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Complications

Shachi says

Edema in Diabetic Nephropathy results from buildup of fluid. The kidneys are responsible for filtering bloodstream and removing excess water out of the body. Diabetic kidney disease with severely impaired kidney functions can cause accumulation of fluid in the body. In addition, reduction of blood plasma osmotic pressure due to loss of proteins will lead water to run into tissues, which will also aggravate swelling. The patients may experience swelling in eyelids, limbs, ankles, or short breath. The causes of edema are many. 1. It can be due to the damage of immune system,which leads to the increased permeability of systemic capillary wall causing the water in the plasma to seep into the interstitial space. 2. Hypoproteinemia- it will secrete more secondary aldosterone and antidiuretic hormone and renal tubule will reabsorb more water and sodium, which will cause edema. Along with aggravation of patients′ condition, more and more renal units will be damaged and glomerulosclerosis will occur at more glomeruli. Excessive loss of protein will lead to hypoproteinemia. Loss of protein from glomerular capillaries leads to decrease of plasma colloid osmotic pressure. Plasma colloid plays an important role in regulating the exchange of water inside and outside the blood vessels. So decrease of plasma colloid osmotic pressure will lead to water retention in tissue, which causes edema. So, Patients with Diabetic Nephropathy may need to restrict their dietary water consumption to relieve their edema. Diuretics may be prescribed to remove the excess fluid out of the body.
Edema in Diabetic Nephropathy results from buildup of fluid. The kidneys are responsible for filtering bloodstream and removing excess water out of the body. Diabetic kidney disease with severely impaired kidney functions can cause accumulation of fluid in the body. In addition, reduction of blood plasma osmotic pressure due to loss of proteins will lead water to run into tissues, which will... (Read More)
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Shachi says

The symptoms of DKA are due to metabolic acidosis and dehydration. The patient will also have symptoms of severe hyperglycemia SYMPTOMS • Polyuria, nocturia • Thirst • Weight loss • Malaise, lethargy • Visual disturbance • Abdominal pain • Anorexia • Nausea, vomiting • Breathlessness SIGNS • Dehydration, loss of skin turgor • Hypotension • Tachycardia • Hypothermia • Acetone odor in breath • Hyperventilation (Kussmaul’s breathing) • Drowsiness • Hyperreflexia, hypotonia • Acute abdomen/gastric dilation PREVENTION • Educate patient about sick day rules • Advise not to omit insulin • Advise patients to do frequent blood sugar monitoring and tell them the targets • Advise patients to test urine for ketones during sick days • Advise patient to seed prompt treatment for fever or any other infection • Increase fluid intake during fever • Keep a vial of regular insulin at home • Advise patients to report to hospital or physician as early as possible if unable to eat or drowsy.
The symptoms of DKA are due to metabolic acidosis and dehydration. The patient will also have symptoms of severe hyperglycemia SYMPTOMS • Polyuria, nocturia • Thirst • Weight loss • Malaise, lethargy • Visual disturbance • Abdominal pain • Anorexia • Nausea, vomiting • Breathlessness SIGNS • Dehydration, loss of skin turgor • Hypotension • Tachycardia • Hypothermia • Acetone odor in breath •... (Read More)
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Shachi says

