Watkin's Manual of Foot and Ankle Surgery:
Wound Care/Diabetes Questions with Complete
Solutions
Diabetes: - (ANSWERS)∙A metabolic disease that causes *high blood glucose.*
→occurs either because *insulin production is inadequate* or because the *body's cells do not
respond properly to insulin*.
∙Nine percent of Americans (30 million people) have diabetes.
→When monitoring diabetes, it is better to *err on the side of hyperglycemia;* hypoglycemia can
result in permanent neuron destruction.
Insulin is a hormone produced by the... - (ANSWERS)pancreas that *moves glucose from the
blood into the cells.*
Diabetes: Type I - (ANSWERS)∙IDDM
→*Body does not produce insulin.*
→Usually develops before age 40, juvenile onset.
→Accounts for only 10% of diabetics
→*Requires insulin injections.*
Diabetes: Type II - (ANSWERS)∙NIDDM
→*body does not produce enough insulin for proper function*, or the cells in the body do not
react to insulin.
→Can sometimes be controlled with diet, exercise, and weight loss
→Overweight people are at greater risk, and the risk also increases with age.
Diabetes: Type III - (ANSWERS)∙Gestational diabetes
→type of hyperglycemia that occurs during pregnancy.
→Occurs in 1% to 3% of women.
→Disappears in 97% of cases at the end of pregnancy.
Type I vs. Type II Diabetes: - (ANSWERS)
Hyperglycemia vs. Hypoglycemia: - (ANSWERS)
Diagnosing Diabetes: - (ANSWERS)∙*FPG (fasting plasma glucose)*:
→Less than 100 mg per dl is normal.
→100 to 125.99 mg per dl is prediabetic.
→Greater than 126 mg per dl is positive for diabetes.
∙*OGTT (oral glucose tolerance test)*:
→Less than 140 mg per dl is normal.
→140 to 199.9 mg per dl is prediabetic.
,Watkin's Manual of Foot and Ankle Surgery:
Wound Care/Diabetes Questions with Complete
Solutions
→200 mg per dl and up means diabetes.
∙*A1C*:
→Less than 5.7% is normal.
→Between 5.7% and 5.99% is prediabetic.
→6.5% and up is diabetic.
Factors That Put Diabetics at Risk for Foot Ulcers: Immunocompromised -
(ANSWERS)∙*Defective PMN* function resulting in an increased risk of infection.
Factors That Put Diabetics at Risk for Foot Ulcers: Angiopathy - (ANSWERS)Blood vessels in the
diabetic are subject to *accelerated atherosclerosis*, increased clotting, and thrombosis
formation.
Factors That Put Diabetics at Risk for Foot Ulcers: Neuropathy - (ANSWERS)∙Diabetic
peripheral neuropathy is caused by *direct metabolic damage to nerves.*
∙Diabetic peripheral neuropathy affects all nerves: sensory, motor, and autonomic.
Factors That Put Diabetics at Risk for Foot Ulcers: Sensory Neuropathy - (ANSWERS)∙*Sensory
impairment typically precedes motor* dysfunction.
∙Classically it *begins in the longest nerves* of the body and so affects the feet and later the
hands.
∙sometimes called the "stocking-glove" pattern. →Protective threshold and proprioception
(loss of balance) are lost.
Factors That Put Diabetics at Risk for Foot Ulcers: Motor Neuropathy - (ANSWERS)Motor deficit
affects the *intrinsic muscles* of the foot, leading to digital deformities.
Factors That Put Diabetics at Risk for Foot Ulcers: Autonomic Neuropathy -
(ANSWERS)∙Autonomic nerves to the *sweat glands are damaged, causing anhidrosis*
(inability to sweat normally).
→This results in dry scaly feet, which are prone to fissuring.
→Other autonomic neuropathic symptoms include a hot, hyperemic foot, increased
arteriovenous shunting, reduced capillary flow, bounding pulses.
Wound Classifications: Wagner Diabetic Ulcer Classification - (ANSWERS)∙*Grade 0*
→Intact skin (cellulitis, erythema)
∙*Grade 1*
→Superficial ulcer involving the skin (no subq involvement)
, Watkin's Manual of Foot and Ankle Surgery:
Wound Care/Diabetes Questions with Complete
Solutions
∙*Grade 2*
→Ulcer extending to tendon capsule or bone (through subq)
∙*Grade 3*
→More extensive ulcer with associated abscess, osteomyelitis, or joint sepsis
∙*Grade 4*
→Local gangrene of the toes or forefoot
∙*Grade 5*
→Gangrene of entire foot
Wound Classifications: Knighton Classification - (ANSWERS)∙I: Partial-thickness ulcer
→Extends through the epidermis and into, but not through, the dermis.
∙II: Full-thickness ulcer
→Ulcer extending to subcutaneous tissue only
∙III: Full-thickness ulcer
→Ulcer extending to tendon, ligament, joint, and/or bone
∙IV: Full-thickness ulcer
→Level III ulcer with abscess and/or osteomyelitis
∙V: Full-thickness ulcer
→Level III ulcer with necrotic tissue in wound
∙VI: Full-thickness ulcer
→Level III ulcer with gangrene
Wound Classifications: University of Texas Wound Classification System (Wound Grade and
Stage Classification) - (ANSWERS)∙Grade 0:
→Pre- or postulcerative site
∙Grade I:
→Ulcers are superficial wound through the epidermis or dermis.
∙Grade II:
→Wound penetrates to tendon or capsule.
∙Grade III:
→Wound penetrates to bone or into a joint.
