complications acute and chronic. complications acute: sudden onset usually reversible chronic:...
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Acute Complications:Hypoglycemia Blood Sugar less than 70
CausesTaking too much medication (insulin
or sulfonylurea)Eating less than usualExercising more than usual
Hypoglycemia Symptoms
Weakness Sweating Shakiness Tremors Nervousness HA/Dizziness/Hunger Irritability Tachycardia, palpitations Convulsions, confusion, coma
Rule of 15 Treat with 15 grams of carbohydrate
Test blood sugar after 15 minutes
Blood sugar should improve by 30 points (15 x 2) If not, repeat treatment
If no improvement or there’s a change in mental status, get transported to an Emergency Room!
Treatments for Hypoglycemia 15 grams of carbohydrate
4 ounces of fruit juice (1/2 cup) 4 ounces of soft drink 4 teaspoons of granulated sugar 2 tablespoons of raisins 1 tablespoon of honey or syrup 3 pieces of hard candy 1 cup of skim milk 3 or 4 glucose tabletsDO NOT OVER TREAT
Acute Complications:Hyperglycemia
Blood Sugar greater than 200 Causes
Forgetting to take medicationNot enough medicationEating more than usualPhysical illness or emotional stressLess physically active than usualPregnancy
Hyperglycemia Symptoms Onset often gradual Increased Urination Increased Thirst Increased Hunger Dry Mouth
Slow wound healing Blurred vision Fatigue Dry, itchy skin Irritability
Chronic Complications Diabetes can damage the lining of blood
vessels and nerves by causing scarring and stiffness. The vessel linings can trap cholesterol and plaque leading to blockage (atherosclerosis).
**The heart must work harder to pump blood through these blocked vessels leading to chronic complications
Chronic Complications1. Macrovascular (large blood vessels)
HeartBrainCirculation
2. Microvascular (small blood vessels)EyesKidneys
3. Neurologic (nerves)PeripheralAutonomic
Macrovascular:Heart and Brain Accelerated Atherosclerosis (rapid,
younger age) Heart Attacks
“hardening of the arteries” Coronary Artery Disease
Heart Failure Strokes
Macrovascular:Circulation Foot ulcers, gangrene, increased risk of
infection Poor sensation Decreased blood flow Slow wound healing
**Most common cause of amputations Pain in legs and calves (“peripheral
vascular disease”)
Microvascular:Eyes Retinopathy (bleeding in the back of the eye and
scar formation)
Impaired vision
Blindness – Leading cause of blindness
Cataracts
Microvascular:Kidneys Can no longer filter wastes out of the body Protein spills in the urine No warning signs Diabetes is the most common cause of
kidney disease requiring dialysis and transplant
Can be detected early with blood and urine tests (chemistries and microalbumin)
Neurologic:Peripheral Neuropathy
Damage to nerves causes numbness, burning, and pain (“peripheral neuropathy”)
Can lead to trouble walking and maintaining balance
Neurologic:Autonomic Neuropathy
Damage to nerves that control bodily functions (“autonomic neuropathy”)
Impotence Gastroparesis (slow emptying of the
stomach) Diabetic diarrhea Neurogenic bladder (loss of bladder tone)
Know Your ABCsA: A1C
B: Blood Pressure
C: Cholesterol Profile
Goal is 6-7%
Goal is <130/80
Goal is LDL <70-100 HDL >40 M HDL >50 F
Triglycerides <150
Know Your ABCsD: Diabetes Kidney Test Less than 30 mg/dl
(microalbumin) Yearly
E: Eye Exam Yearly
F: Foot Exam Yearly
G: Goals of therapy each visit
H: Heart Protection daily if ordered statins aspirin
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