The microvascular disease may also impair skin healing, so that even minor breaks in the skin can develop into a major infection and deep ulcers, especially in the lower extremities.
Control of blood glucose can prevent or delay many of these complications, but may not reverse them once established. Macrovascular complications involve atherosclerosis of large blood vessels, such as those supplying the heart, brain, and extremities.
This can lead to angina, myocardial infarction, transient ischemic attacks, strokes, and peripheral arterial disease. Cardiovascular disease is 2 to 4 times more prevalent in diabetic patients and is responsible for approximately 75% of diabetes-related deaths.
Diabetic foot syndrome is common among diabetics due to the atherosclerosis of the blood vessels to the extremities. It results from 3 factors: neuropathy, ischemia, and sepsis.
Loss of sensory nerves in the feet leads to painless trauma and potential ulcer formation. The lack of blood supply (ischemia) results in slower healing and possible sepsis.
These events can result in gangrene and ultimately amputation. Blood sugar control is so important, as well as IV antibiotics to limit the spread of infection.
Foot care is an important aspect of diabetic teaching, with proper toenail trimming and the use of orthotic shoes to prevent ongoing trauma associated with a diabetic foot. Immune dysfunction is another major complication, developing from the direct effects of hyperglycemia on cellular immunity.
Therefore, diabetic patients are especially susceptible to bacterial and fungal infections. In order to prevent and avoid the complications associated with diabetes, achieving and maintaining adequate control of blood sugar, diet, exercise, medications, monitoring, and education is a must.
Let’s go over a couple of questions for review: A patient presents with a blood glucose of425, positive ketones in their urine sample, weakness, vomiting, and fruity-smelling breath.
What complication of diabetes are they exhibiting?
C. Diabetic Ketoacidosis
Hyperglycemic State If you chose C, diabetic ketoacidosis, you’re right! Those are all signs and symptoms of the acute complications of DKA.
Here’s another one – Microvascular chronic complications include which of the following?
A. Diabetic retinopathy and peripheral vascular disease
B. Diabetic nephropathy and diabetic neuropathy
C. Cerebrovascular disease and coronary artery disease
D. All of the above
If you chose B, diabetic nephropathy and diabetic neuropathy, you’re correct! Microvascular complications affect the smaller blood vessels leading to neuropathy, nephropathy, and retinopathy.