpose of this study was to determine the description of diabetic foot care in patients with diabetes mellitus consisting of personal self-care, podiatric care, and footwear and socks. Method: This type of research is descriptive quantitative research. Data was collected using a diabetic foot care questionnaire. The number of samples in this study was 51 people. The sampling method is a non-probability technique using consecutive sampling. The study was conducted in the Kuranji Health Center Working Area in July – November 2021. Result: The results showed that most respondents (64.70%) had poor personal self-care in foot care, 82.3% of respondents had poor podiatric care habits. and 52.94% of respondents have good habits in choosing footwear. Conclusion: From the results of the study, it was concluded that people with diabetes have bad habits in performing foot care so that this is one of the risk factors for complications in the feet. To increase awareness of people with diabetes in performing foot care, it is recommended that nurses can provide education and teach people with diabetes to take care of their feet Keywords: Diabetes Mellitus; Foot Complications; Foot Care  INTISARI : DIABETIC FOOT SELF CARE PADA DIABETISI Latar Belakang : Diabetes Melitus (DM) dapat menyebabkan komplikasi pada berbagai sistem tubuh. Salah satu komplikasi DM adalah komplikasi pada kaki yang dapat menimbulkan ulkus kaki diabetik dan berujung dengan amputasi kaki. Pencegahan komplikasi pada kaki dapat dilakukan diabetisi dengan melakukan perawatan kaki rutin atau diabetic foot care.Tujuan : Tujuan penelitian ini adalah untuk mengetahui gambaran diabetic foot care pada pasien diabetes melitus yang terdiri dari personal self care, podiatric care, serta footwear and sock.Metode : Jenis penelitian ini adalah penelitian deskriptif kuantitatif. Pengumpulan data dilakukan menggunakan kuesioner diabetic foot care. Jumlah sampel dalam penelitian ini adalah 51 orang. Metode pengambilan sampel adalah dengan Teknik non probability dengan menggunakan consecutive sampling. Penelitian dilakukan di Wilayah Kerja Puskesmas Kuranji pada Bulan Juli – November 2021.Hasil : Hasil penelitian menunjukkan bahwa sebagian besar responden (64,70%) memiliki personal self care yang kurang baik dalam perawatan kaki, 82,3% responden memiliki kebiasan podiatric care yang kurang baik dan 52,94% responden memiliki kebiasaan baik dalam pemilihan alas kaki.Kesimpulan : Diabetisi memiliki kebiasaan yang kurang baik dalam melakukan perawatan kaki sehingga ini menjadi salah satu faktor resiko terjadinya komplikasi pada kaki. Untuk meningkatkan kesadaran diabetisi dalam melakukan perawatan kaki disarankan perawat dapat memberikan edukasi dan mengajarkan diabetisi untuk melakukan perawatan kaki Kata Kunci : Diabetes Melitus; Komplikasi Kaki; Perawatan Kaki

scholarly journals Assessment of heart rate variability (HRV) in subjects with type 2 diabetes mellitus with and without diabetic foot: correlations with endothelial dysfunction indices and markers of adipo-inflammatory dysfunction

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Antonino Tuttolomondo ◽  
Alessandro Del Cuore ◽  
Alessandro La Malfa ◽  
Alessandra Casuccio ◽  
Mario Daidone ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Rate ◽  
Endothelial Dysfunction ◽  
Diabetic Foot ◽  
Healthy Subjects ◽  
Serum Levels ◽  
Sympathovagal Balance ◽  
Foot Complications ◽  
Patients With Diabetes ◽  
Hrv Analysis

Abstract Background Some studies have suggested that patients with diabetes and foot complications have worse cardiovascular and cerebrovascular risk profiles, higher degrees of endothelial dysfunction and arterial stiffness and a higher inflammatory background than patients with diabetes without diabetic foot complications. Patients with diabetes mellitus have an alteration in the sympathovagal balance as assessed by means of heart rate variability (HRV) analysis, which is also related to the presence of endothelial dysfunction. Other studies suggest a possible role of inflammation coexisting with the alteration in the sympathovagal balance in favor of the atherosclerotic process in a mixed population of healthy subjects of middle and advanced age. Aims The aim of this study was to evaluate the degree of alteration of sympathovagal balance, assessed by HRV analysis, in a cohort of patients with diabetes mellitus with diabetic foot and in control subjects without diabetic foot compared with a population of healthy subjects and the possible correlation of HRV parameters with inflammatory markers and endothelial dysfunction indices. Methods We enrolled all patients with diabetic ulcerative lesions of the lower limb in the Internal Medicine with Stroke Care ward and of the diabetic foot outpatient clinic of P. Giaccone University Hospital of Palermo between September 2019 and July 2020. 4-h ECG Holter was performed. The following time domain HRV measures were analyzed: average heart rate, square root of the mean of successive differences of NN (RMSSD), standard deviation or square root of the variance (SD), and standard deviation of the means of the NN intervals calculated over a five-minute period (SDANN/5 min). The LF/HF ratio was calculated, reactive hyperemia was evaluated by endo-PAT, and serum levels of vaspine and omentin-1 were assessed by blood sample collection. Results 63 patients with diabetic foot, 30 patients with diabetes and without ulcerative complications and 30 patients without diabetes were enrolled. Patients with diabetic ulcers showed lower mean diastolic blood pressure values than healthy controls, lower MMSE scores corrected for age, lower serum levels of omentin-1, lower RHI values, higher body weight values and comparable body height values, HF% and LF/HF ratio values. We also reported a negative correlation between the RHI value and HRV indices and the expression of increased parasympathetic activity (RMSDD and HF%) in subjects with diabetic foot and a statistically significant positive correlation with the LF/HF ratio and the expression of the sympathovagal balance. Discussion Patients with diabetic foot show a higher degree of activation of the parasympathetic system, expressed by the increase in HF values, and a lower LF/HF ratio. Our findings may corroborate the issue that a parasympathetic dysfunction may have a possible additive role in the pathogenesis of other vascular complications in subjects with diabetic foot.

