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Diabetes Complications | NCLEX RN Review 2019

September 19, 2019


Welcome to this video tutorial on the complications
of diabetes. Diabetes is a group of metabolic diseases
characterized by hyperglycemia (high blood sugar) that results from defects in insulin
secretion, insulin action, or both, and affects multiple systems of the body. Uncontrolled diabetes can cause metabolic
imbalance leading to acute complications, requiring immediate medical attention. Ongoing hyperglycemia will then develop into
chronic complications. Let’s start by looking at the acute complications
that require immediate medical intervention. Hypoglycemia, or a blood glucose level of
less than 60 mg/dL, is a potential complication of insulin therapy or oral hypoglycemic agents. It can also be caused by skipping a meal,
inconsistent carbohydrate intake, over-exercising, or alcohol consumption. Common signs and symptoms of hypoglycemia
may be adrenergic (caused by activation of the sympathetic nervous system) or neuroglycopenic
(which is caused by depression of central nervous system activity as the brain receives
an insufficient supply of glucose). Adrenergic symptoms usually result from a
rapid drop in glucose and occur first, including being pale, sweaty, having tachycardia, palpitations,
nervousness, irritability, feeling cold, weak, trembling, and hungry. The particular signs and symptoms vary depending
on the blood glucose level, how fast the glucose level dropped, and the duration of hypoglycemia. When the hypoglycemia is slow-developing,
as with long-acting insulin or with oral hypoglycemic agents, the central nervous system signs and
symptoms predominate. Those signs include headache, mental confusion,
numbness around mouth, incoherent speech, double vision, fatigue, emotional lability,
convulsions, and coma. If a rapid drop in blood sugar occurs and
is allowed to persist, both the sympathetic and central nervous system signs usually occur. The diabetic patient should be educated about
recognizing signs of hypoglycemia and how to treat it. As long as the patient is conscious, they
should self-treat with 15 g of quick-acting carbohydrate, such as 4 oz of juice (no added
sugar), 3-4 glucose tablets, or 3 hard candies. Recheck the fingerstick blood glucose in 15
minutes and if it remains below 60, the patient should self-treat again. In an unconscious patient, never try to give
oral glucose. In the hospital setting, one ampule of 50%
dextrose is given IV push. In the outpatient setting a friend or family
member can inject 1mg of glucagon subcutaneously, which causes the liver to release its glycogen
store. The patient will usually regain consciousness
within 10-20 minutes, and should then eat a snack of 45g carbohydrates to aid in replacing
glycogen stores. Patients are often nauseated after receiving
glucagon and may vomit. When hypoglycemia is severe, seizures may
also occur. Diabetic ketoacidosis (DKA) is another serious
acute complication when excess blood acids, called ketones, build up in the body. Ketones are formed when the body burns fat
for fuel instead of glucose. This can occur when there is not enough insulin
in the body to process sugars. DKA is triggered by illness or not taking
insulin. The progressive hyperglycemia causes glucose
to spill out into the urine, resulting in water and electrolyte losses, causing dehydration
and an increase in thirst. The lack of insulin and corresponding elevation
of glucagon leads to increased release of glucose by the liver as well as ketone bodies,
which are acidic and must be cleared from the circulation. DKA can occur in patients with type 1 or type
2 diabetes, but it’s rare with type 2. Risk for DKA is increased with type 1 diabetes,
under age 19, stress, physical or emotional trauma, high fever, heart attack, stroke,
smoking, or drugs/alcohol. Signs and symptoms of DKA include high blood
sugar levels, high levels of ketones in urine, fruity smelling breath, flushed face, nausea
and vomiting, abdominal pain, rapid deep gasping breaths, frequent urination,extreme thirst,
dry mouth and skin, weakness, confusion, and loss of consciousness. If left untreated, DKA can lead to coma or
death. Treatment involves rehydration with IV fluids,
insulin therapy, and electrolyte replacement. Hyperglycemic Hyperosmolar Nonketotic Syndrome
(HHNS) has some similarities to DKA, but is an acute complication of type 2 diabetes. The differences include profound dehydration,
with fluid deficit as high as 8-9 liters. Blood sugar levels are higher, with serum
glucose levels in the range of 600 to 2000. Ketosis is absent because patients with type
2 diabetes have insulin secretion to prevent ketosis. The kidneys try to get rid of the extra blood
sugar by putting more glucose into the urine, which increases urination and loss of body
fluid, causing dehydration. Dehydration makes the blood thicker and the
blood sugar level is too high for the kidneys to be able to fix. This also causes an imbalance of minerals
in the blood, especially sodium and potassium. This imbalance of fluids, glucose, and minerals
in the body can lead to severe problems, such as brain swelling, abnormal heart rhythms,
seizures, coma, or organ failure. Without rapid treatment, HHNS can cause death. Primary treatment involves IV rehydration,
which resolves the hyperglycemia, so IV insulin is usually not needed. Ok, now let’s look at the chronic complications
of diabetes, that develop from ongoing hyperglycemia. They are classified as microvascular or macrovascular. These complications are a result of the length
and degree of hyperglycemia. Microvascular complications affect the smaller
blood vessels, such as the eyes (leading to diabetic retinopathy), kidneys (leading to
diabetic nephropathy), and nerves (leading to neuropathy). The effects of high blood glucose as well
as high blood pressure can damage eye blood vessels, causing retinopathy, cataracts and
glaucoma. Diabetic retinopathy is the leading cause
of new blindness among adults 20 to 74 years old in the United States. High blood pressure also accelerates the development
and progression of retinopathy. Diabetic nephropathy is the leading cause
of end-stage renal disease in the US, with 20% of all diabetic patients having nephropathy. Excess blood glucose overworks the kidneys
and high blood pressure damages the small blood vessels. Microscopic amounts of albumin in the urine
is the earliest lab abnormality, which may then progress to albuminuria (clinical proteinuria). Aggressive blood pressure control lessens
the albuminuria, decreases the rate of deterioration of the kidneys, and improves survival. Diabetic neuropathy affects 60-70% of diabetic
patients, and involves damage to nerves in the peripheral nervous system. The most common symptoms involve numbness
in the legs or feet; but depending on the nerves affected, it can also cause shooting
pains; problems with the digestive system, urinary tract, blood vessels, and the heart. Microvascular disease may also impair skin
healing, so that even minor breaks in skin can develop into a major infection and deep
ulcer, 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 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 of
425, positive ketones in their urine sample, weakness, vomiting, and fruity smelling breath. What complication of diabetes are they exhibiting? A. Hypoglycemia
B. Nephropathy C. Diabetic Ketoacidosis
D. Hyperosmolar Hyperglycemic State If you chose C, diabetic ketoacidosis, you’re
right! Those are all signs and symptoms of the acute
complication 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. Thank you for watching this video about the
complications of diabetes! Be sure to check out our other videos!

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3 Comments

  • Reply Maha Khaled September 19, 2018 at 9:38 pm

    Thanks for this video☄😍

  • Reply Victor Mbachu December 3, 2018 at 9:41 pm

    Very good video!

  • Reply nisar fathima June 14, 2019 at 6:29 pm

    Very informative, thanks,just now subscribed

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