Diabetic ketoacidosis(DKA) is an acute, life threatening metabolic acidosis which mostly complicates type 1diabetes. When cells don't get the glucose they need for energy, body begins to burn fat for energy, which produces ketones. Ketones are acids that build up in the blood and appear in the urine when body doesn't have enough insulin. They are a warning sign that diabetes is out of control or that you are getting sick. High levels of ketones can poison the body. When levels get too high, a person can develop diabetic ketoacidosis, or DKA. Self-Care at Home Home care is generally directed toward preventing diabetic ketoacidosis and treating moderately to elevated high levels of blood sugar. Ø If have type 1 diabetes, should monitor blood sugars as instructed by health care practitioner. Check these levels more often if feel ill, if you are fighting an infection, or if you have had a recent illness or injury. Ø Be alert for signs of infection and keep yourself well hydrated by drinking sugar free fluids throughout the day. The goals of treatment: Ø Improving Circulating Volume and Tissue perfusion Ø Decreasing serum glucose and osmolarity Ø Clearing blood and urine ketones Ø Correcting electrolyte imbalances Ø Identifying and treating the underlying cause FLUID AND ELECTROLYTES As it takes about 48-72 hours for DKA to develop, full replacement of the previous losses and correction of acid-base disturbances should be done with the same speed. Initially the fluid of choice is normal saline. 1 litre should be infused in the first 1 hour; The next 1 litre in the next 2 hours; 2 litres in the next 4 hours; 2 litres in the next 8 hours. i.e. about of saline should be monitored by BP, CVP, pulse an skin turgor. If the sodium levels are >150 mEg/I, half normal saline can be used. When the blood sugar levels reach around 250 mg/ld, the fluid should be changed to 5% dextrose saline drip (along with administration of insulin) to prevent hypoglycemia. Care should be taken not to infuse large amount of fluid too rapidly in elderly patients and especially those with pre-existing heart disease, congestive cardiac failure or renal failure. Insulin It is now well-accepted that a slow, steady infusion of insulin is ideal- often in adults after a bolus of 0.1-0.2units/kg body weight. If this is not possible an hourly small injection of short or rapid acting insulin is equally effective. The recommended insulin infusion dose is 0.1unit/kg/hour Potassium Potassium levels should be monitored regularly. Initially it may be low, normal or high. If it is low, start a potassium drip immediately with 40 meg of KCI per litre of fluid to begin with making sure that the urine output is adequate (>50 ml/hr). If the response is not adequate, adjust the dose of the KCI drip accordingly. If patient is taking oral feeds, oral potassium can be formula. Next Steps Follow-up In cases of mild dehydration with borderline diabetic ketoacidosis, may be treated and released from the emergency department providing that you are reliable and will promptly follow-up with your health care practitioner. Whether you are released to go home or monitored in the hospital, it is important that close monitoring of blood sugar and urinary ketone levels be continued. Elevated blood sugars should be controlled with extra insulin doses and drinking plenty of sugar-free fluids. Long-term care should include periodic follow-up with health care practitioner to achieve good control of blood sugars. Care includes screening for and treating the complications of diabetes by periodic blood tests of hemoglobin A1C, kidney function, and cholesterol, as well as an annual eye examination and regular inspection of the feet (for evidence of wounds or damage to nerves).
Diabetic ketoacidosis(DKA) is an acute, life threatening metabolic acidosis which mostly complicates type 1diabetes. When cells don't get the glucose they need for energy, body begins to burn fat for energy, which produces ketones. Ketones are acids that build up in the blood and appear in the urine when body doesn't have enough insulin. They are a warning sign that diabetes is out of control... (Read More)
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Shachi says

