Long term Complications of Diabetes Flashcards by Audrey Mejia

Long term complications of diabetes usually does not occur until

10 years after diagnosis

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Hyperglycemia causes changes to

the medium layer of large vessels

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Blood vessels thicken and

sclerosis plaque adheres to walls

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This accelerated atherosclerosis causes

diminished blood flow

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These atherosclerosis changes happen more often in

diabetics and at earlier age

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Diabetics have twice the risk of disease and death than

non-diabetics

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Recovery from stroke can be impaired in

Cerebrovascular Disease causing neuropathy

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S&S of Cerebrovascular Disease can
mimic

hypoglycemia and looks like a stroke

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The typical S&S of Coronary Artery Disease
may

not be present = silent MI’s

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Blockage or narrowing of an artery in the legs (or rarely the arms), usually due to atherosclerosis and resulting in decreased blood flow.

Occlusive peripheral arterial disease

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Causes a greater incidence of gangrene, amputation in diabetics

Peripheral Vascular Disease

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Management of macrovascular complications

Aggressive modification of risk factors such as smoking, hypertension, diet, exercise

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Microvascular complications

Increased blood glucose causes thickening of capillary basement membrane

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Microvascular complications affect

Eyes
Kidneys
Nerves

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Almost all patients with type 1 diabetes and majority of pts with type 2 have some degree of

retinopathy after 20 years.

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Small vessels in the retina are affected in

diabetic retinopathy

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Three phases of diabetic retinopathy:

non-proliferative, pre-proliferative, and pro-liferative

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Phases of diabetic retinopathy:

Early stage. Asymptomatic. Micro aneurysms, fluid leak

Non-proliferative

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Macular edema (10% of pt’s) can lead to

visual changes and loss of central vision

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Edema around the retina

Macular edema

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Phases of diabetic retinopathy:

Increased destruction of retinal blood vessels
Possible vision changes from macular edema

Pre-proliferative

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Phases of diabetic retinopathy:

Abnormal growth of new blood vessels growing from retina into the vitreous
New vessels rupture, vitreous becomes cloudy block light – loss of vision
Scar tissue forms in vitreous – pulls retina, retina detachment

Proliferative

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vitreous means

becomes cloudy

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Is retinopathy painful?

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Diabetic retinopathy is the ___ leading cause of blindness

3rd

Early stages of diabetic retinopathy

lesions and macular edema causes blurry vision

Later stages of diabetic retinopathy

Hemorrhage S&S: floaters, cobwebs, sudden hazy vision, could lead to compete vision loss

Diagnostic Tests for diabetic retinopathy: Ophthalmoscopic exam of

dilated pupils to exam retina

Diagnostic Tests for diabetic retinopathy: Rare exam where dye is injected into arm vein travels to vessels of retina

Fluorescein angiography

Management of diabetic retinopathy

Prevention Keep blood glucose at near normal levels Yearly eye exams Control HTN, smoking cessation Advanced cases – Photocoagulation Major hemorrhage: vitrectomy

Surgery where bloody water is removed from the eye and replaced with NS

vitrectomy

Lazer eye surgery used to treat retinopathy

Photocoagulation

Maintaining blood glucose to normal or near normal level with intensive insulin therapy and pt education has decreased risk of retinopathy by

76%

Protein in urine is the 1st sign of

problems with kidneys

Kidney disease from thickened capillary basement membrane from hyperglycemia

nephropathy

Kidney’s filtration mechanism is stressed, allowing blood proteins to leak into urine

nephropathy

As it progresses, breakdown of insulin decreases causing episodes of hypoglycemia

nephropathy

Microalbumin found in urine with this disease

nephropathy

Signs & Symptoms of kidney dysfunction:

Persistent albuminuria Decline in glomerular filtration rate

Management of nephropathy

Achieving and maintain near normal blood glucose levels Test urine for proteins, BUN, creatinine Treat HTN - ACE inhibitors Avoid nephrotoxic medications Low sodium/low protein diet

If nephropathy progresses to ESKD

Dialysis or Transplant is needed

Still have diabetes after nephropathy, kidneys can again fail if

blood glucose not controlled

Types of diabetic neuropathies

Peripheral, autonomic, and spinal

Capillary basement membrane thickening, and demyelination of the nerves thought to be r/t hyperglycemia

Neuropathy

Two most common neuropathies:

Peripheral and Autonomic Neuropathy

Affects the distal portion of the nerves, especially of lower extremities

Peripheral Neuropathy

½ patients do not have symptoms

Peripheral Neuropathy

Initial symptoms: paresthesia, burning sensation, eventually numb

Peripheral Neuropathy

In peripheral neuropathy, a light touch can be

painful

peripheral neuropathy can cause numbness with

shooting pain

awareness of posture and movement of body and weight of objects in relationship to body

Proprioception

Decrease in proprioception

Peripheral Neuropathy

Neuropathy related joint changes of foot as a result of abnormal weight distribution from lack of proprioception

Charcot joints

Decrease in DTR and vibratory – may be only sign

Peripheral Neuropathy

DTR

deep tendon reflex.

Those patients with peripheral neuropathy, pain is

difficulty to control

Those patients with peripheral neuropathy should wear

White socks

Broad range of dysfunction affecting almost every organ system

Autonomic neuropathies

Many medications diabetics take for HTN also effect

erectile dysfunction

Type of autonomic neuropathy: fixed tachycardia, orthostatic hypotension, silent MI’s

Cardiovascular

Fixed tachycardia cannot

fix itself

Type of autonomic neuropathy: delayed intestinal emptying, diarrhea or constipation

Med that can be prescribed for GI neuropathy

Reglan

Hypoglycemic Unawareness: Diminished adrenergic symptoms of hypoglycemia such as

sweating/nervousness, shakiness

Absence of sweating of lower extremities, with excessive upper extremities sweating

Sudomotor neuropathies

Sudomotor neuropathy can leave feet dry and susceptible to

cracking

Management of autonomic neuropathy

Prevention, alleviating symptoms and modify risk factors

Nursing care of autonomic neuropathy

Tight control of blood glucose, check HgB A1C Annual eye exams Test urine for microalbumin once a year to check kidney function Cardiac evaluation twice a year : BP, cholesterol Daily skin inspection Monitor for infection

Nursing care of feet

Cleaned, dried, lubricated with lotion but not between the toes Calluses, thick toenails should be treated by podiatrist and nails trimmed

DIABETICS WHO ARE UNDERGOING SURGERY - NPO: Blood sugar may often

Blood sugar often elevated times of stress (infection, illness, hospitalization)

DIABETICS WHO ARE UNDERGOING SURGERY - NPO: During perioperative period, frequent

blood glucose monitoring needed

DIABETICS WHO ARE UNDERGOING SURGERY: Pt is NPO having surgery that day,

check am BGM and notify provider

DIABETICS WHO ARE UNDERGOING SURGERY: If BGM elevated (over 200)

may order short acting coverage

Post – Operative diet

Clear liquid diet often ordered…juice, jello, flavored ices ….. HYPERGLYCEMIA

SICK day rules for diabetic

Sugar Insulin Carbs Ketones