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-Sensory Macrovascular Complications
Diabetes results in damage and
dysfunction in multiple organ systems.
Damage to large vessels providing
circulation to the brain, heart, and
Includes PVD, CVA, and CV disease.
DM is an independent risk factor for CAD Microvascular Complications
Microvascular Retinopathy and nephropathy. Result from abnormal thickening of the
Result basement membrane in muscle capillaries.
basement Increase in the presence of hyperglycemia. Retinopathy affects 80% of diabetics 15 years
after Nephropathy affect 30%---HTN is an important
contributing factor to diabetic nephropathy.
contributing Diabetic Retinopathy
Diabetic Diabetic Nephropathy
Diabetic 30-40% Type 1 will develop 5-10% Type 2 will develop Protein in urine earliest marker Microalbumin (albumin /creatinine ratio) Hypertension is an important contributing factor
Hypertension to diabetic nephropathy.
to Neuropathic Complications
Neuropathic Produces symptoms in 60% of diabetics. Excessive glucose is thought to interfere with
Excessive myoinositol in neurons .
myoinositol Autonomic dysfunction---GI, bladder, postural
hypotension, and sexual dysfunction.
hypotension, Sensory dysfunction---carpel tunnel syndrome,
paresthesias. Responsible for increased serious foot problems
(may lead to amputation).
(may Glycemic control improves nerve function. Manifested as pain and loss of sensation. Autonomic Neuropathy
Autonomic Cardiovascular : resting tachycardia orthostatic hypotension Gastrointestinal: gastroparesis
fecal incontinence Genito-urinary: neurogenic bladder
erectile dysfunction Hypoglycemia Complications
Causes---insufficient food intake,
Causes---insufficient unplanned activity, or an inappropriate
insulin or sulfonylurea dose.
symptoms---pallor, tremor, diaphoresis,
palpitations, and anxiety.
visual disturbance, weakness, paresthesias,
confusion, agitation, coma, death.
Can have hypoglycemia unawareness. Pediatric Considerations
Goals of therapy • Achieving normal growth and
• Avoiding acute and chronic
• Addressing psychosocial issues
• Educating children regarding selfcare Pediatric Considerations
– Dehydration: diabetic ketoacidosis
– When blood glucose is >240 mg/dl or during
illness, test for ketones
– Hypoglycemia may be difficult to detect; subtle
behavioral changes---lethargy, pallor, and sleep
– Rarely manifested before adolescence
– Screening for neuropathy/nephropathy ongoing
– Counseling on metabolic control before initiation
of pregnancy Geriatric Considerations
Increased prevalence of type 2 DM
– Increased adiposity, decreased lean body
mass, decreased activity levels, decreased
insulin secretion, hyperglycemic effect of
certain medications, concurrent illness
Goals of therapy
– Prevention and management of acute and
– Attention to psychosocial issues
– Education regarding self-care Geriatric Considerations
– Hyperglycemia: often asympt...
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- Spring '14
- Glucose, blood glucose