chronic care plan. programme 1 2 long-term complications co-morbid conditions
TRANSCRIPT
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Complications
• Eyes (retinopathy) blindness
• Also cataracts
• Kidneys (nephropathy) kidney failure
• Nerves (neuropathy) decreased pain perception
• Blood vessels
• Limbs peripheral vascular disease
• Heart heart attacks
• Brain strokes
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Amputations
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Long-term complications
• Take years to develop
• May occur in childhood
• Glucose control (HbA1c) related to risk of complications
• Early control in childhood important (metabolic memory)
• Complications due to injury to blood vessels
• Cause of mortality
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Neuropathy
• Peripheral neuropathy• Painful neuritis• ‘Glove and sticking’ distribution• Loss of sensation• Reduced reflexes
• Autonomic neuropathy• Alteration in gastric function (gastroparesis)• Bloating, decreased appetite, constipation, diarrhoea• Palpitations• Urinary retention
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Nephropathy
• Increase protein excretion
• Small increase early microalbuminuria
• Treatment can slow progression
• Large amount of protein excretion macroalbuminuria or proteinuria
• Can cause increased blood pressure
• Kidney failure
• Treatment is dialysis or transplant
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Nephropathy screening
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• Annual microalbumin tests
• Start 5 years after diagnosis or at start of puberty
• Monitor blood pressure
• Treat microalbuminuria proteinuria and/or high blood pressure with medication
• Improve control (i.e. decrease HbA1c)
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Retinopathy
• Bleeding and new blood vessels in the eye
• 5-10% chance of blindness
• Rapid improvement of poor control can cause retinopathy to get worse
• Screen from 5 years after diagnosis or at start of puberty
• Eye examination
• Retinoscopy
• Fundus photography is better if available
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Co-morbid conditions (1)
• Not caused by diabetes
• More common in children & adolescents with diabetes
• Common genetic predisposition
• Auto-immune disease
• Often no clinical symptoms
• Need laboratory screening
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Co-morbid conditions (2)
• Thyroid dysfunction• Goitre, hypothyroidism, hyperthyroidism• Thyroid function tests, thyroid antibodies
• Coeliac disease• Sensitivity to gluten bowel dysfunction• Often asymptomatic positive transglutaminase or
endomysial or gliadin antibodies
• Addisons disease• Unexplained decrease in insulin doses, hypoglycaemia,
slow growth, fatigue, increased skin pigmentation
• Refer for management
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Other issues
• Osteopenia
• Necrobiosis lipoidica diabeticorum
• Itchy/painful hardened skin patches
• Lipohypertrophy (if injection sites are not rotated correctly)
• Lipoatrophy
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