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.
