Diabetes

Diabetic foot
1.Probe-to-bone test in the diagnosis of osteomyelitis has sensitivity of 90% compared to radiograph's sensitivity of 55% and MRI's sensitivity of 100%.
2.When diameter of plantar ulcer is> 2cm and depth >3 mm risk of osteomyelitis is high.
3.Layers of epidermis,mnemonic:Corn Lovers Grow Several Bales(from superficial to deep)
-Stratum Corneum
-Stratum Lucidum
-Stratum Granulosum
-Stratum Spinosum
-Stratum Basale(germinativum)
4.Claw toe:All joints plantar flexed;(metatarsophalangeal(MTPJ) & proximal(PIPJ) and distal interphalangeal joints(DIPJ).
Mallet toe:Only DIPJ is plantar flexed
Lumbricals normally extend PIPJ & DIPJ while they flex MTPJ.Loss of lumbricals action leads to clawtoes
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Screening for CAD in diabetes
What Diabetes care 30:2729,2007 recommends rather hesitatingly as screening test is EBCT/mutislice CT(Cardiac) to look for CAC score,and proceed for further evaluation if score is >400.There is no recommendation for the frequency to rescreen for those with CAC <400.
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Gatifloxacin and dysglycemia
Gatifloxacin has been associated with both hypoglycemia and hyperglycemia.With the exception of a slight increase in the risk of hypoglycemia with levofloxacin, these risks were not shared by other fluoroquinolones. Dysglycemic events were not restricted to patients receiving drug treatment for diabetes.Although the mechanism of these apparently competing adverse effects is not fully understood, studies in animals suggest that although gatifloxacin can promote insulin release and hypoglycemia by blocking the ATP-sensitive potassium channels of pancreatic islet cells, it can also trigger the vacuolation of pancreatic beta cells, leading to reduced insulin levels and hyperglycemia.
( N Engl J Med 2006; 354:2725-2726, Jun 22, 2006. )
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Biguanide and lactic acidosis(>5 mmol/l)
Lactic acidosis often has non specific and subtle symptoms like myalgias, malaisiae,somnolence and abdominal distress and also may be associated with bradyarrhythmia and hypotension.Biguanides reduce pyruvate dehydrogenase activity and mitochondrial transport of reducing agents, enhancing anaerobic metabolism.Metformin is readily removed by hemodialysis, which would be appropriate for severe, life-threatening acidosis. Metformin is a cation at physiologic pH and cimetidine,digoxin, procainamide, quinidine, ranitidine, iodinated contrast media, and amiloride might compete with renal tubular secretion of metformin at the site of organic cation transport.Metformin is dialyzable .Hence prompt hemodialysis is life saving measure.