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what are the acute complications and chronic complications of diabetes mellitus related to?
- acute complications: related to excessive hyperglycemia
- chronic complications: related to insults to microvasculature or microvasculature
what are the 6 acute complications of diabetes mellitus?
- hypoglycemia (low blood glucose)
- hyperglycemia (high blood glucose)
- diabetic ketoacidosis
- hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)
- somogyi effect
- dawn phenomenon
what can cause hypoglycemia?
can result from skipping meals, an excess of either insulin or oral diabetes medication
How are most hypoglycemic reactions that are mild managed?
managed by self-administrating the sugar needed to correct the situation (sugar product or fruit juice)
what happens in severe hypoglycemia?
results in coma and the assistance of health care professionals may be required
what are some symptoms of hypoglycemia? (5)
- shaking (tremor)
- mood changes
- excessive hunger
how does hyperglycemia develop?
develops when there is too much glucose, not enough insulin or insufficient insulin activity in the blood stream
what are the symptoms of hyperglycemia? (4)
- blurred vision
- excessive thirst
- frequent urination
how can hyperglycemia be managed?
- management through rehydration if dehydrated
- oral anti-diabetic agent or insulin
what is diabetic ketoacidosis and which diabetes is it much more common in?
- life-threatening biochemical imbalance
- more common in type 1 diabetes
how does diabetic ketoacidosis (DKA) occur?
- hyperglycemia accelerated because most tissues cant utilize glucose without insulin
- too little insulin causes energy-starved cells to break down lipids, results in production of acidic ketone bodies
- they accumulate in blood stream and urine
- leads to disruption of blood pH
what does diabetic ketoacidosis result in?
results in the loss of lean muscle mass
what are the early symptoms of diabetic ketoacidosis? if untreated what other symptoms occur? what are the late signs?
- early symptoms:
- frequent urination that lasts for days or more
- if untreated:
- abdominal pain
- fruity smelling breath
- blurred vision
- Late signs:
- air hunger
what are the risk factors of diabetic ketoacidosis in people with already diagnosed type 1 diabetes? (5)
- serious illness
- surgerywhen people with diabetes miss their insulin treatment
DKA can be the ____________________ in people who don't yet have other symptoms.
first sign of type 1 diabetes
Is diabetes ketoacidosis a complication for people with type 2 diabetes? how is it triggered?
- can occur but very rare
- usually triggered by severe illness
which ethnic groups are more likely to have DKA as a complication of type 2 diabetes? (2)
Treatment for DKA is aimed at the correction of the 3 main problems which are?
- electrolyte imbalance
- metabolic acidosis
what does HHNS stand for?
Hyperosmolar hyperglycemic nonketotic syndrome
what happens in HHNS?
- lack of effective insulin which results in hyperglycemia
- in HHNS hyperglycemia, the body tries to get rid of the excess sugar by polyuria (excessive urination)
- leads to sever dehydration
where is HHNS most frequently seen?
frequently seen in elderly patients of type 2 diabetes (may occur with type 1, but less often)
What are the symptoms of HHNS? (4)
- initially high urine production, frequent bathroom visits
- urine becomes very dark
- polydipsia (excessive thirst)
- severe dehydration will lead to seizures followed by coma, eventually death
what are the warning signs for HHNS? (6)
- dry, parched mouth
- plasma glucose level over 600 mg/dl
- high fever
- warm, dry skin
- weakness on one side of body
Treatment for HHNS involves 4 approaches, what are they?
- vigorous intravenous re-hydration
- electrolyte replacement
- administration of insulin
- diagnosis and management of precipitating and coexisting problems
what are some ways to prevent HHNS? (3)
- check plasma glucose regularly
- know their target blood glucose range
- when ill check blood glucose more often, and drink glass of liquid every hour
what is the somogyi effect?
occurs when the blood glucose level swings high following hypoglycemia
what is the cause of somogyi effect? (2)
- caused by high level of insulin in blood during night (when person takes long-acting insulin)
- caused by release of stress hormones which may follow hypoglycemic episode during night
what is the dawn phenomenon? (3)
- hormones that are released as a defensive mechanism against low plasma glucose level in the early morning hours
- may partially block the effect of insulin
- blood sugar levels may rise resulting in elevated before-breakfast plasma glucose levels
what are the long term chronic complications of DM? (3)
- high blood glucose damages blood vessels (high blood pressure, atherosclerosis, blindness)
- infections of the skin and gums
what organs do chronic complications of DM effect? (6)
- brain and cerebral circulation
- heart and coronary circulation
- peripheral nervous system
- peripheral vascular tree
what are the 4 main chronic complications for diabetes mellitus?
- microvasculature (small blood vessel level)
- macrovasculature (large blood vessel)
- lower-limb amputations
what is the microvascular disease? what does it cause?
- thickening of the basement membrane, which results in decreased tissue perfusion
- causes hypoxia and ischemia of various organs mainly eyes, kidneys, nerves
what 3 organs does mircovascular disease affect and what does it cause?
- retina: retinopathy
- kidneys: diabetic nephropathy
- nerves: diabetic neuropathy
what is diabetic retinopathy?
leading cause of adult-onset blindness caused by changes in blood vessel in the retina
what is diabetic nephropathy? (2)
- with the blood glucose levels elevated, the kidney's filtration mechanism is stressed
- earliest sign is thickening in glomerulus, allowing blood proteins to leak into the urine
what is diabetic neuropathies? what is one complication it can cause?
- group of diseases that affect all types of nerves including peripheral, autonomic and spinal nerves
- can cause loss of sensitivity and decreased sensations of pain and temperature
Gastrointestinal dysfunction is a result of diabetic autonomic neuropathy, what are the most common alterations of the GI tract? (4)
- gastroparesis: delayed gastric emptying, bloating, nausea, vomiting
- constipation and diarrhea
- urinary disorders: bladder voiding-loss of sensation of a full bladder, urinary retention
- sexual disorders: erectile dysfunction, retrograde ejaculation
what are the 3 main diabetic macrovascular disease?
- coronary artery disease (CAD)
- stroke (CVD)
- peripheral arterial disease (PVD)
what are the dermatological manifestations of Diabetes Mellitus?
- disorders of healing
- skin ulcers
complications of diabetes that contribute to the increased risk of foot infections are: (3)
- neuropathy: loss of pain and pressure sensation;increased dryness and fissuring of skin
- PVD: poor circulation of the lower area contributes to poor wound healing & development of gangrene
- Immunocompromise: hyperglycemia impairs ability of specialized leukocytes to destroy bacteria; lower resistance to infections in poorly controlled diabetes
what are some infections in diabetic patients? (3)
- urinary infection
- dermatological and soft tissue infection
- respiratory tract infections
Individuals with DM are at increased risk for infection throughout the body because of? (3)
- diminished sense
- microvascular and macrovascular complications cause decreased oxygen supply to tissue
- pathogens are able to multiply rapidly because increased glucose in body fluids provides excellent source of energy