Complications

Question 1

Proliferative retinopathy
What is it?
Risk factors?
Screening?

Answer 1

• Progressive damage to retina that leads to development of new, unstable blood vessels that are prone to hemorrhage, scar tissue, detachment of retina, blindness
• Non-proliferative is early stage, proliferative is advanced
• risk factors- older age, nephropathy, pregnant women with pre-existing DM, dyslipidemia
• Screening- T1DM- 5 years after dx, T2DM- @ dx & annually, pregnant- first trimester, each trimester, 1 year PP

Question 2

Diabetic peripheral neuropathy
What is it?
S/S?
Risk factors?
Screening?

Answer 2

• damage to nerve tissues in leg/feet caused by chronic hyperglycemia
• small nerve fiber damage- pins & needles sensation, burning (early s/s)
• large nerve fiber damage (later s/s)- loss of protective sensation (LOPS), numbness, risk for injury/ulceration
• risk factors- older age, smoking, DM duration
• screening- T1DM- 5 years after dx, T2DM @ dx and annually
• screening- temperature, vibration (tuning fork), protective sensation (10 g monofilament), pinprick sensation

Question 3

DAN- Diabetic autonomic neuropathy
What is it?
S/S
Risk factors

Answer 3

• damage to autonomic nerves of the body (nerves in control of bladder, GI tract, sex organs)
• hypo unawareness, orthostatic hypotension, gastroparesis, neurogenic bladder, incontinence, constipation, ED, sudomotor dysfunction (increased or decreased sweating)
• risk factors: DM duration, older age, smoking

Question 4

Foot ulcer
s/s
risk factors

Answer 4

• formed as result of tissue breakdown
• swelling, warmth, discharge/odor, pain, thickened skin, discoloration
• neuropathy, smoking, previous ulcer/amputation, peripheral vascular dz, DIY foot surgery
• Daily self-exam of feet, annual foot exam, visual foot inspection q each routine visit

Question 5

Charcot foot

Answer 5

• impacts bones, joints, soft tissues of foot/ankle
• bones become weak & can break
• lead to bone destruction, dislocation, deformity
• arch is completely broken
• inflammation, pain, redness, warm to touch, rapid onset
• risk factor- neuropathy

Question 6

Peripheral artery dz

Answer 6

• plaque build up in arteries –> decreased blood flow through vessels in the legs
• s/s: pain, cramping in calves/thighs/butt, numbness,
  skin is cool/pale/purple, lack of hair growth, intermittent claudication
• risks: smoking, dyslipidemia, DM duration, older age
• screen: Ankle brachial index annually; 1-1.4 normal; < or = 0.9 is abnormal

Question 7

Peripheral vascular dz

Answer 7

• circulation d/o involving narrowing, blockages, spasms of blood vessel
• any blood vessel outside the heart but usually legs/feet
• often caused by plaque build-up
• s/s: warm, brown/mottled skin, stasis ulcers, pain/cramps in thighs/butt/calves, diminished tibial pulses
• risks: DM duration, smoking, physical inactivity, coronary artery dz, hypercholesterolemia, older age, male gender
• lab tests: AKI, doppler U/S, angiogram, treadmill test