Patient is on 81mg of aspirin and Plavix for antithrombotic effects. Patient had a femoropopliteal bypass done on 2/18 in an attempt to revascularize to his L foot. However, the doctors recommended amputation of the 2nd and 3rd toe because of extensive tissue loss and revascularization cannot be accomplished. The patient is also receiving hyperbaric oxygen therapy for wound healing in addition to controlling his blood glucose levels.
DM type II
Type 2 Diabetes is a heterogeneous group of disorders characterized by decreased liver, muscle, and adipose tissue sensitivity to insulin and a defect in insulin secretion from the pancreatic beta cells. Type 2 Diabetes results from decreased insulin production by the pancreas and increased insulin resistance, which is characterized by an inability to use insulin effectively.
In the first stage, genetic factors probably influence both insulin sensitivity and insulin secretion. There is an initial period of hyperinsulinemia in which the pancreatic beta cells are able to overcome insulin resistance. In the second stage, insulin resistance continues to increase, and this compensatory hyperinsulinemia becomes insufficient to maintain normal glucose homeostasis. Under conditions of insulin resistance, visceral adipose tissue is very sensitive to the effects of catecholamines, and insulin resistance is associated with enhanced lipolysis. This leads to increased fatty acid production and mobilization, exacerbating resistance in liver and muscle tissue. In addition, impairments in insulin-mediated glucose transport into skeletal muscle, the major target for glucose disposal, becomes impaired. Also in this stage, physiologic stress states that increase the production of hormones such as catecholamine, cortisol, growth hormone, and glucagon will cause hyperglycemia.
In the third stage, there is further increase in insulin resistance. The restraining effects of insulin on hepatic glucose production become impaired, and plasma glucose levels increase. Fasting and postprandial hyperglycemia result from increased insulin resistance, unrestrained hepatic glucose production and glucose toxicity.
Wound healing is slowed when the patient is diabetic. Macrovascular and microvascular changes are due to elevated blood sugar levels that can cause fatty deposits to stick to the endothelial lining of vessels and cause narrowing and then blockage of circulation. Narrowed blood vessels lead to decreased blood flow and oxygen to a wound. An elevated blood sugar level also decreases the function of RBCs that carry nutrients to the tissue. This lowers the efficiency of the white blood cells that fight infection. Without sufficient nutrients and oxygen, the wound would heal slowly.
Diabetic neuropathy is when the nerves in the body are affected and the patient develops a loss of sensation because their blood glucose levels are uncontrolled. The elevated blood glucose over time affects the mye