Therapeutic footwear for patients with diabetes

1994 ◽  
Vol 84 (9) ◽  
pp. 470-479 ◽  
Author(s):  
J White
Keyword(s):  
Diabetic Foot ◽  
Therapeutic Footwear ◽  
Foot Complications ◽  
Patients With Diabetes ◽  
Successful Prevention ◽  
Risk Categories

The proper prescription and utilization of therapeutic footwear is crucial to successful prevention of diabetic foot complications. The author reviews shoe alternatives' characteristics and proper fit. The concept of foot risk categories is explained and appropriate shoe selections are discussed.

scholarly journals Delay between Onset of Symptoms and Seeking Physician Intervention Increases Risk of Diabetic Foot Complications: Results of a Cross-Sectional Population-Based Survey

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Norina A. Gavan ◽  
Ioan A. Veresiu ◽  
Etta J. Vinik ◽  
Aaron I. Vinik ◽  
Bogdan Florea ◽  
...  
Keyword(s):  
Medical Care ◽  
Diabetic Foot ◽  
Population Based ◽  
Cross Sectional ◽  
Physician Intervention ◽  
Foot Complications ◽  
Patients With Diabetes ◽  
History Of ◽  
Post Hoc ◽  
The Impact

We present a post hoc analysis of 17,530 questionnaires collected as part of the 2012 screening for neuropathy using Norfolk Quality of Life tool in patients with diabetes in Romania, to assess the impact on foot complications of time between the onset of symptoms of diabetes/its complications and the physician visit. Odds ratios (ORs) for self-reporting neuropathy increased from 1.16 (95% CI: 1.07–1.25) in those who sought medical care in 1–6 months from symptoms of diabetes/its complications onset to 2.27 in those who sought medical care >2 years after symptoms onset. The ORs for having a history of foot ulcers were 1.43 (95% CI: 1.26–1.63) in those who sought medical care in 1–6 months and increased to 3.08 (95% CI: 2.59–3.66) in those who sought medical care after >2 years from symptoms of diabetes/its complications onset. The highest ORs for a history of gangrene (2.49 [95% CI: 1.90–3.26]) and amputations (2.18 [95% CI: 1.60–2.97]) were observed in those who sought medical care after >2 years following symptoms onset. In conclusion, we showed that waiting for >1 month after symptoms onset dramatically increases the risk of diabetic foot complications. These results show the need for accessible educational programs on diabetes and its chronic complications and the need to avoid delays in reporting.

scholarly journals Predictors of foot care behaviours in patients with diabetes in Turkey

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6416 ◽  
Author(s):  
Yasemin Yıldırım Usta ◽  
Yurdanur Dikmen ◽  
Songül Yorgun ◽  
İkbal Berdo
Keyword(s):  
Health Beliefs ◽  
Diabetic Foot ◽  
Linear Regression Analysis ◽  
Illness Perception ◽  
Health Belief ◽  
Personal Control ◽  
Foot Care ◽  
Foot Complications ◽  
Patients With Diabetes ◽  
Behaviour Score

Background The management of diabetic foot complications is challenging, time-consuming and costly. Such complications frequently recur, and the feet of individuals with diabetes can be easily infected. The variables that predict foot care behaviours must be identified to improve foot care attitudes and behaviours. Thus, this study aimed to evaluate the predictors of foot care behaviours in individuals with diabetes and the role of these variables. Methods This descriptive and analytic study was carried out between July 2015 and July 2016, and 368 outpatients with diabetes from a public hospital in Turkey were included. The participants had no communication, psychiatric or neurological problems and had been diagnosed with diabetes for at least 1 year. Foot care behaviour was the dependent variable and was evaluated with the foot care behaviour questionnaire. The relationship among foot care behaviours and sociodemographic characteristics, diabetes-related attitudes, disease perception, health beliefs and perceived social support was evaluated. Factors that independently predicted effective foot care behaviours were estimated via a linear regression analysis. Results The foot care behaviour score of the participants was above average (54.8 ± 5.0). Gender (t = −2.38, p = 0.018), history of a foot wound (t = −2.74, p = 0.006), nephropathy (t = 3.13, p = 0.002), duration subscale of the illness perception scores (t = 2.26, p = 0.024) and personal control subscale of the health belief scores (t = −2.07, p = 0.038) were significant predictors of foot care behaviours. These variables, which provided model compatibility, accounted for approximately 22.0% of the total variance of the foot care behaviour score (R = 0.47, R2 = 0.22, F = 5.48, p ≤ 0.001). Discussion Our results show factors that may affect diabetic foot care behaviours. Several of these factors prevent individuals from practising these behaviours. Further studies on the roles of barriers as predictors of foot care behaviours must be conducted.