∙Stage A: Clean
∙Stage B: Nonischemic infected
∙Stage C: Ischemic
∙Stage D: Infected ischemic
Wound Classifications:
Wound Care/Diabetes Questions with Complete
Solutions
Diabetes: - (ANSWERS)∙A metabolic disease that causes *high blood glucose.*
→occurs either because *insulin production is inadequate* or because the *body's cells do not
respond properly to insulin*.
∙Nine percent of Americans (30 million people) have diabetes.
→When monitoring diabetes, it is better to *err on the side of hyperglycemia;* hypoglycemia can
result in permanent neuron destruction.
Insulin is a hormone produced by the... - (ANSWERS)pancreas that *moves glucose from the
blood into the cells.*
Diabetes: Type I - (ANSWERS)∙IDDM
→*Body does not produce insulin.*
→Usually develops before age 40, juvenile onset.
→Accounts for only 10% of diabetics
→*Requires insulin injections.*
Diabetes: Type II - (ANSWERS)∙NIDDM
→*body does not produce enough insulin for proper function*, or the cells in the body do not
react to insulin.
→Can sometimes be controlled with diet, exercise, and weight loss
→Overweight people are at greater risk, and the risk also increases with age.
Diabetes: Type III - (ANSWERS)∙Gestational diabetes
→type of hyperglycemia that occurs during pregnancy.
→Occurs in 1% to 3% of women.
→Disappears in 97% of cases at the end of pregnancy.
Type I vs. Type II Diabetes: - (ANSWERS)
Hyperglycemia vs. Hypoglycemia: - (ANSWERS)
Diagnosing Diabetes: - (ANSWERS)∙*FPG (fasting plasma glucose)*:
→Less than 100 mg per dl is normal.
→100 to 125.99 mg per dl is prediabetic.
→Greater than 126 mg per dl is positive for diabetes.
∙*OGTT (oral glucose tolerance test)*:
→Less than 140 mg per dl is normal.
→140 to 199.9 mg per dl is prediabetic.
,Watkin's Manual of Foot and Ankle Surgery:
Wound Care/Diabetes Questions with Complete
Solutions
→200 mg per dl and up means diabetes.
∙*A1C*:
→Less than 5.7% is normal.
→Between 5.7% and 5.99% is prediabetic.
→6.5% and up is diabetic.
Factors That Put Diabetics at Risk for Foot Ulcers: Immunocompromised -
(ANSWERS)∙*Defective PMN* function resulting in an increased risk of infection.
Factors That Put Diabetics at Risk for Foot Ulcers: Angiopathy - (ANSWERS)Blood vessels in the
diabetic are subject to *accelerated atherosclerosis*, increased clotting, and thrombosis
formation.
Factors That Put Diabetics at Risk for Foot Ulcers: Neuropathy - (ANSWERS)∙Diabetic
peripheral neuropathy is caused by *direct metabolic damage to nerves.*
∙Diabetic peripheral neuropathy affects all nerves: sensory, motor, and autonomic.
Factors That Put Diabetics at Risk for Foot Ulcers: Sensory Neuropathy - (ANSWERS)∙*Sensory
impairment typically precedes motor* dysfunction.
∙Classically it *begins in the longest nerves* of the body and so affects the feet and later the
hands.
∙sometimes called the "stocking-glove" pattern. →Protective threshold and proprioception
(loss of balance) are lost.
Factors That Put Diabetics at Risk for Foot Ulcers: Motor Neuropathy - (ANSWERS)Motor deficit
affects the *intrinsic muscles* of the foot, leading to digital deformities.
Factors That Put Diabetics at Risk for Foot Ulcers: Autonomic Neuropathy -
(ANSWERS)∙Autonomic nerves to the *sweat glands are damaged, causing anhidrosis*
(inability to sweat normally).
→This results in dry scaly feet, which are prone to fissuring.
→Other autonomic neuropathic symptoms include a hot, hyperemic foot, increased
arteriovenous shunting, reduced capillary flow, bounding pulses.
Wound Classifications: Wagner Diabetic Ulcer Classification - (ANSWERS)∙*Grade 0*
→Intact skin (cellulitis, erythema)
∙*Grade 1*
→Superficial ulcer involving the skin (no subq involvement)
, Watkin's Manual of Foot and Ankle Surgery:
Wound Care/Diabetes Questions with Complete
Solutions
∙*Grade 2*
→Ulcer extending to tendon capsule or bone (through subq)
∙*Grade 3*
→More extensive ulcer with associated abscess, osteomyelitis, or joint sepsis
∙*Grade 4*
→Local gangrene of the toes or forefoot
∙*Grade 5*
→Gangrene of entire foot
Wound Classifications: Knighton Classification - (ANSWERS)∙I: Partial-thickness ulcer
→Extends through the epidermis and into, but not through, the dermis.
∙II: Full-thickness ulcer
→Ulcer extending to subcutaneous tissue only
∙III: Full-thickness ulcer
→Ulcer extending to tendon, ligament, joint, and/or bone
∙IV: Full-thickness ulcer
→Level III ulcer with abscess and/or osteomyelitis
∙V: Full-thickness ulcer
→Level III ulcer with necrotic tissue in wound
∙VI: Full-thickness ulcer
→Level III ulcer with gangrene
Wound Classifications: University of Texas Wound Classification System (Wound Grade and
Stage Classification) - (ANSWERS)∙Grade 0:
→Pre- or postulcerative site
∙Grade I:
→Ulcers are superficial wound through the epidermis or dermis.
∙Grade II:
→Wound penetrates to tendon or capsule.
∙Grade III:
→Wound penetrates to bone or into a joint.
∙Stage A: Clean
∙Stage B: Nonischemic infected
∙Stage C: Ischemic
∙Stage D: Infected ischemic
Wound Classifications:
