Amputation and Diabetes

Question 1

what is the main cause of lower limb amputation

Answer 1

peripheral vascular disease (PVD)

Question 2

what causes peripheral vascular disease

Answer 2

• diabetes
• hypertension
• hyperlipidaemia
• smoking
• atherosclerosis

Question 3

define peripheral vascular disease

Answer 3

The narrowing of blood vessels outside of the heart and brain

Question 4

how can an artery be opened once affected by PVD

Answer 4

a stent to open blocked artery and remove black build up

Question 5

define atherosclerosis

Answer 5

the process of occlusion

Question 6

list the steps that lead from PVD to amputation

Answer 6

1. Impaired circulation
2. oedema
3. decline in circulation
4. ulcers;/infection
5. impaired healing
6. gangrene
7. amputation

Question 7

What symptoms can be observed in a skin assessment to diagnose PVD

Answer 7

decline in hair growth
dry appearance
thickened nails
decline in pulse

Question 8

what symptoms can be observed in an assessment of ulcer to diagnose PVD

Answer 8

• pain
• odour
• location e.g. heels, phalanges

Question 9

list treatments for PVD

Answer 9

• medications
• angioplasty (stent to open artery + meds to dissolve plaque)
• vascular surgery

Question 10

list the causes of upper limb amputation

Answer 10

• severe trauma
• PVD
• thermal burns/frost bite
• severe blood loss/nerve damage
• tissue necrosis

Question 11

define hyperglycaemia

Answer 11

A high blood glucose level

There is an inability of cells to take in glucose from blood due to lack of/defect of inulin

Question 12

define insulin

Answer 12

a hormone that allows transport of glucose into the cells, lowering the blood glucose levels

Question 13

where is insulin located

Answer 13

packed into granules with B cells

Question 14

when is insulin triggered to be released

Answer 14

when there is an increase in blood glucose levels

Question 15

What will happen when the pancreas secretes insulin and B cells synthesise

Answer 15

a decline in blood glucose levels

Question 16

what will happen when the pancreas secretes glucagon and A cells synthesis

Answer 16

an increase in blood glucose levels

Question 17

What occurs in the Absorptive (fed) state

Answer 17

anabolic processes use glucose in a variety of ways.

In the liver, glucose is converted to glycogen or fat, which store energy for future use.

Fat is also stored in adipose tissue and glycogen in muscle tissue.

Question 18

What occurs in the Post absorptive (fasting) state

Answer 18

• pancreas releases glucagon
• stored glycogen is broken down into glucose
• liver makes glucose from amino acids

Question 19

what is the normal blood glucose level

Answer 19

4-6 mmol/L

Question 20

what is the normal fasting blood glucose level

Answer 20

7.8 mmol/L

Question 21

what is the normal 2h post ingestion level

Answer 21

11.1 mmol/L

Question 22

list the characteristics of Type 1 Diabetes

Answer 22

• absolute lack of insulin
• T cells destroy B cells
• glucose cannot enter cell

Question 23

what is the livers role in Type 1 diabetes

Answer 23

increased break down of stored glycogen

increased production of glucose from non carb sources l

Question 24

list the characteristics of type 2 diabetes

Answer 24

• insulin resistance

- glucose can not enter if cells are not responding to insulin

Question 25

what occurs if an individual has type 2 diabetes - resistance type

Answer 25

decreased ability of peripheral tissues to respond to insulin

Question 26

what occurs if an individual has type 2 diabetes - deficiency

Answer 26

- B cell dysfunction | - inadequate insulin secretion

Question 27

list treatment options for type 1

Answer 27

- insulin to increase glucose uptake and decrease amino acids

Question 28

list treatment options for type 2

Answer 28

- diet and exercise | - oral hypoglycaemic agents to stimulate insulin release and decrease resistance

Question 29

what is an acute consequence of uncontrolled hyperglycaemia

Answer 29

- diabetic keto acidosis | - non ketotic hyperosmolar coma

Question 30

what are the 2 chronic consequences of uncontrolled hyperglycaemia

Answer 30

1. Vascular complications | 2. Neuropathies

Question 31

list 2 vascular complications as a result uncontrolled hyperglycaemia

Answer 31

1. macro vascular - damage to large blood vessels of brain, heart and extremities. 2. Microvascular - thickening of basement membrane and capillaries

Question 32

define diabetic neuropathy

Answer 32

Damage to peripheral nerves secondary to chronic uncontrolled hyperglycaemia - results in loss of feeling in hands and feet - decreased pain awareness

Question 33

define diabetic foot

Answer 33

- due to PVD or neuropathy | - loss of sensation, impaired wound healing, infection, gangrene

Question 34

ulcers

Answer 34

due to peripheral neuropathy which can develop into infection