الفهرس 
Pathophysiology of Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
Diabetes mellitus is characterized by chronic hyperglycemia together with disturbances of carbohydrate, fat and protein metabolism resulting from defects of insulin secretion, insulin action or both.
Assessment of the diabetic foot through gathering of clinical data is important in identifying risk for both ulceration and amputation. When this is accomplished, a significant reduction in lower extremity complications can indeed be realized locally.
Diabetic foot ulceration occurs as a consequence of the interaction of multiple pathophysiologic mechanisms including peripheral neuropathy, peripheral vascular disease and infection.
Three key points for identifying ulcer risk include:
1) Loss of protective sensation,
2) Deformity and limited joint mobility, and
3) Previous history of ulceration or amputation.
There are many classification systems worldwide including Wagner classification system which is the most widely accepted; the University of Texas wound classifi¬cation system and the Kobe classification system.
Investigations are very important in assessing diabetic foot. Imaging techniques vary in their sensitivity for detection of osteomyelitis. Radiography remains the first screening examination in any patient with suspected infection.
Angiography is indicated in the diabetic patients with nonhealing ulcers or osteomyelitis requiring endovascular and surgical planning. MRA studies assess foot vessel runoff.
Debridement is applied in management of all diabetic feet. The main reason for debriding a wound is to avoid substratum for bacterial growth, ongoing inflammation, and leukocyte infiltration with delayed phases of wound healing.
Variety of materials has been used as wound dressings to arrest bleeding, absorb exudates, ease pain, and protect the wound. Modern dressings are designed to promote and maintain a moist wound environment in the different phases of wound healing. Clearly, no one dressing will be suitable for all types of wounds or all stages of wound healing.
Therapy is commenced with wide spectrum antibiotic which is then focused according to the microbiology culture results. Sometimes chronic wounds remain or the wound is deep with an irregular contour, and plastic surgery techniques must be employed such as skin grafts and flaps.
Employing HBO2 as a component to refractory diabetic wound management decreases risk of a major amputation. Negativepressure wound therapy is a newer noninvasive adjunctive therapy system that uses controlled negative pressure using vacuum assisted closure device.
External shock wave therapy stimulates tissue healing, reduces calcification and inhibition of pain receptors .Growth factors and development of bioengineered skin equivalents represents an exciting innovation in the treatment of diabetic foot ulcers.