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CHRONIC COMPLICATIONS OF DIABETES (DIABETIC NEUROPATHY (treatments…
CHRONIC COMPLICATIONS OF DIABETES
MICRO- AND MACROVASCULAR CHANGES
smaller areas with lots of vessels
HAPPEN OVER TIME!
DIABETIC RETINOPATHY
eyes cant get oxygen and nutrients needed
can cause hypoxia
can cause edema
eye will develop new vessels to "feed" the eye
fragile, thinner, and weaker vessels
increased risk of damage to vessels
annual eye doctor visits
type 1 - after diagnosed for 5 years
type 2 - annually
effects safety and ability to manage disease
cant draw insulin appropriately - too much too little
cooking safety
fall risks
VASCULAR DISEASE
cardiovascular
decreases life span by 10-15 years
increased risk of death 80%
hypertension
ACE inhibitors
Aspirin (81mg)
325 mg already had problems with blood
erectile dysfunction
provide support and education regardless of age
boy diagnosed at 8 could have lots of complications with diabetes and develop ED at 16/17 y.o
cerebrovascular
stroke
death increased by 2-4%
more likely with pt with hyperglycemia
risk increases with smoking
DIABETIC NEUROPATHY
progressive degeneration of nerve function due to decrease oxygen
smoking increases the risk
diabetic gastroparesis (LOOK IN BOOK) this is important
risk for constipation
increase fluids
increase activity
types (look in book)
focal neuropathies
orthostatic hypotension
assessments
BS, stools (gastroparesis
check feet for tactile sensory
treatments
gabapetin
neurotin
other antidepressants to help with pain
GI stimulators
educate on shoes (peripheral neuropathy)
check shoes in evening for fit
look in mirror to check feet
GERD - gastroparesis
Decrease in kidney function and failure.
Results of diabetic neuropathy
COGNITIVE DYSFUNCTION
dementia (70-80 y.o)
look for increased short term memory loss
treatments
NAMENDA
helps to prevent progression of demetia
symptoms
disoriented
confusion
forgetful (extremely)
DIABETIC NEPHROPATHY
chronic changes in kidney vessels
not reversible
end stage renal disease (ESRD)
labs
treatment
antihypertensive
INFECTION (acute but can become chronic)
bacteria love sugar!!! (hyperglycemia
delayed wound healing
may not feel the injury
failure to treat wounds (foot)
amputation increases risk for infection
with any incision, monitor for infection
education
cleaning equip
not sharing equip
table 64.10 and 64.5