Skin problems are common in people with diabetes. Blood glucose provides an excellent breeding ground for bacteria and fungi, and can reduce the body’s ability to heal itself. These factors put people with diabetes at greater risk for skin problems. In fact, as many as a third of people with diabetes will have a skin disorder related to their disease at some time in their lives. Fortunately, most skin conditions can be prevented and successfully treated if caught early. But if not cared for properly, a minor skin condition can turn into a serious problem with potentially severe consequences. Some of the problems listed below—such as bacterial infections, fungal infections and itching—are skin conditions that can affect anyone. However, people with diabetes are more prone to getting these conditions, which can lead to serious complications. Some of the conditions listed—such as diabetic dermopathy, necrobiosis lipoidica diabeticorum and eruptive xanthomatosis—occur only in people with diabetes. (Remember, people with diabetes also can develop skin conditions that affect people who do not have diabetes.) Some common skin conditions include: Dry skin — If your blood glucose is high, your body loses fluid, causing your skin to become dry. This occurs because the body is turning the water into urine to remove excess glucose from the blood. Your skin also can get dry if the nerves, especially those in your legs and feet, do not get the message to sweat (because of diabetic neuropathy). Sweating helps keep your skin soft and moist. Dry skin can become red and sore, and can crack and peel. Germs can enter through the cracks in your skin and cause an infection. In addition, dry skin usually is itchy, and scratching can lead to breaks in the skin and infection. Acanthosis nigricans — This is a condition that results in the darkening and thickening of the skin. Often, areas of tan or brown skin, sometimes slightly raised, appear on the sides of the neck, the armpits, and groin. Occasionally, these darkened areas may appear on the hands, elbows, and knees. Acanthosis nigricans usually strikes people who are very overweight. There is no cure for acanthosis nigricans, but losing weight may improve the condition. Acanthosis nigricans usually precedes diabetes. Atherosclerosis — Atherosclerosis is the narrowing of blood vessels from a thickening of the vessel walls. While atherosclerosis most often is associated with blood vessels in or near the heart, it can affect blood vessels throughout the body, including those that supply the skin. When the blood vessels supplying the skin become narrow, changes occur due to a lack of oxygen. Loss of hair, thinning and shiny skin, thickened and discolored toenails, and cold skin are symptoms of atherosclerosis. Because blood carries the white blood cells that help fight infection, legs and feet affected by atherosclerosis heal slowly when they are injured. Bullosis diabeticorum (diabetic blisters) — In rare cases, people with diabetes develop blisters that resemble burn blisters. These blisters—called bullosis diabeticorum—can occur on the fingers, hands, toes, feet, legs, or forearms. Diabetic blisters usually are painless and heal on their own. They often occur in people who have diabetic neuropathy. Bringing your blood glucose level under control is the treatment for this condition. Diabetic dermopathy — Diabetes can affect the small blood vessels of the body that supply the skin with blood. Changes to the blood vessels because of diabetes can cause a skin condition called diabetic dermopathy. Dermopathy appears as scaly patches that are light brown or red, often on the front of the legs. The patches do not hurt, blister or itch, and treatment generally is not necessary. The patches are sometimes called skin spots. Digital sclerosis — The word "digital" refers to your fingers and toes, and "sclerosis" means hardening. Digital sclerosis, therefore, is a condition in which the skin on your toes, fingers and hands become thick, waxy and tight. Stiffness of the finger joints also may occur. The treatment is to bring your blood glucose level under control. Lotions and moisturizers may help soften the skin. Eruptive xanthomatosis — Eruptive xanthomatosis can occur in some individuals when blood glucose levels are not well controlled and when triglycerides in the blood rise to extremely high levels. This condition appears as firm, yellow, pea-like bumps on the skin. The bumps—which are surrounded by red halos and are itchy—usually are found on the feet, arms, legs, buttocks and backs of the hands. Treatment for eruptive xanthomatosis consists of controlling your blood glucose level. Lipid-lowering drugs also may be needed. Itching — Itching skin, also called pruritus, can have many causes, such as a yeast infection, dry skin or poor blood flow. When itching is caused by poor blood flow, the lower legs and feet are most often affected. Using lotion can help to keep your skin soft and moist, and prevent itching due to dry skin. Necrobiosis lipoidica diabeticorum — Necrobiosis lipoidica diabeticorum (NLD) is caused by changes in the blood vessels and generally affects the lower legs. With NLD, the affected skin becomes raised, yellow and waxy in appearance, often with a purple border. Sometimes, NLD is itchy and painful. As long as the sores do not break open, treatment is not necessary. If the sores do break open, see your health care provider for treatment. Scleroderma diabeticorum — Like digital sclerosis, this condition causes a thickening of the skin; but scleroderma diabeticorum affects the skin on the back of the neck and upper back. This condition, which is rare, most often affects people with diabetes who are overweight. The treatment is to bring your blood glucose level under control. Lotions and moisturizers may help soften the skin. Keeping your diabetes under control is the most important factor in preventing the skin-related complications of diabetes. Follow your health care provider’s advice regarding nutrition, exercise, and medication. Keep your blood glucose level within the range recommended by your health care provider. Proper skin care also can help reduce your risk of skin-related problems.
Skin problems are common in people with diabetes. Blood glucose provides an excellent breeding ground for bacteria and fungi, and can reduce the body’s ability to heal itself. These factors put people with diabetes at greater risk for skin problems. In fact, as many as a third of people with diabetes will have a skin disorder related to their disease at some time in their lives. Fortunately,... (Read More)
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Shachi says

People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications. Foot problems occur when there is nerve damage, also called neuropathy. This can cause tingling, pain (burning or stinging), or weakness in the foot. It can also cause loss of feeling in the foot, so you can injure it and not know it. Poor blood flow or changes in the shape of your feet or toes may also cause problems. Dos and Don'ts for Diabetic Foot DO'S Keep your blood sugar levels within a good range. Never walk barefoot Check your feet every day with a mirror for cuts, blisters, red spots, swelling, colour changes, open sores, and ingrown toe nails. Wash your feet everyday with water and soap. Water should be of room temperature. Dry your feet in between the toes. Use powder if needed Keep the skin soft and smooth. Apply skin lotion over top and bottom of feet but not between your toes. Trim your toenails straight across and file the edges with nail file. Wear comfortable, well-fitting shoes. Inspect the inside of shoes for foreign objects and torn linings. Change your socks daily. Prefer cotton seamless socks. Protect your feet from hot and cold. Wear socks at night in winters if you feel cold. Put your feet up when sitting. Move your ankles 2-3 times a day. Plan your physical activity with your doctor. Get your feet checked by your doctor periodically. DON'TS Don't walk barefoot, even indoors! Don't smoke. Smoking reduces blood circulation; in diabetics, this can lead to the loss of a limb. Don't cut corns or callouses yourself. Avoid open-toed shoes, particularly sandals with thongs between the toes. Do not wear tight fitting footwear. There is specially designed footwear for diabetics. Contact your diabetes care provider for that. Don’t use hot water bottles or heating pads Don’t use chemical agents or blades to remove corns and calluses, go and see your podiatrist. Don’t wear tight socks or knee-highs. Contact your doctor for even minor foot problems. Do not try to treat it yourself.
People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications. Foot problems occur when there is nerve damage, also called neuropathy. This can cause tingling, pain (burning or stinging), or weakness in the foot. It can also cause loss of feeling in the foot, so you can injure it and not know it. Poor blood flow or changes... (Read More)
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