pathophysiology of persistent hyperglycaemia
- glucose becomes irreversibly bound to RBCs, blood vessel walls
microvascular complications
diabetic retinopathy
leading cause of blindness
- accumulation of AGE
- RBC aggregation
- macular thickness
- decreased perfusion
microvascular complications
diabetic nephropathy
renal failure
- hyperglycaemia
- increased blood viscosity
- increased renal blood flow
microvascular complications
diabetic neuropathy
- persistent hypergylcaemia
- AGE formation
- demyelination
results in - altered or loss of sensation
- increased/ decreased pain
- numbnes, tingling and burning
- neuropathy
macrovascular complications
atherosclerosis
cause of morbidiity and mortality in patients with DM
AGE production
* vasoconstriction
* vascular changes and thickening of vessel wall
* thickening of wall
results in
* coronary artery disease
* cerebrovascular disease
* peripheral vascular disease
macrovascular complications
peripheral vasuclar disease
- PVD - causes disruption of peripheral perfusion due to blood vessel obstruction and thrombus formation
- reduced perfusion
- can lead to pain, pallor
- can result in necrosis
management goals
* re-establish perfusion to peripheral tissues
* reduce disease progression
what increases risk of infections
- impaired vision
- neuropathy
- skin damage
- increased glycosylated Hb
- hypergylcaemic envrionment
what needs to be involved in a diabetes management plan
- retinal screening
- feet checks
- urine
- BP
- GFR
- lipid profile
- dental health
- mental health
whats a HbA1c used for
- long term control of dibatetes
- forms irreversibly from glucose and haemoglobin
- every 3 months
whats a urine ACR used for
- test to identify the presence of low level of protein
- annually
what is GFR (glomerular filtiration rate) measured for
- blood test derived from serum creatinine level that reflects renal function
- annually
what is the best indicator of a patients current diabetes management is
a glycated haemoglobin level
a person with poorly controlled diabetes has increased risk of infection due to what?
a hyperglycaemic envrionment which supports microbial growth
what are the microvascular complications of diabetes
- peripheral neuropathy
- retinopathy
- nephropathy
how often should a person with diabetes have their HbA1C levels checked?
every 3 months
what are the possible signs and symptoms of diabetic peripheral neuropathy
increased pain sensation
numbness in the extremitites
