Long term Complications of Diabetes Flashcards
Long term complications of diabetes usually does not occur until
10 years after diagnosis
Hyperglycemia causes changes to
the medium layer of large vessels
Blood vessels thicken and
sclerosis plaque adheres to walls
This accelerated atherosclerosis causes
diminished blood flow
These atherosclerosis changes happen more often in
diabetics and at earlier age
Diabetics have twice the risk of disease and death than
non-diabetics
Recovery from stroke can be impaired in
Cerebrovascular Disease causing neuropathy
S&S of Cerebrovascular Disease can
mimic
hypoglycemia and looks like a stroke
The typical S&S of Coronary Artery Disease
may
not be present = silent MI’s
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
Causes a greater incidence of gangrene, amputation in diabetics
Peripheral Vascular Disease
Management of macrovascular complications
Aggressive modification of risk factors such as smoking, hypertension, diet, exercise
Microvascular complications
Increased blood glucose causes thickening of capillary basement membrane
Microvascular complications affect
Eyes
Kidneys
Nerves
Almost all patients with type 1 diabetes and majority of pts with type 2 have some degree of
retinopathy after 20 years.
Small vessels in the retina are affected in
diabetic retinopathy
Three phases of diabetic retinopathy:
non-proliferative, pre-proliferative, and pro-liferative
Phases of diabetic retinopathy:
Early stage. Asymptomatic. Micro aneurysms, fluid leak
Non-proliferative
Macular edema (10% of pt’s) can lead to
visual changes and loss of central vision
Edema around the retina
Macular edema
Phases of diabetic retinopathy:
Increased destruction of retinal blood vessels
Possible vision changes from macular edema
Pre-proliferative
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
vitreous means
becomes cloudy
Is retinopathy painful?
No
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
GI
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