Comparing Blood Sugar Levels Measured by the Glucometer in Healthy and Crushed Fingers to Predict Gangrene in Tehran, Iran

Authors

Department of Plastic Surgery, 15 Khordad Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

10.5812/atr.40753

Abstract

Background
Crushed fingers are one of the most common reasons that patients visit the emergency centers for hand surgery, and based on the level of injury, it can cause many disabilities for patients. It is difficult to decide the treatment strategies (amputation, aggressive revascularization, immediate or delayed complex reconstruction and immediate conservative treatment) for crushed fingers.


Objectives
The current study aimed to compare the blood sugar (BS) levels measured by the glucometer in healthy and crushed fingers to predict gangrene in patients referred to 15 Khordad Hospital in Tehran, Iran.


Methods
This cohort study was conducted on 265 patients with crushed fingers referred to the emergency center of 15 Khordad hospital in Tehran, Iran, from March 2015 to March 2016. Blood glucose levels were measured by glucometer in the crushed fingers and in the finger of the opposite side at the same time and measurements were recorded. Data were analyzed using t-test and chi-square test with SPSS software version 22.


Results
The results showed that 317 crushed fingers of 265 patients were ischemic based on the color, temperature, capillary refill time and pulse oximetry and accordingly the vascular reconstruction was not possible. Of 317 crushed fingers, 61 (19.24%) became gangrene (all with sugar levels lower than 37). The mean BS levels of the amputated and non-amputated fingers were 33.5 ± 1.52 and 111.04 ± 15.27 mg/dL, respectively. Therefore, there was a significant difference in the mean BS level between the patients with amputated and non-amputated fingers (P < 0.001).


Conclusions
The lower levels of sugar in crushed fingers compared to healthy fingers can help to diagnose gangrene in crushed fingers.

Keywords


1. Reagan DS, Grundberg AB, Reagan JM. Digital artery damage associated
with closed crush injuries. J Hand Surg Br. 2002;27(4):374–7. doi:
10.1054/jhsb.2001.0727. [PubMed: 12162982].
2. Pederson WC, Stevanoic M. Reconstruction surgery; Extensive injuries
to the upper limb. 17. Philadelphia: Saunder; 2006. pp. 317–49.
3. Moran SL, Strickland J, Shin AY. Upper-extremity mucormycosis infections
in immunocompetent patients. J Hand Surg Am. 2006;31(7):1201–
5. doi: 10.1016/j.jhsa.2006.03.017. [PubMed: 16945728].
4. Seyed Forotan SK, Rahimian S, Akbari H, Mousavi SJ, Hasani E. A comparison
between diagnostic methods of ischemia in prediction of
digital gangrene probability in HazrateFateme Hospital. Iran J Surg.
2009;17(1).
5. Cohen BE, Harmon CS, Phizackerley PJ. Glucose metabolism in
experimental skin flaps. Plast Reconstr Surg. 1983;71(1):79–86. doi:
10.1097/00006534-198301000-00019. [PubMed: 6849026].
6. Im MJ, Su CT, Hoopes JE, Anthenelli RM. Skin-flap metabolism in
rats: oxygen consumption and lactate production. Plast Reconstr Surg.
1983;71(5):685–8. [PubMed: 6340141].
7. Vidal-Puig A, O’Rahilly S. Metabolism. Controlling the glucose factory.
Nature. 2001;413(6852):125–6. doi: 10.1038/35093198. [PubMed:
11557965].
8. Mueckler M, Thorens B. The SLC2 (GLUT) family of membrane
transporters. Mol Aspects Med. 2013;34(2-3):121–38. doi:
10.1016/j.mam.2012.07.001. [PubMed: 23506862].
9. Okeke LI, Dogo D, Ladipo JK, Ajao OG. Crush injuries of the hand. Afr J
Med Med Sci. 1993;22(3):69–72. [PubMed: 7839916].
10. Unlu RE, Abaci Unlu E, Orbay H, Sensoz O, Ortak T. [Crush injuries of
the hand.]. Ulus Travma Acil Cerrahi Derg. 2005;11(4):324–8. [PubMed:
16341971].
11. Funk DL, Chan L, Lutz N, Verdile VP. Comparison of capillary and
venous glucose measurements in healthy volunteers. Prehosp Emerg
Care. 2001;5(3):275–7. [PubMed: 11446542].
12. Yaraghi A, Mood NE, Dolatabadi LK. Comparison of capillary and venous
blood glucose levels using glucometer and laboratory blood
glucose level in poisoned patients being in coma. Adv Biomed Res.
2015;4:247. doi: 10.4103/2277-9175.170242. [PubMed: 26693472].
13. Juneja D, Pandey R, Singh O. Comparison between arterial and capillary
blood glucose monitoring in patients with shock. Eur J Intern Med.
2011;22(3):241–4. doi: 10.1016/j.ejim.2011.01.004. [PubMed: 21570641].