by diabetes • Risk is 40 times increased in diabetes • 70% of people die five years following an amputation • Foot problems account for 40% of healthcare resources in developing countries; 15% in developed countries
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Diabetic neuropathy Curriculum Module III-7C
Some statistics Slide 4 of 37
• 85% of all amputations begin with an
ulcer • Foot problems cost USD 6 billion/year in the USA • 49-85% of amputations can be prevented
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Diabetic neuropathy ACTIVITY Curriculum Module III-7c Slide 5 of 37
Discuss
• How and when people have their
feet examined in your country?
• What conditions put people at high
risk of injury in your country?
Slides current until 2008
Diabetic neuropathy Curriculum Module III-7C
Peripheral neuropathy – Slide 6 of 37
sensory motor
• Most common form of neuropathy
• Affects approximately 50% after 15 years • Affects long nerves (feet and legs) first – glove and stocking distribution • Bilateral • Equal symptoms in both limbs
Slides current until 2008
Diabetic neuropathy Curriculum Module III-7C
Diabetic peripheral neuropathy –
Slide 7 of 37
risk factors
• Poor glycaemic control
• Long duration • Age • Height • Excessive alcohol
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Diabetic neuropathy Curriculum Module III-7C
Nerve damage – neuropathy
Slide 8 of 37
• Symptoms: – burning – pins and needles – pain
• No symptoms
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Diabetic neuropathy Curriculum Module III-7C Slide 9 of 37
Slides current until 2008
Diabetic neuropathy Curriculum Module III-7C
Painless nature of diabetic foot
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disease
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Diabetic neuropathy Curriculum Module III-7C
Sensory nerve damage
Slide 11 of 37
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Diabetic neuropathy Curriculum Module III-7C
Motor nerve damage
Slide 12 of 37
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Diabetic neuropathy Curriculum Module III-7C
Localized callus Slide 13 of 37
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Diabetic neuropathy Curriculum Module III-7C
Autonomic nerve damage Slide 14 of 37
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Diabetic neuropathy Curriculum Module III-7C Slide 15 of 37
Take off the shoes!
Slides current until 2008 Diabetic neuropathy Curriculum Module III-7C
• Rationale – Identify and confirm presence of disease – Predict healing of ulcers or determine need for early surgical intervention Slides current until 2008 Diabetic neuropathy Curriculum Module III-7C
Peripheral vascular disease
Slide 31 of 37
non-invasive evaluation
• Doppler ultrasound – Measures pressure at brachial, pedal and toe arteries – Ankle Brachial Index (ABI) <0.9 abnormal 0.9 to 1.0 normal >1.3 non-compressible
Slides current until 2008
Diabetic neuropathy Curriculum Module III-7C
Peripheral vascular disease
Slide 32 of 37
non-invasive evaluation
• Duplex arterial imaging –
allows narrowing or obstruction of blood vessels to be localized
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Diabetic neuropathy Curriculum Module III-7C
Peripheral vascular disease
Slide 33 of 37
Treatment
• Quit smoking
• Walk through pain
• Surgical intervention
Slides current until 2008
Diabetic neuropathy Curriculum Module III-7C Slide 34 of 37
Risk categorization system
Category Risk profile Check-up frequency
0 No sensory neuropathy Once a year
1 Sensory neuropathy Every 6 months
Sensory neuropathy 2 /peripheral vascular Every 3 months disease/foot deformities 3 Previous ulcer Every 1-3 months
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Diabetic neuropathy Curriculum Module III-7C
Cause of diabetic amputation
Slide 35 of 37
Neuropathy or vascular disease
Trauma
Ulcer
Failure to heal
Infection
Amputation Pecararo Slides current until 2008 Diabetic neuropathy Curriculum Module III-7C Slide 36 of 37
An amputation every 30 seconds due to diabetes
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Diabetic neuropathy ACTIVITY Curriculum Module III-7c Slide 37 of 37
