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THE HEALTH | JANUARY-FEBRUARY , 2022
| Column |
SEPSIS ALERT
BY ASSOC PROF DR TAN TOH LEONG
AND DR EVELYN CHAU YI WEN
EVER WALKED into a hospital treatment room filled with a foul-smelling stench ? Or do you know someone who has amputated his foot due to poor diabetic control ?
This is one of the most known complications of uncontrolled diabetes mellitus . Uncontrolled diabetes mellitus can lead to poor wound healing in the foot , causing an unpleasant smell .
Diabetic patients have a 15 per cent lifetime risk of having foot ulcers , and 25 per cent will undergo amputation due to unsalvageable wounds . Usually , ulcers are caused by poorly treated or neglected wounds .
Now , many may ask , how can a wound go unnoticed ? Yes , it is possible for a chronic diabetic patient .
How is it so ? Chronic diabetic patients may have a problem with their eyesight ( retinopathy ), altered sensation ( neuropathy ) and even kidney problems ( nephropathy ), not to mention the increased risk of heart attack , stroke , sexual dysfunction and so on .
Diabetes and infections
Diabetic patients may not notice a wound on their foot because of their poor eyesight and poor sensation over the foot . Treating a seemingly simple wound on a diabetic patient is not simple at all .
Diabetes and infections are bad partners . An infected site is usually warm , tender , red in colour , swollen and may even have pus draining from the site .
These reactions result from our body ’ s natural defence mechanism to restrict the spread of infection . While a diabetic patient is known to have reduced organ functional capacity and impaired immune mechanism , a high glucose level in the body reduces the killing capacity of our white cells , prolongs the inflammation process , causing further tissue damage .
When the body ’ s immune response fails to control the local infection on
Diabetes mellitus risk of sepsis !
A simple wound on the foot of a diabetic patient can lead to multiple complications
Assoc Prof Dr Tan Toh Leong is Consultant Emergency Physician , Faculty of Medicine , Universiti Kebangsaan Malaysia ( UKM ) and Founder and President of Malaysian Sepsis Alliance ( MySepsis ), while Dr Evelyn Chau Yi Wen is a Trainee Lecturer in the Emergency Department , Faculty of Medicine , UKM and a Committee Member of MySepsis . the wound , there is a risk that the infection can spread throughout the body , affecting other systems . This will then escalate , resulting in sepsis or even septic shock .
Why must we know about sepsis ?
Sepsis is associated with high resource utilisation and caused high mortality , contributing to 11 million annual global deaths as of 2019 . Sepsis is also one of the causes of death for Covid-19 infections .
So , what is sepsis ? Sepsis is a life-threatening organ dysfunction caused by the dysregulated host response to infection . Different from a simple local infection , sepsis involves multiorgan dysfunction like the heart , kidneys , lungs , liver , and nervous system .
As a result , a simple wound on the foot can lead to kidney failure , needing dialysis or lung failure leading to intubation and even death . Often , diabetes is a major risk factor for the rapid escalation of the disease and contributes to higher mortality risk .
What can be done ?
Once a patient is in sepsis , early treatment must be given before more organs fail . Early fluid resuscitation and antibiotics must be given . The source of infection , i . e ., the diabetic foot ulcer , must be debrided .
Should the condition of the foot become too severe , amputation might be needed . Overall , diabetic patients have up to 40 times higher risk of getting lower extremity amputation than non-diabetics . Other than that , a corticosteroid may be needed to control the infection .
The endpoint is that the sugar level must be controlled . An annual eye check , frequent foot care , repeated diabetic education and control of other comorbidities must be ensured . — The Health
What is the targeted sugar control ?
Fasting or before a meal : 4.4 - 7.0 mmol / L 90 minutes after meal : 4.4 - 8.5mmol / L HbA1C level : 7.0 per cent
Tips for sugar control
• A balanced diet , low in saturated fat , low in sodium , high in fruits , vegetables , wholegrain , cereals , and legumes
• Weight management ; for overweight and obese ( BMI > 23.0kg / m2 ) for weight loss at least 5-10 per cent
• Physical activity at least three times / week ; and with no more than 48-72 hours without physical activity
• Tobacco cessation
• Glucose lowering drugs