Complications

Acute and Chronic

Complications

Acute: sudden onset usually reversible

Chronic: gradual onset can be irreversible

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

Questions?