1. LONG TERM COMPLICATIONS Lauren Martin RD, LDN Rachel Sedgwick Intern

2. SKIN COMPLICATIONS

3. GENERAL SKIN CONDITIONS 1. Bacterial Infections2. Fungal Infections  Styes  Boils  Folliculitis  Carbuncles  Infections around nails  Candida albicans (yeast- like fungus)  Jock itch  Athlete’s foot  Ringworm

4. GENERAL SKIN CONDITIONS 3. Itching  Localized  Caused by dry skin, yeast infection, poor circulation  Use mild soap with moisturizer & apply skin cream after bathing

5. SKIN CARE TIPS  Talcum powder for skin-skin contact (armpits, etc.)  Avoid extremely hot baths or showers  Use mild shampoos and soaps  Moisturize often, especially in cold or windy weather  Treat cuts immediately to prevent further infection  Check feet daily for sores or cuts

6. FOOT COMPLICATIONS & CARE

7. DIABETES & YOUR FEET  Decreased circulation causes slow healing of injuries  Peripheral neuropathy: nerve damage in legs & feet  Causes little or no feeling in feet – risk for undetected trauma/injury  Untreated problems may lead to infection & possible amputation  very preventable!  Examine your feet every day!

8. PREVENTION OF FOOT PROBLEMS  Wear shoes and socks that fit & allow feet to breathe  Look for areas of redness when taking shoes off – sign of improper fitting shoe  Avoid going barefoot & use hard-soled slippers  Get tested for sensation in your feet: “monofilament”  This should be done once every year  Tell doctor if any areas of feet are numb

9. MONOFILAMENT TEST

10. DAILY FOOT CARE  Wash with mild soap & water daily & dry completely  Look at tops & bottoms of feet (use mirror as needed)  Fissures, cracks, calluses, red spots, cuts, bruises  Use lotion for dry feet or powder for sweaty feet  Remove calluses by gently rubbing with emery board or pumice stone  Do not use chemical removers or sharp instruments  Trim toenails to follow curve of toe & be even with end of toe  Nails are softer & easier to cut after bathing

11. X X

13. EYE COMPLICATIONS

14. THE EYE  When you look at an object…  The image is sent from the lens  vitreous (area filled with clear gel-like fluid)  retina  Retina = thin membrane at back of eye that receives images  Optic nerve = transmits image from retina to brain  Macula = center of vision of retina

16. Optomap Technology www.optos.com

17. DIABETIC RETINOPATHY  Weak spots develop in walls of smallest blood vessels & balloon-like outpouchings occur – “microaneurysms”  If the outpouchings cause swelling in the retina  vision impairment  Vision impairment from retinopathy ≠ blurred vision from high glucose levels

18. PROLIFERATIVE RETINOPATHY  New, smaller blood vessels form to help blood flow  “Neovascularization”  Very fragile & break easily  Bleeding can occur between the retina & vitreous or into vitreous  Visual loss or total blindness if untreated

19. RETINAL DETACHMENT  Scars may develop & attach the retina & vitreous  If scars contract…  Retina torn away from back surface of eye & cause blank spots in vision  Immediate care is necessary!

20. PREVENTION & TREATMENT  Dilated eye exam by eye specialist  Regular eye exams at diagnosis & yearly thereafter  Keep blood pressure within recommended targets  Diabetes is the leading cause of new blindness… Get checked!

21. CATARACTS Accumulation of sugars in the lens of the eye causing swelling & clouding

22. GLAUCOMA Increased pressure in the eye causing damage to optic nerve in back of eye Tunnel vision Diabetics 2x as likely to develop

23. ORAL & DENTAL HEALTH

24. Diabetes and Oral health  Nearly 26 million Americans who have gum disease have unexpected oral health problems  Oral Health Problems is added to the list of “other complications” associated with diabetes  Blood sugar levels that are poorly controlled may lead to oral health problems

25. Types of Oral Health Problems  Plaque/Tartar – the “bad guy” of gum disease  Gingivitis – early stage of gum disease  Periodontitis – severe gum disease  Thrush – fungal infection  Dry Mouth – increased risk of cavities  Poor healing of ulcers

26. Warning signs  Bleeding gums – even if there is no pain  Red, swollen, or tender gums  Gums that have pulled away from teeth  Puss between teeth and gums  Bad breath  Loose teeth  Changes in bite  Ill fitting dentures

27. Is This A Two Way Street?  Yes!  The relationship between serious gum disease & diabetes goes two ways  Those with diabetes are more susceptible to serious gum disease AND…  Serious gum disease can affect blood sugar control and contribute to the progression of diabetes

28. How can I prevent Oral Health Problems?  Good Blood Sugar Control  Take good care of your teeth, gums & tongue  Brush and floss  Regular dental check-ups  Every 6 months  Avoid smoking  Remove and clean dentures regularly

29. QUESTIONS?