old Diabetic.Management plz?? @Dr. Sandip Debashis Mishra

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As the photographs show, it is a neuro-ischaemic ulcer over Lt great TOE with cellulitis & from the description, it is a case of diabetes. Should be advised insulin basal bolus regimen with / without OADs as per the requirement. But BSL to be maintained slightly towards higher side (FBS around 120 & PPBS around 200) because if we try to get strict control of BSL, the ischemia may worsen. Control of infection with antibiotics as per the pus c/s report. Immediate thorough debridement is required. But H�O� to be used for 1st time only, not on subsequent days of daily dressing. Use only NS to irrigate & Superoxide solution to spray n bandage to be done firmly (not too tight / too loose). Later on when the sloughs totally off & granulation tissues seen, growth factor gel / granules can be given to fill the wound. Then finally SSG. Fore foot offloading is required & foot end should be raised while sitting.

@Dr. Ashok Leel @Dr amit sharma
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DIABETIC FOOT ULCER. In uncontrolled blood flow decreases in affected limb causing poor healing of wound and often may require amputation if care isn't taken adequately. Care should be taken are.... 1. Strict control of blood sugar : Strict and adequate control of blood sugar is the mainstay of treatment. Often need Insulin with or without OHD for speedy recover. Monitor HbA1C quarterly and keep it below 6.5. Monitor Fasting and PP Blood Sugar. Advice low carb diabetic diet. 2. Off loading : Off loading of wound means avoid of pressure and further trauma over wound area. Don't use tight cover dressing and use clutches to walk until the wound heal if possible. 3. Daily dressing : Regularly dress the wound. (I) Debride the dead tissues with scalpel blade. (II) Chemical debridement also may be done. Cream containing Papain + Urea (eg. Debri Cure cream) may be applied once or twice a day for this purpose which slough out the dead tissues. Before applying this irrigate the wound with isotonic salaine or clean with a cleaning solution then apply the cream under a covered bandage which should not be too tight. Wash hand before and after application. H2O2 is better not use before applying this cream as it reduces its efficacy. (III) Growth factor containing cream also may be used. 4. Prevention of infections : Adequate control of infection is needed. Antibiotic of choices are Linezolide + Cefixime, Clindamycin etc. In non response send swab from the wound area for culture and sensitivity testing. 5. Ensuring circulation and nerve function :Assess for Peripheral arterial disease (PAD) and Peripheral Neuropathy (PN). Asses clinically. If suspected then confirm by Doppler study (PAD) and NCV test (PN). Anti depressants, Methylcobalamin, L-Carnitine, Pregabalin, Gabapentin etc are used in neuropathy. PAD sometimes need angioplasty or By Pass grafting.

Diabetes foot Adv Swab stick for C /S, CBC, blood sugar fasting pp, creat, Tab augmentin 625mg tds Tab metro 100ml tds Tab LNL 400 mg BD Tab pan D 1bd before meal Tab tramadol tds Debridement of necrotic tissue for under LA Wound clean with NS Betadine solution and H2O2 Bectigras dressing alternate day Diabetic diet Strictly Diabetic control

Thanks Dr ashok
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Diabetic Foot is a disease which requires multidisciplinary management including at least Surgeon & Endocrinologist. Strict control of Blood Sugar. Control of Infection. Well planned extensive local wound care. Nutritional supplements. These all are needed to save a limb & healing.

Diabetic foot ulcer.

I agree
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Strict control of Diabetes with Insulin. Linzolid600 bid and rest management as suggested by Surgeon

Diabetic foot Standard treatment of this Keep on insulin Antibiotics Vitamins

I agree with Dr. Golam Mortuza Sir

Thank you sir
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Agree with Dr Abdul Hameed Ansari.

Thanks Dr Karbasum.
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Diabetic food

???
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