Chronic Diabetes

Question 1

Effects of Kidney Failure

Answer 1

1) Waste removal: accumulation of nitrogenous wastes = nausea, vomiting, confusion, seizures
2) Blood pH control: reduced excretion of hydrogen ions which increases blood acidity= metabolic acidosis
3) Fluid/ electrolyte: reduced potassium

Question 2

Nephropathy

Answer 2

Damage associated to small blood vessels that supply the glomeruli

Question 3

What are the risk factors for Diabetic nephropathy?

Answer 3

Hypertension, Genetics, Smoking and Chronic hyperglycemia

Question 4

Ways to Spot Nephropathy

Answer 4

1) Annual screening, early intervention can help
2) Serum creatinine for Estimated Glomerular Filtration rate, high serum creatinine levels in the blood can indicate lack of filteration in kidneys
3) If albuminuria present (proteins in urine), drugs to delay progression: Ace inhibitors, Angiotensin II receptor antagonists
4) Need control of hypertension and BGL

Question 5

Monitoring for Retinopathy

Answer 5

• Funduscopic- dilated eye examination
• Fundus photography (image of retina)
  Should be conducted annually

Question 6

Monitoring Neuropathy (foot and lower extremities)

Answer 6

• Visual examination of foot (daily by patient)
  Comprehensive for examination:
• visual examination
• sensory examination with monofilament and tuning fork
• palpation (pulses, temp, callus formation)

Question 7

Types of Diabetic Neuropathy

Answer 7

Peripheral neuropathy (distal symmetric polyneuropathy) : Most common, loss of sensory function starts in the feet, then legs and then hands. Numbness, tingling or burning sensation. Can be more sensitive to pain or loss of pain sensation. Loss of sensations increases the risk of serious infections.

Sensory neuropathy: loss of protective sensation in lower extremities, major risk for amputation.

Question 8

Treatment and interventions for Sensory Neuropathy

Answer 8

• Tight blood glucose control
  Drug therapy
• Topical creams
• Tricyclic antidepressants
• Selective serotonin and norepinephrine reuptake inhibitors
• antiseizure medications

Question 9

Autonomic Neuropathy

Answer 9

• Can effect nearly all body systems
• Gastroparesis (delayed gastric emptying, can trigger hypoglycemia because of delayed absorption of food)
• Cardiovascular abnormalities such as: postural hypotension, resting tachycardia, painless myocardial infarction

Effect on sexual function
- erectile dysfunction
- decreased libido
- vaginal infections

Question 10

Why do foot complications increase with the presence of Diabetes?

Answer 10

• can be result of micro and macrovascular diseases.
• Sensory neuropathy major risk factor as loss of protective sensation (LOPS) prevents patient from knowing if injury has occured.
• Peripheral Artery Disease (PAD) also reduces blood flow to the lower limbs as peripheral arteries develop atherosclerosis which can lead to PAD. Lowered blood flow reduces wound healing and higher risk of infections
• Smoking increases risk

Question 11

Why does sensory neuropathy occur in Diabetes?

Answer 11

Persistent hyperglycemia leads to accumulation of sorbitol and fructose in the nerves that causes damage. Result is reduced nerve conduction and demyelination. Ischemic damage due to chronic hyperglycemia in blood vessels that supply peripheral nerves is also implicated.

Question 12

How can patients self manage and prevent foot complications?

Answer 12

Patient and family member teaching to precent foot ulcers
- Proper footwear
- avoid foot injury
- Skin and nail infection
- daily inspection of feet
- prompt treatment of small problems
- regular podiatrist appointments

Question 13

What is dermopathy and how can it present?

Answer 13

Skin lesion characterised by reddish brown, round or oval patches. It may appear before other clinical signs or symptoms of diabetes as thin skin is prone to injury.

Question 14

Why does diabetes make an individual susceptible to infection?

Answer 14

State of hyperglycemia causes defect in mobilisation of inflammatory cells and an impaired phagocytosis by neutrophils and monocytes. Recurring or persistent infections can lead healthcare provider to suspect diabetes. Loss of protective sensation may delay detection of infection. Persistent Glycosuria can predispose the bladder to infections. Decreased circulation due to angiopathy may delay immune response.

Question 15

How can a person with Diabetes manage and prevent Infections?

Answer 15

Treat promptly and vigorously
Patient teaching for prevention
- Hand hygiene
- Flu and pneumonia vaccine

Question 15

What are some things that should be consider when managing diabetes in an Older Adults?

Answer 15

Glycaemic control challenging
- Increased hypoglycaemic unawareness
- Functional limitations
- renal insufficiency

Diet exercise: main treatment
Patient teaching must be adapted to needs, and involve family where possible

Question 15

What is the difference between Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD)?

Answer 15

AKI
- deterioration of renal function over hours to days, usually reversible if patient provided prompt care
- can occur due to trauma, blood loss, heart failure
- dramatic increased nitrogenous waste in blood such as urea and creatinine
- Fluid retention leading to decreased urine output (Oliguria)
- Hyperkalaemia (elevated potassium in blood) causes heart arrythmia, patient might complain of chest pain, palpatation could lead to death.