A 62 year diabetic male teacher by profession has developed pitting swelling on upper and inner side of left foot in the evening for 2 months. In each morning swelling subsided. About 2 weeks back, an ulcer formed on inner side left foot at the base of great toe, which is speading. Inspite of daily dressing, the ulcer is not getting healed. In adition, wound & other toes getting black. Patient is on oral hypoglycemic drugs. Blood sugar level is not under control, its fluctuating between 50 to 340. Friends, please provide your valueable advice.



Culture and sensitivity should be sent in addition And based on that appropriate antibiotics for cellulitis

could be peripheral vascular disease secondary to diabetes... vascular Doppler would be useful....also putting patient on insulin would be for better for glycemic control...

start basal bolus insulin therapy. regular dressing with betadine. advice pus c/s. doppler usg.

Control her bld glucose. start insulin & observe glucose levels

If she is on amlosipine stop it & start another antiht

adv strict diet cntrol wid OHA daily dressing clean wid betadine solution n aply ointmnt too. Do Blood sugar-F/PP Rx.. Tab. Zifi Turbo 1BID for 10 days.(aftr meals) Tab. Chymoral forte 1BID (before meals in 30min Cap. Becosule Z 1BId for 10 days

is treatment of unani and allopathy same or does unani have any threatment of its own

LFT for swlng on n off blood sugar HbA1c for unctnrl DM

acase peripheral vascular desease secondary to dm good gkycemic control can be done by insulin. .regular antiseptic dressing. cst of pus. .tt accordingly can be helpful. ..

Sir please check Fbs, ppbs levels to adjust insulin which should be started now probably 4-6units 20mins before mealtime and doses may be increased as required and then switch to biphasic insulin Please check his renal functions, lipid level, ECG This ulcer is an issue because of vascular insufficiency He needs arterial and venous doppler of left leg and arterial doppler of the other leg Cilastazol 50mg be can be added In view of pvd he needs to be on short term heparin also and then may need oral anticoagulant for a more extended time till ulcer heals However he must have a doppler done following which an MRI or CT angiography should be done. Based on the report further treatment will probably be a revascularisation procedure Those who have peripheral vascular disease are also likely to have cardiac Coronary insufficiency too

Irrespective of the cause, be it diabetic angiopathy or a local pathology ,patient first require strict glycemic control followed by control of infection by broad spectrum antibiotics otherwise he may develop sepsis In future he may require debridement if necrotic patch develops but glycemic control has to be achieve to get optimal results.

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