Chronic Complications Of Diabetes

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Why does chronic hyperglycemia damage cells and tissues

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1. the accumulation of damage by products of glucose metabolism such a sorbitol, which is associated with damage to nerve cells ,.

2. the formation of abnormal glucose molecules in the basement membrane of small blood vessels such as those that circulate to the eyes and kidneys. 3 A derangement in red blood cell function that leads to a decrease in oxygenation to those tissues

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Macrovascular complications

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Diseases of the large and medium blood vessels that occur with greater frequency and the earlier onset and people with diabetes. These include cerebrovascular, cardiovascular oh, and peripheral vascular disease

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How can a person with diabetes decrease risk factors associated with macrovascular complications

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Stop smoking, lose weight, control blood pressure, decrease fat intake, and other sedimentary lifestyle habits need to be changed

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Angiopathy

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Chronic complications associated with diabetes are primarily those of end-organ disease from damage to blood vessels secondary to Chronic hyperglycemia and is one of the leading causes of diabetes related deaths

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Diabetic retinopathy

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Refers to the process of microvascular damage to the retina as a result of chronic hyperglycemia, neuropathy, and hypertension in patients with diabetes. It is estimated to be the most common cause of new cases of adult blindness.

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What are the two classifications of retinopathy?

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Nonproliferative and proliferative

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What is nonproliferative retinopathy?

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The most common form, partial occlusion of the small blood vessels in the retina causing microaneurysms to develop in the capillary walls. The walls of these microaneurysms are so weak is that capillary fluid leaks out, causing retinal edema and eventually hard exudates or intraretinal hemorrhages. This may cause mild to severe vision loss, depending on which part of the retina is affected

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What is proliferative retinopathy?

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This is the most severe form, includes the retina and vitreous, when the retinal capillary to become occluded the body compensates by forming new blood vessels to supply the retina with blood. These new vessels are extremely fragile and Hemorrhage easily. Eventually light is prevented from reaching the retina.As the vessels worn they become torn and bleed. The patient sees black or red spots or lines. There is also a risk for partial or complete retinal detachment

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Complications related to long-term diabetes

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Retinopathy, nephropathy, neuropathy, cardiovascular disease, peripheral vascular disease, and cerebrovascular disease

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Interproffesional Care for diabetic retinopathy

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*The earliest and most treatable stages of retinopathy produce no vision changes so it is important that diabetics have dilating eye exam within 5 years of diagnosis of diabetes

* Maintain healthy blood glucose ranges

*Maintain and controlling blood pressure

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Laser photocoagulation

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Used to treat retinopathy. Destroys the ischemic areas of the retina that produce growth factors that encourage neovascularization

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Vitrectomy

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Aspiration of blood, membrane, and fibers from the inside of the eye through a small incision just behind the cornea. Used to treat vitreous hemorrhage

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Iluvien (fluocinolone intravitreal implant)

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Treatment for retinopathy. Injectable micro insert that produces sustained treatment via continuous delivery of corticosteroid fluocinolone acetone for 36 months.

Injected in the back of pts eye using a 25 gauge

Self healing

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Diabetic Nephropathy

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Microvascular complication r/t damages to the small blood vessels that supply the glomerular of the kidney.

Risk - hypertension,genetics, smoking, chronic hyperglycemia

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How are patients screened for diabetic nephropathy?

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Patients with diabetes should be screened annually with a random spot urine collection to assess for albuminuria, and measure the albumin-to-creatinine ratio

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Treatment for diabetic Nephropathy

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*Managing blood pressure is critical

* ACE INHIBITORS and Angiotensin 11 receptor antagonists. Lisinopril and Losartan

*Manage blood glucose

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Diabetic Neuropathy

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Nerve damage that occurs because of the metabolic derangements associated with diabetes mellitus. The most common type of neuropathy affecting persons with diabetes is sensory neuropathy.

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What are the two major categories of diabetes related neuropathy

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Sensory neuropathy which affects the peripheral nervous system and autonomic neuropathy

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Sensory Neuropathy

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The most common form a sensory neuropathy is distal symmetric polyneuropathy, which affects the hands and or feet bilaterally. This is sometimes referred to a stocking glove neuropathy

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Characteristics of distal symmetric polyneuropathy

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Loss of sensation, abnormal sensation, pain, and paresthesias. The pain, which is often described as burning, cramping, crushing, or tearing, is usually worth it night and may occur only at that time. The paresthesias may be associated with tingling, burning oh, and itching sensation. The patient may report a feeling of walking on pillows or numb feet

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Hyperesthesia

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A complication of sensory neuropathy. At times the skin becomes so sensitive that even like pressure from bed sheets cannot be tolerated. Complete or partial loss of sensitivity to touch and temperature is common. Foot injury in ulcerations can occur without the patient ever having pain

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Treatment for diabetic related neuropathy

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The only treatment is managing blood glucose

Drug therapy may be used to treat neuropathic symptoms particularly the pain

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Drug therapy for neuropathy pain

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Topical cream such as capsaicin an amitriptyline

Selective serotonin and norepinephrine reuptake Inhibitors such as Cymbalta

Anti-seizure medications such as Gabapentin and Lyrica

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Autonomic neuropathy

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Autonomic neuropathic pain csn affect nearly all body systems and lead to hypoglycemia unawareness, Bowel incontinence, diarrhea, and urinary retention. It can also lead to gastroparesis or delayed gastric emptying. Cardiovascular abnormalities related to autonomic neuropathy are postural hypotension, resting tachycardia, and painless myocardial infarction. Assess patients with diabetes for postural hypotension to determine if they are at risk for Falls

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Skin complications related to diabetes

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Diabetes-related dermopathy common acanthosis nigricans, necrobiosis lipoodica diabeticorum

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Diabetic dermopathy

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Characterized by reddish, brown, round ,or oval patches. They are initially scaly, then they flatten out and become indented

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Acanthosis Nigricans

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A manifestation of insulin resistance.C an appear as a velvety light brown to black skin thickening mainly seen on flexors, axillary, and the neck

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Infection related to diabetes

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The person with diabetes is more susceptible to infections because of a defect in the mobilization of white blood cells and impaired phagocytosis by neutrophils and monocytes. Candida albicans as well as boils and furnucles in the undiagnosed patient oftenly the healthcare provider to suspect diabetes

Bladder infections and Neutrogenic bladder

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Psychological considerations for diabetic

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Diabetic patients have high rates of depression, anxiety, and eating disorders. Assess for manifestations of depression and or diabetes distress. Diabulimia is a condition where people may intentionally decrease their dose of insulin or a omit the dose. This may lead to weight loss and hyperglycemia .

Be sure to use open-ended communication to identify these behaviors