1. Complications Acute and Chronic

2. Complications  Acute: sudden onset usually reversible  Chronic: gradual onset can be irreversible

3. Acute Complications: Hypoglycemia  Blood Sugar less than 70 Causes  Taking too much medication (insulin or sulfonylurea)  Eating less than usual  Exercising more than usual

4. Hypoglycemia Symptoms Weakness Sweating Shakiness Tremors Nervousness HA/Dizziness/Hunger Irritability Tachycardia, palpitations Convulsions, confusion, coma

5. Rule of 15  Treat with 15 grams of carbohydrate  Test blood sugar after 15 minutes  Blood sugar should improve by 30 points (15 x 2)  If not, repeat treatment  If no improvement or there’s a change in mental status, get transported to an Emergency Room!

6. Treatments for Hypoglycemia 15 grams of carbohydrate 4 ounces of fruit juice (1/2 cup) 4 ounces of soft drink 4 teaspoons of granulated sugar 2 tablespoons of raisins 1 tablespoon of honey or syrup 3 pieces of hard candy 1 cup of skim milk 3 or 4 glucose tablets DO NOT OVER TREAT

7. Acute Complications: Hyperglycemia  Blood Sugar greater than 200 Causes  Forgetting to take medication  Not enough medication  Eating more than usual  Physical illness or emotional stress  Less physically active than usual  Pregnancy

8. Hyperglycemia Symptoms  Onset often gradual  Increased Urination  Increased Thirst  Increased Hunger  Dry Mouth  Slow wound healing  Blurred vision  Fatigue  Dry, itchy skin  Irritability

9. Chronic Complications  Diabetes can damage the lining of blood vessels and nerves by causing scarring and stiffness. The vessel linings can trap cholesterol and plaque leading to blockage (atherosclerosis).  **The heart must work harder to pump blood through these blocked vessels leading to chronic complications

10. Chronic Complications 1. Macrovascular (large blood vessels) Heart Brain Circulation 2. Microvascular (small blood vessels) Eyes Kidneys 3. Neurologic (nerves) Peripheral Autonomic

11. Macrovascular: Heart and Brain  Accelerated Atherosclerosis (rapid, younger age)  Heart Attacks “hardening of the arteries” Coronary Artery Disease  Heart Failure  Strokes

12. Macrovascular: Circulation  Foot ulcers, gangrene, increased risk of infection Poor sensation Decreased blood flow Slow wound healing **Most common cause of amputations  Pain in legs and calves (“peripheral vascular disease”)

13. Microvascular: Eyes  Retinopathy (bleeding in the back of the eye and scar formation)  Impaired vision  Blindness – Leading cause of blindness  Cataracts

14. Microvascular: Kidneys  Can no longer filter wastes out of the body  Protein spills in the urine  No warning signs  Diabetes is the most common cause of kidney disease requiring dialysis and transplant  Can be detected early with blood and urine tests (chemistries and microalbumin)

15. Neurologic: Peripheral Neuropathy  Damage to nerves causes numbness, burning, and pain (“peripheral neuropathy”)  Can lead to trouble walking and maintaining balance

16. Neurologic: Autonomic Neuropathy  Damage to nerves that control bodily functions (“autonomic neuropathy”)  Impotence  Gastroparesis (slow emptying of the stomach)  Diabetic diarrhea  Neurogenic bladder (loss of bladder tone)

17. Know Your ABCs A: A1C B: Blood Pressure C: Cholesterol Profile Goal is 6-7% Goal is <130/80 Goal is LDL <70-100 HDL >40 M HDL >50 F Triglycerides <150

18. Know Your ABCs D: Diabetes Kidney TestLess than 30 mg/dl (microalbumin)Yearly E: Eye ExamYearly F: Foot ExamYearly G: Goals of therapyeach visit H: Heart Protectiondaily if ordered statins aspirin

19. Questions?