Orthopaedic Care of the Diabetic Patient

 - See: General Orders

- Effects on Musculoskeletal System: 
    - see importance of glucose control in the surgical patient
    - diabetic foot pathology:
           - vascular pathology:
           - diabetic charcot foot and ankle:
           - neuropathic ulceration:
    - diabetic osteomyelitis
           - experimental evidence that suggests that gram positive bacteria thrive in hyperglycemic state and that gram negative bacteria 
                   grow less well in a hyperglycemic serum;
           - this may explain why diabetic patients are more prone to staph infections;
    - diabetic skeletal muscle necrosis: (tumoriform focal muscular degeneration);


- Management of Hyperglycemia:
    antidiabetic agents
    DKA
    hyperosmalar non ketotic coma
    insulin iv infusion
    sliding scale
    types of insulin
    - preop insulin management:
           - 1 unit of insulin disposes of about 8 gm of glucose;
           - 1 unit of glucose should decrease blood glucose by about 50;
           - most operative patients can be maintained in the 120 to 180 blood glucose range w/ regular insulin infusion rate set at 1.0 unit/hour and 2.0 U/hour;
           - note: make the distinction between IDDM and NIDDM
                  - IDDM: pt must receive insulin on a routine schedule and must not be be placed solely on a sliding scale;
                  - NIDDM: pt may be placed solely on Sliding Scale;


- Diabetic Hypertensive Patient:
     - Ca channel blockers may adversely affect Insulin secretion;
     - Diuretics and Beta blockers also have problems;
     - Consider ACE to be the 1st choice for therapy



American Association of Clinical Endocrinologists
Centers for Disease Control
First Aid Manual - 1
First Aid Manual - 2
Iowa Family Practice Handbook - 1
Iowa Family Practice Handbook - 2
Merck Manual



References

Hyperglycemia in the Hospital Setting. 

Glucagonoma - NEJM images in clinical medicine 

Sweet Potatoes Step Out From Under Marshmallows 

Exercise: For Type 2 Diabetes, 2 Types of Training

The Claim: Drinking Water Before Meals Aids Weight Loss

Diabetic Myonecrosis: Likely an Underrecognized Entity




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, January 2, 2015 10:00 pm