COMPLICATIONS OF DIABETES MELLITUS

COMPLICATIONS OF DIABETES MELLITUS

CHRONIC COMPLICATIONS:

DIABETIC RETINO-PATHY:

DESCRIPTION:

• Chronic and progressive impairment of the retinal circulation that eventually causes hemorrhage.
• Permanent vision changes and blindness can occur.
• The client has difficulty with carrying out the daily tasks of blood glucose testing and insulin injections.

ASSESSMENT:

• A change in vision is caused by the rupture of small micro aneurysms in retinal blood vessels.
• Blurred vision results from macular edema.
• Sudden loss of vision results from retinal detachment.
• Cataracts result from lens opacity.

INTERVENTIONS:

• Maintain safety.
• Early prevention via the control of hypertension and blood glucose levels.
• Photo coagulation (laser therapy) may be done to remove hemorrhagic tissue to decrease scaring and prevent progression of the disease process.
• Vitrectomy may be done to remove vitreous hemorrhages and thus decrease tension on the retina, preventing detachment.
• Cataract removal with lens implantation improves vision.

DIABETIC NEPHROPATHY:

DESCRIPTION:

• Progressive decrease in kidney function.

ASSESSMENT:

• Microalbuminuria
• Thirst
• Fatigue
• Anemia
• Weight loss
• Signs of malnutrition
• Frequent urinary tract infections
• Signs of neurogenic bladder

INTERVENTIONS:

• Early prevention measures include the control of hypertension and blood glucose levls.
• Assess vital signs.
• Monitor intake and output.
• Monitor blood urea nitrogen, creatinine, and urine albumin levels.
• Restrict dietary protein, sodium, and potassium intake as prescribed.
• Avoid nephro toxic medications.
• Prepare the client for dialysis procedure if planned.
• Prepare the client for kidney transplant if planned.
• Prepare the client for pancreas transplant if planned.

DIABETIC NEUROPATHY:

DESCRIPTION:

• General deterioriation of the nervous system throughout the body.
• Complications include the development of non healing ulcers of the feet, gastric paresis, and erectile dysfunction.

CLASSIFICATION:

• Focal neuropathy or mono neuropathy: Involves a single nerve or group of nerves, most frequently cranial nerves Ⅲ (oculomotor) and Ⅵ (abducens), resulting in diplopia.
• Sensory of peripheral neuropathy: Affects distal portion of nerves, most frequently in the lower extremities.
• Autonomic neuropathy: symptoms vary according to the organ system involved.
• Cardiovascular: Cardiac denervation syndrome (heart rate does not respond to changes in oxygenation needs) and orthostatic hypo-tension occur.
• Pupilary: Pupil does not dilate in response to decreased light.
• Gastric: Decreased gastric emptying (gastroparesis)
• Urinary: Neurogenic bladder
• Skin: Decreased sweating
• Adrenal: Hypoglycemic unawareness
• Reproductive: Impotence (male), painful intercourse (female)

ASSESSMENT:

• Findings depend on the classification
• Parasthesias 
• Decreased or absent reflexes
• Decreased sensation to vibration or light touch.
• Pain, aching, and burning in the lower extremities
• Poor peripheral pulses
• Skin breakdown and signs of infection
• Weakness or loss of sensation in cranial nerves Ⅲ (oculomotor), Ⅳ ( trochlear),Ⅴ (trigeminal), and Ⅵ (abducens).
• Dizziness and postural hypotension.
• nausea and vomiting
• Diarrhea or constipation.
• Incontinence
• Dyspareunia
• Impotence
• Hypoglycemic unawareness

INTERVENTIONS:

• Early prevention measures include the control of hypertension and blood glucose levels.
• Careful foot care is required to prevent trauma
• Administer medications as prescribed for pain relief.
• Initiates bladder training programs.
• Instruct in the use of estrogen-containing lubricants for women with dyspareunia.
• Prepare the male client with impotence for penile injections or other possible treatment options as prescribed.
• Prepare for surgical decompression of compression lesions related to the cranial nerves as prescribed.