Skip to main content

Treatment of Long-Term Complications Associated with Diabetes Mellitus!

 

TREATMENT OF CONCOMINANT CONDITIONS RELATED TO DIABETES MELLITUS

  1. Coronary Heart Disease
  2. Dyslipidemia
  3. Hypertension
  4. HIV and AIDS
  5. Antipsychotic Therapy
  6. Hypoglycemia
  7. Diabetic Ketoacidosis (DKA)
  8. Hyperosmolar Hyperglycemic state
  9. Retinopathy
  10. Neuropathy
  11. Foot Ulcers 
TREATMENT OF LONG-TERM COMPLICATIONS
1. Retinopathy
2. Neuropathy
3.Microablumiuria
4. Foot Ulcers

9.RETINOPATHY

  • Diabetic retinopathy is the leading cause of blindness in adults 20-74 years of age in the United States.

Pathophysiology:

  • Diabetic retinopathy occurs when the microvasculature that supplies blood to the retina becomes damaged. This damage permits leakage of blood components through the vessel walls.

Etiology:

  • The risk of retinopathy is increased in patients with longstanding DM, chronic hyperglycemia, hypertension and nephropathy. Glaucoma, cataracts and eye disorders are more frequent in pt. with DM.

Treatment:

  • The AD recommends that patients with DM receive a dilated eye examination annually by an ophthalmologist or optometrist.
  • Examinations should begin within 5 years of diagnosis of T1 DM and shortly after the diagnosis of T2 DM.

Prevention:

  • Glycemic control is the best prevention for slowing the progression of retinopathy along with optimal blood pressure control.
  • Early retinopathy may be reversed with improved glucose control.

10.NEUROPATHY

  • Peripheral neuropathy is a common complication reported in T2 DM.

Clinical Presentation:

  • Gastroparesis, resting tachycardia, orthostatic hypotension, Impotence, Constipation and Hypoglycemic autonomic failure.

Symptoms:

  1. Pain
  2. numbness in the extremities
  3. The feet are affected more often than the hands and fingers.

Complication:

    • Autonomic neuropathy is a common complication as DM progresses.

    Treatment:

    • Current options include Pregabalin, Low-dose tricyclic antidepressants, Duloxetine, Venlafaxine, Topiramate, NSAIDs and Topical Capsaicin.

    Therapy:

    • Therapy for each individual is addressed separately.

    11.MICROALBUMINURIA AND NEPHROPATHY

    "Microalbuminuria is defined as between 30-300mcg of albumin per milligram of creatinine. The presence of microalbuminuria is a strong risk factor for future kidney disease in T1 DM".
    • Diabetes Mellitus is the leading contributor to end-stage renal diseases.

    Normal Units:

    • The desirable value is less than 30mcg of albumin per milligram of creatinine.

    Diagnosis:

    • Early evidence of nephropathy is the presence of albumin in the urine. Therefore, as the disease progresses, larger amounts of protein spill into the urine.

    Screening:

    • The most common form of screening for protein in the urine is a random collection for measurement of the urine albumin-to-creatinine ratio.

    Therapy:

    • Glycemic control and blood pressure control are primary measures for the prevention and progression of nephropathy.
    • ACE Inhibitors and Angiotensin II receptor blockers prevent the progression of renal diseases in patients with T2 DM.
    • Treatment of advanced nephropathy includes dialysis and kidney transplant.

    Recommendations:

    • The ADA recommends urine protein tests annually in T2DM patients.
    • For children with T1 DM, annual urine protein testing should begin with the onset of puberty or 5 years after the diagnosis of diabetes.

    12.FOOT ULCERS

    "A foot ulcer is an open sore that develops and penetrates to the subcutaneous tissues".
    Complications of the feet develop primarily as a result of peripheral vascular disease, neuropathies and foot deformations.

    Pathophysiology:

    • Peripheral vascular disease causes ischemia to the lower limbs. This decreased blood flow deprives the tissues of oxygen and nutrients and impairs the ability of the immune system to function adequately.

