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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
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


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