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Dysfunction sensory macrovascular complications

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Unformatted text preview: nction -Auto dysfunction -Auto -Sensory dysfunction -Sensory Macrovascular Complications Macrovascular Diabetes results in damage and Diabetes dysfunction in multiple organ systems. dysfunction Damage to large vessels providing Damage circulation to the brain, heart, and extremities. extremities. 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 Retinopathy after diagnosis. after Nephropathy affect 30%---HTN is an important Nephropathy 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 Autonomic hypotension, and sexual dysfunction. hypotension, Sensory dysfunction---carpel tunnel syndrome, Sensory paresthesias. paresthesias. Responsible for increased serious foot problems Responsible (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 diabetic diarrhea fecal incontinence Genito-urinary: neurogenic bladder erectile dysfunction Hypoglycemia Complications Hypoglycemia Causes---insufficient food intake, Causes---insufficient unplanned activity, or an inappropriate insulin or sulfonylurea dose. insulin Counterregulatory mechanisms Counterregulatory symptoms---pallor, tremor, diaphoresis, palpitations, and anxiety. palpitations, Neuroglycopenic symptoms---hunger, Neuroglycopenic visual disturbance, weakness, paresthesias, confusion, agitation, coma, death. confusion, Can have hypoglycemia unawareness. Pediatric Considerations Goals of therapy • Achieving normal growth and Achieving development development • Avoiding acute and chronic Avoiding complications complications • Addressing psychosocial issues • Educating children regarding selfcare Pediatric Considerations Pediatric Acute complications – 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 disturbances Chronic complications – 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 Increased mass, decreased activity levels, decreased insulin secretion, hyperglycemic effect of certain medications, concurrent illness certain Goals of therapy – Prevention and management of acute and Prevention chronic complications chronic – Attention to psychosocial issues – Education regarding self-care Geriatric Considerations Acute complications – Hyperglycemia: often asympt...
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