Diabetic Foot Complications Despite Successful Pancreas Transplantation

2017 ◽  
Vol 38 (6) ◽  
pp. 656-661 ◽  
Author(s):  
Dong-Kyo Seo ◽  
Ho Seong Lee ◽  
Jungu Park ◽  
Chang Hyun Ryu ◽  
Duck Jong Han ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Pancreas Transplantation ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot And Ankle ◽  
Charcot Arthropathy ◽  
Level Of Evidence ◽  
Foot Complications ◽  
Patients With Diabetes ◽  
Normal Glucose Level

Background: It is known that successful pancreas transplantation enables patients with diabetes to maintain a normal glucose level without insulin and reduces diabetes-related complications. However, we have little information about the foot-specific morbidity in patients who have undergone successful pancreas transplantation. The purpose of this study was to investigate the prevalence and predisposing factors for foot complications after successful pancreas transplantation. Methods: This retrospective study included 218 patients (91 males, 127 females) who had undergone pancreas transplantation for diabetes. The mean age was 40.7 (range, 15-76) years. Diabetes type, transplantation type, body mass index, and diabetes duration before transplantation were confirmed. After pancreas transplantation, the occurrence and duration of foot and ankle complications were assessed. Results: Twenty-two patients (10.1%) had diabetic foot complications. Fifteen patients (6.9%) had diabetic foot ulcer and 7 patients (3.2%) had Charcot arthropathy. Three patients had both diabetic foot ulcer and Charcot arthropathy. Three insufficiency fractures (1.4%) were included. Mean time of complications after transplantation was 18.5 (range, 2-77) months. Creatinine level 1 year after surgery was higher in the complication group rather than the noncomplication group ( P = .02). Conclusion: Complications of the foot and ankle still occurred following pancreas transplantation in patients with diabetes. Level of Evidence: Level III, comparative study

scholarly journals Glycated Hemoglobin (HbA1c) as a Biomarker for Diabetic Foot Peripheral Neuropathy

Diseases ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 16
Author(s):  
Giulia Casadei ◽  
Marta Filippini ◽  
Lorenzo Brognara
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Neuropathy ◽  
Diabetic Foot ◽  
Glycated Hemoglobin ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Glycemic Variability ◽  
Future Research ◽  
Patients With Diabetes ◽  
Axonal Dysfunction ◽  
Biomarker Research

Background: Diabetic peripheral neuropathy (DPN) is known to predict foot ulceration, lower-extremity amputation and mortality. Patients with diabetes mellitus have a predisposition toward developing chronic inflammatory demyelinating polyneuropathy, and this may also facilitate the formation of diabetic foot and cutaneous impairment, which are considered one of the most serious impairments of diabetes mellitus, with a prevalence of 4–10% in this population. Biomarkers research provides opportunities for the early diagnosis of these complications for specific treatments useful to prevent amputation and, therefore, physical inability and mental disturbance. The recent literature has suggested that glycemic levels may be a novel factor in the pathogenesis of diabetic foot complications and is an important mediator of axonal dysfunction. The aim of this systematic literary review is to determine whether hemoglobin A1c (HbA1c) is a positive predictor for diabetic foot peripheral neuropathy and its complications, such as foot cutaneous impairments. There is a lack of consensus regarding the effect of glycemic variability on diabetic foot peripheral neuropathy, unlike other complications such as retinopathy, nephropathy or micro/macrovascular pathology. Methods: Relevant articles were searched in the Medline database using PubMed and Scopus and relevant keywords. The primary search terms used were “glycated hemoglobin” OR “HbA1c” AND “diabetic neuropathies” AND “Foot”. Results: A number of articles (336) were initially identified while searching the scientific literature regarding this topic, and 32 articles were selected and included in this review. Conclusions: This review highlights the role of HbA1c in diabetic foot peripheral neuropathy. Biomarkers play an important role in the decision-making process, and HbA1c levels are extensively used for diabetic foot clinical outcomes and settings, but biomarker research in diabetic foot peripheral neuropathy is in its infancy and will require careful attention to a number of factors and associations, since the consequences of DPN also include neurological alterations. HbA1c is an accurate and easy-to-administer test and can be an effective biomarker in establishing the diagnosis of diabetes, but future research should focus on standardizing the HbA1c level and selecting which DPN value and its correlated complications, such as foot cutaneous impairments, are the most informative.

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