Rehabilitation guidance for diabetes mellitus complicated with lower limb fracture

  In recent years, with the continuous improvement of people’s living standards, the prevalence of diabetes has gradually increased, and the number of patients with diabetes and fractures has also increased. This is because factors such as high blood sugar, lack of insulin, and microvascular disease can damage the microstructure of bone tissue, induce or aggravate osteoporosis, and increase the risk of fractures in diabetic patients. Among them, the most common is lower limb fractures. So, what should a diabetic patient do if he has a lower limb fracture? What should I pay attention to during recovery?
Preoperative preparation

  Fractures and surgery are both large trauma and stress to the body, which can easily lead to large fluctuations in blood sugar. If blood sugar is too high, it will lead to an increase in the incidence of acute complications of diabetes (such as diabetic ketoacidosis). This is surgery The main reason for the post-mortality increase; in addition, high blood sugar can cause an increase in the incidence of infections and wounds that are difficult to heal. Therefore, it is recommended not to undergo surgery immediately for patients with fractures who have not injured blood vessels and nerves.
  Patients in need of surgery are generally recommended to control their blood sugar within the ideal range before undergoing surgery. Specifically, the fasting blood glucose level should be controlled below 7.8mmol/L, and the postprandial blood glucose should be controlled below 10.0mmol/L. Of course, it is not that diabetic patients cannot undergo surgery, but that blood sugar must be monitored.
  Therefore, patients should use hypoglycemic drugs as prescribed by their doctors before surgery, so that their physical conditions can better meet the requirements of surgery and facilitate postoperative recovery.
Postoperative recovery

  1. General care
  of diabetic lower limb fracture patients need long-term bed rest, but you know, the bed itself is an opportunity to onset of diabetic complications, such as severe bedsores and other wounds are difficult to heal by diabetes weakness there, so to observe, if slightly Early treatment is necessary. At the same time, blood sugar should be strictly controlled. If you can still eat normally, the hypoglycemic drugs should be slightly increased because the amount of exercise is reduced; if the appetite is not good, you will eat less every day, you can increase or decrease the drugs according to the blood sugar measurement, but pay attention Avoid bad conditions such as low blood sugar.
  Patients with diabetic lower limb fractures are best to choose hypoglycemic drugs that have a protective effect on bones, such as metformin and glucagon-like peptide-1 receptor agonists, and avoid the use of thiazolidinediones and sodium-glucose that may be harmful to bone health Cotransporter 2 inhibitor.
  2. Pain care
  of lower extremity fractures in patients with diabetes, pain situation occurs on day 1-3 after surgery, and at this time can be reflected to the doctor to receive appropriate analgesic treatment. Specifically, oral pain medications or analgesic pumps can be used.
  3. Rehabilitation
  of lower limb fractures in diabetic patients after rehabilitation doctor will evaluate, develop an appropriate rehabilitation exercise programs for patients, including initial rehabilitation, rehabilitation continue to promote content rehabilitation and post-rehabilitation stage 4, and contains training project , Intensity, time, frequency and other details to maximize the recovery of the patient’s quadriceps and knee joint function. Specific patients can try the following two types of training under the guidance of a doctor:
  Pull-ups. The patient raises his arms to hold the medical ring pull device on the bed, and uses the strength of the upper arms and lower limbs to pull their back and buttocks away from the surface of the bed. This exercise can prevent postoperative complications such as pressure ulcers and falling pneumonia.
  Quadriceps isometric contraction exercises. Many movements of the lower limbs can only be completed by the strength of the quadriceps. Insufficient quadriceps muscle strength will affect many functions of the lower limbs. However, after a lower limb injury or surgery, the quadriceps atrophy is the most obvious and fastest. Therefore, it is necessary to carry out rehabilitation training for the quadriceps as soon as possible. The method of quadriceps isometric contraction is as follows: lying on your back or sitting on the bed, straighten the lower limbs of the injury or surgery on the bed, tighten the thigh muscles for 5 seconds, and then relax. This is 1 time, the patient needs to Do it about 200 times.
  4. Diet Care
  diet is an important source of calcium daily in diabetic patients with lower extremity fractures, to supplement calcium diet is necessary to increase the intake of dairy products and soy products.
  In addition, calcium can also be supplemented under the guidance of a doctor. But it should be noted that the human body can only absorb up to 178 mg of calcium each time. If a large amount of calcium is supplemented at one time, the absorption rate is only about 25%, and the excess calcium will be excreted from the body. However, if a small amount of calcium supplement is used multiple times, the average absorption rate can reach 64%. Therefore, the daily calcium supplement for patients can be divided into 3 to 4 times, each time the calcium supplement does not exceed 200 mg.