    Symptoms:

    1. Intermittent claudication
    2. Cold feet
    3. Pain at rest
    4. Loss of hair on the feet and toes

    Treatment:

    • Treatment includes glycemic control, preventing infection, debriding dead tissues, treating edema and limiting ambulation.

    Therapy:

    • Smoking cessation is the single most important treatment for peripheral vascular disease.
    • In addition, exercising by walking to the point of pain and then resting and resuming can be a vital therapy to maintain and improve the symptoms of peripheral vascular disease.
    • Pharmacologic interventions with Pentoxifylline or Cilostazol also may be useful to improve blood flow and reduce the symptoms of peripheral vascular disease.

    Recommendations:

    • To prevent foot complications, the ADA recommends daily visual examination of the feet and a foot check performed at every physician visit.
    • Sensory testing with a 10-guage monofilament can detect areas of neuropathy.


    Labels:

    Comments

    Post a Comment

    Popular posts from this blog

    Diabetes Mellitus: Clinical Presentation and Diagnosis!

     CLINICAL PRESENTATION AND DIAGNOSIS OF DM 2. SCREENING American Diabetes Association (ADA) recommends routine screening for T2 DM every 3 years in all adults starting at 45 years of age. Testing of T2 DM should be considered in any adult, regardless of their age, who have a BMI greater than or equal to 25kg/m2. The ADA does not currently recommend widespread screening for T1 DM because of the relatively low incidence in the general population, although measurement of Islet antibodies may be appropriate for high-risk individuals. 3.GESTATIONAL DIABETES: "Gestational diabetes is the glucose intolerance in women during pregnancy". All pregnant women who have risk factors for T2 DM should be screened for undiagnosed T2 DM at their first prenatal visit using standard diagnostic criteria.  Any women found to have diabetes in the early point at pregnancy is considered to have T2 DM or GDM. All other pregnant women, not currently known to have DM should be screened for GDM with a 75...
    Post a Comment
    Read more

    Hospital Acquired Pneumonia- Definition, Predisposing Factors, Clinical Features and Management!

     HOSPITAL ACQUIRED PNEUMONIA Definition: "HAP refers to a new episode of pneumonia occurring at least 2 days after the administration to hospital. It is the most common Hospital Acquired Infection (HAI) and leading cause of HAI-associated death". Predisposing factors: Aspiration of nasopharyngeal secretion Bacteria introduced into the lower GIT. Bacteriaemia Old age Mode of Spread:  Droplet infection Infecting agent: Bacteria: S.pneumonia , S.aureus , H.influenza Virus: Adenovirus, Corona virus, Herpes Simplex Clinical Features: Purulent sputum New radiological infiltrates Temperature > 38 degree Celsius Leukocytosis Investigations: Chest Pain:  to confirm the diagnosis and exclude complication. Pulse Oximetry : to monitor response to oxygen therapy, if SaO2 < 93% features of sever pneumonia, identify ventilatory failure or acidosis. Cell count:  ESR, Neutrophil leukocytosis Microbiological studies:  for severe CAP and those that do not respond to ...
    Post a Comment
    Read more

    Management of H.pylori and NSAID-associated ulcers Eradication!

    MANAGEMENT FOR H.PYLORI ERADICATION It is known that H.pylori infection is associated with over 90% of duodenal ulcers and 80% of Gastric Ulcers. Antibiotics alone or acid-suppressing agents alone, do not eradicate H.pylori . Both therapies act synergistically as growth of the organism occurs at elevated pH and antibiotics efficacy is enhanced during growth. Additionally, increasing intragastric pH may enhance antibiotic absorption. High eradication rates are achieved by a short course of Triple Therapy consisting of:            1 .PPI                                         2. Clarithromycin                         3. Amoxicillin/Metronidazole          in a twice recommended simultaneous regimen. First-Line Therapy :  European Guidelines recommended 1 we...
    Post a Comment
    Read more