-
macrovascular complications
- medium and large vessels disease more common with than those without DM
- CVD- 2-3x incr risk MI
- cerebrovascular disease- 2x incre risk stroke
- PVD: 2-3x incre risk impaired arterial circualtion
- renal disease- 40% those seeking tx has hx of dm
-
macrovascular complications
pathology
- specific pathology unknown, but theories that incr levels of glucose in blood thought to be detrimental to blood vessels and cause thickening, sclerosing, and occulsion by plaque that adheres to vessel walls
- still being studied
-
macrovascular compl
managment
- modify risk factors- glu control
- smoking cessation
- optimize nutrition- healthy heart diet
- excerise to dec bs in type 2
- wt loss PRN
- control bp and chole
-
Microvas compl
- thickening of basement membranes
- retina
- kidney
- 10-20 yrs after disease onset
-
diabetic retinopathy
- DM is the leading cause of blindness
- dm also have incr risk of cataracts and glaucoma
- retinopathy will affect at least all dm 1 within 20 yrs and 60% type 2
-
Dm retinopathy
what happens
- microvascular damage
- microaneurysm formation
- neovascularization
- hemmorrhage
- scarring retinal deattachment
- retina- is very rich in blood supply- decrease the blood supply to the retina hence vision changes
-
DM retinopathy
s/s
- painless
- gradual changes in vision
- watch for indication for hemorrgage
- - cobwebs, floaters, sudden vision changes
- educate about annual dilated eye exam
- control glu levels*** KEY
-
nephropathy
- 10-15 from onset of disease
- most often affects: glomeruli
- glomeruli changes: capill basement membrane thickening scelerosis (plaque formation)
- dece renal perfusion
- local renal vasculature pressure rises
- also: decreased renal perfusion due to macrovascular changes
- as disease progresses: decr catabolism of insulin- hypogly not breaking down insulin as fast (end up with more insulin)
- end result- htn, acute renal injury
-
Nephropathy
signs of renal failure
- proteinuria- albumin
- incre BUN/cr, GFR low under 60
- Htn
- wt gain/fluid retention
-
Nephropathy
management
- *** control glu levels
- control HTN
- - ace inhibitors, ARB
- avoid utis- infection/inflamm- recurring uti can incre risk of renal damage
- low K, Na diet- cause u will not be excreting it
- protect kidneys
- - avoid nephotoxic drugs like gentamycin and vancomycin
-
neuropathies
prevention
peripheral
autonomic
- control of blood glu levels can decre the incidence of neuropathies by 60%
- control that blood glucose
-
Peripheral neuropathy
- lower extremities more often
- symmetric and may progress proximally
- paresthesia, heightened or burning sensations
- eventually numbness
- disturbs gait, ability to discern tough
- - safety concerns
- - foot wear
- - foot care
- - can they feel
-
peripherihal neuropathy management
- control blood glu
- pain management
- - gabepentin
- - duloxetine (cymbalta) antidepressant
- TENS
- safety
-
Autonomic neuropathy (chronic)
nerve cells don't respond
nerve conduction coming from this
- cardiac- orthostatic hypotension- but HR doesn't go up, painless MI
- GI- gastroparesis- delay gastric emptying- can cause gerd (reglan)
- renal no nerve to contract- urinary retention, neurogenic bladder- uti
- adrenal- decre awareness of hypoglycemia bc SNS is not stimulated- no symptoms until comatose
- sexual- erectile dysfunction, impotence
-
DM foot problems
- patho neuropathy
- impaired circulation
- impaired wbc- numbers good but doesn't work as well
- Diabetic foot ulcers
- soft tissue injury
- pressure points
- progresses
- heal slowly
-
dm foot problems
teaching points for pt
- good footwear
- poditry
- inspect feet dialy- mirror
- drying between toes
- no soaking feet
- good glucose control
- no restricting
- cotton
- protect from drama, no bear foot, don't cross legs, no heating pads
- no OTC agents for calluses bc it could tear the skin
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