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CanuckGirl
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what are the acute complications and chronic complications of diabetes mellitus related to?
- acute complications: related to excessive hyperglycemia
- chronic complications: related to insults to microvasculature or microvasculature
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what are the 6 acute complications of diabetes mellitus?
- hypoglycemia (low blood glucose)
- hyperglycemia (high blood glucose)
- diabetic ketoacidosis
- hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)
- somogyi effect
- dawn phenomenon
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what can cause hypoglycemia?
can result from skipping meals, an excess of either insulin or oral diabetes medication
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How are most hypoglycemic reactions that are mild managed?
managed by self-administrating the sugar needed to correct the situation (sugar product or fruit juice)
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what happens in severe hypoglycemia?
results in coma and the assistance of health care professionals may be required
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what are some symptoms of hypoglycemia? (5)
- sweating
- shaking (tremor)
- mood changes
- headaches
- excessive hunger
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how does hyperglycemia develop?
develops when there is too much glucose, not enough insulin or insufficient insulin activity in the blood stream
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what are the symptoms of hyperglycemia? (4)
- blurred vision
- excessive thirst
- frequent urination
- nausea
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how can hyperglycemia be managed?
- management through rehydration if dehydrated
- oral anti-diabetic agent or insulin
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what is diabetic ketoacidosis and which diabetes is it much more common in?
- life-threatening biochemical imbalance
- more common in type 1 diabetes
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how does diabetic ketoacidosis (DKA) occur?
- hyperglycemia accelerated because most tissues cant utilize glucose without insulin
- too little insulin causes energy-starved cells to break down lipids, results in production of acidic ketone bodies
- they accumulate in blood stream and urine
- leads to disruption of blood pH
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what does diabetic ketoacidosis result in?
results in the loss of lean muscle mass
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what are the early symptoms of diabetic ketoacidosis? if untreated what other symptoms occur? what are the late signs?
- early symptoms:
- anorexia
- fatigue
- frequent urination that lasts for days or more
- if untreated:
- abdominal pain
- fruity smelling breath
- blurred vision
- Late signs:
- air hunger
- shock
- death
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what are the risk factors of diabetic ketoacidosis in people with already diagnosed type 1 diabetes? (5)
- infection
- injury
- serious illness
- surgerywhen people with diabetes miss their insulin treatment
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DKA can be the ____________________ in people who don't yet have other symptoms.
first sign of type 1 diabetes
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Is diabetes ketoacidosis a complication for people with type 2 diabetes? how is it triggered?
- can occur but very rare
- usually triggered by severe illness
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which ethnic groups are more likely to have DKA as a complication of type 2 diabetes? (2)
- Hispanic
- African-american
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Treatment for DKA is aimed at the correction of the 3 main problems which are?
- dehydration
- electrolyte imbalance
- metabolic acidosis
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what does HHNS stand for?
Hyperosmolar hyperglycemic nonketotic syndrome
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what happens in HHNS?
- lack of effective insulin which results in hyperglycemia
- in HHNS hyperglycemia, the body tries to get rid of the excess sugar by polyuria (excessive urination)
- leads to sever dehydration
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where is HHNS most frequently seen?
frequently seen in elderly patients of type 2 diabetes (may occur with type 1, but less often)
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What are the symptoms of HHNS? (4)
- initially high urine production, frequent bathroom visits
- urine becomes very dark
- polydipsia (excessive thirst)
- severe dehydration will lead to seizures followed by coma, eventually death
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what are the warning signs for HHNS? (6)
- dry, parched mouth
- plasma glucose level over 600 mg/dl
- high fever
- warm, dry skin
- weakness on one side of body
- hallucinations
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Treatment for HHNS involves 4 approaches, what are they?
- vigorous intravenous re-hydration
- electrolyte replacement
- administration of insulin
- diagnosis and management of precipitating and coexisting problems
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what are some ways to prevent HHNS? (3)
- check plasma glucose regularly
- know their target blood glucose range
- when ill check blood glucose more often, and drink glass of liquid every hour
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what is the somogyi effect?
occurs when the blood glucose level swings high following hypoglycemia
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what is the cause of somogyi effect? (2)
- caused by high level of insulin in blood during night (when person takes long-acting insulin)
- caused by release of stress hormones which may follow hypoglycemic episode during night
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what is the dawn phenomenon? (3)
- hormones that are released as a defensive mechanism against low plasma glucose level in the early morning hours
- may partially block the effect of insulin
- blood sugar levels may rise resulting in elevated before-breakfast plasma glucose levels
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what are the long term chronic complications of DM? (3)
- high blood glucose damages blood vessels (high blood pressure, atherosclerosis, blindness)
- infections of the skin and gums
- depression
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what organs do chronic complications of DM effect? (6)
- eye
- brain and cerebral circulation
- heart and coronary circulation
- kidneys
- peripheral nervous system
- peripheral vascular tree
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what are the 4 main chronic complications for diabetes mellitus?
- microvasculature (small blood vessel level)
- macrovasculature (large blood vessel)
- infections
- lower-limb amputations
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what is the microvascular disease? what does it cause?
- thickening of the basement membrane, which results in decreased tissue perfusion
- causes hypoxia and ischemia of various organs mainly eyes, kidneys, nerves
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what 3 organs does mircovascular disease affect and what does it cause?
- retina: retinopathy
- kidneys: diabetic nephropathy
- nerves: diabetic neuropathy
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what is diabetic retinopathy?
leading cause of adult-onset blindness caused by changes in blood vessel in the retina
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what is diabetic nephropathy? (2)
- with the blood glucose levels elevated, the kidney's filtration mechanism is stressed
- earliest sign is thickening in glomerulus, allowing blood proteins to leak into the urine
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what is diabetic neuropathies? what is one complication it can cause?
- group of diseases that affect all types of nerves including peripheral, autonomic and spinal nerves
- can cause loss of sensitivity and decreased sensations of pain and temperature
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Gastrointestinal dysfunction is a result of diabetic autonomic neuropathy, what are the most common alterations of the GI tract? (4)
- gastroparesis: delayed gastric emptying, bloating, nausea, vomiting
- constipation and diarrhea
- urinary disorders: bladder voiding-loss of sensation of a full bladder, urinary retention
- sexual disorders: erectile dysfunction, retrograde ejaculation
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what are the 3 main diabetic macrovascular disease?
- coronary artery disease (CAD)
- stroke (CVD)
- peripheral arterial disease (PVD)
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what are the dermatological manifestations of Diabetes Mellitus?
- disorders of healing
- skin ulcers
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complications of diabetes that contribute to the increased risk of foot infections are: (3)
- neuropathy: loss of pain and pressure sensation;increased dryness and fissuring of skin
- PVD: poor circulation of the lower area contributes to poor wound healing & development of gangrene
- Immunocompromise: hyperglycemia impairs ability of specialized leukocytes to destroy bacteria; lower resistance to infections in poorly controlled diabetes
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what are some infections in diabetic patients? (3)
- urinary infection
- dermatological and soft tissue infection
- respiratory tract infections
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Individuals with DM are at increased risk for infection throughout the body because of? (3)
- diminished sense
- microvascular and macrovascular complications cause decreased oxygen supply to tissue
- pathogens are able to multiply rapidly because increased glucose in body fluids provides excellent source of energy
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