complication of dm

7/27/2019 Complication of Dm

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COMPLICATIONOF

DIABETES MELLITUSKLINIK DIABETES TERPADU

RS ISLAM KLATEN


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When you have diabetes, youre:

Twenty times more likely to develop

KIDNEY disease Four times more likely to have a STROKE

Four times more likely become BLIND

Two to four times more likely to have a

HEART attack


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Researchers continue to make greatprogress what triggers complication DM

& how to manage or prevent them

Blood sugar close to normal reducerisks of complication

Controlled blood sugar not to late tostart (As soon as begin managing blood

sugar level slow the progression ofcomplication & reduce chances ofdeveloping still more healthn problems


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COMPLICATIONS of DM

ACUTE

1.Diabetic ketoacidosis (DKA)

2.Hyperglycemic hyperosmolar state (HHS)

3.Hypoglycemia 4. Lactic acidosis

CHRONIC

1.Microangiopathy (retinopathy, nephropathy,neuropathy, Cardiomyopathy, Diabetic foot, etc)

2.Macroangiopathy (Heart attack/IMA, Stroke,

PAD)


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Acute complications

Medical emergencies, complications are

these spark medical emergencies

requiring immediate attention.

This include low blood sugar, high blood

sugar and excessive blood acids.


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PATOFISIOLOGI KAD & HHS


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laktic acid


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DKA

Occurs when muscle cells become sostarved for energy that body takesemergency measures & breaks down fat toxic acids as ketones

Most common type 1 DM insufficientinsulin to adjust raise of blood sugar

Cause by extreme stress or illness

Infection body produce adrenalinworks against insulin

Forget to take insulin


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Sign & symptom of DKA

Deep, rapid breathing

Sweet, fruity smell on breath

Loss of appetite

Nausea

Vomiting

Fever

Stomach pain

Weight loss

Fatigue

Weakness

Confusion Drowsiness


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Clinical presentation

Lost more than 5% body weight

More than 35 breaths a minute

Cant control blood sugar Become confused

Nausea and vomiting


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What should you do?

Check ketones if feeling especiallystressed or blood sugar persistently above240mg/dL

High ketones in blood ketones excretedin urine.

High ketones in urine must treatment &

stay in hospital DKA can lead into coma and posibly

death.


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Treatment

Replenishing lost fluids through i.v. line

Insulin combined with glucose, injected

into iv stop making ketones

Gradually blood sugar level back to

normal, if quickly can produce swelling in

the Brain


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HHS

Blood sugar reaches such a high level that bloodbecome thick and syrupy (level >600 mg/dL)

Cells cant absorb much blood sugar, the sugar

passed from blood to urine draws tremenous

amounts of fluid from body and producesdehydration

Common in type 2 DM, especially who dont

monitor blood sugar and who dont know have DM Trigger factors: high-dose steroid, diuretics,

infection, illness, stress or drinking excessive

alcohol


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HHS, sign & symptom

Excesive thirst

Increased urination

Weakness

Leg cramps

Confusion

Rapid pulse

Convulsions

Coma


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What should you do?

Check blood sugar level (> 600mg/dL)

Emergency treatment can correct the

problem within hours

Give intravenous fluids to restore water to

the tissue

Short acting insulin to help cells canabsorb glucose

Without prompt treatment can be fatal


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Hypoglycemia Blood sugar level


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Sign & symptom of Hypoglycemia

Later symptomp (BG < 40mg/dL)

Slurred speech

Drunkenlike behavior

Drowsiness

Confusion

Emergency symptoms (BG


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Hypoglycemia unawareness

Some people had DM for several yearsdont experience early symptoms of hypoglycemia, such as shakiness or

nervousness because chemicalchanges from long standing DM may maskthe symptoms or keep them for occuring

This condition may not realize blood sugaris low until later symptoms, such asconfusion or slurred speech, set in.


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What should you do?

As soon realize blood sugar is low, eat ordrink somethingraise BG level quickly.Example:

Hard candy, equal to about five live savingA regular (not diet) soft drink

Half a cup of fruit juice

Glucose tablets, nonprescription sugarpills made especially for treating low bloodsugar


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What should you do?

If after 15 minutes continue to experiencesymptoms, repeat the treatment. If theystill, contact the doctor.

If lose consiousness or for some otherreason are unable to swallow, thetreatmen of choice is an injection D 40%or glucagon injection (fast acting hormonecontra insulin to stimulate the releasesugar into the blood)


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Alhamdullillah

Thank you for

your attention


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CHRONICCOMPLICATION

OfDIABETESMELLITUS


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Chronic complications

Development of other diseases

Long-term DM complications are those

that develop gradually and that may

become disabling or live-threatening. They

include nerve, kidney, eye, heart and

blood vessel disease


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MICROVASCULAR

RETINOPATHY

NEPHROPATHY

CARDIOMYOPATHYNEUROPATHY

AUTONOMIC CARDIAC

GASTRIC

UROGENITAL

CHRONIC COMPLICATIONS


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CHRONIC COMPLICATION

MACROVASCULAR

CHD RISK 2 4 x

DEATH

60 %

CEREBROVASCULAR

STROKE : 4 x

PERIPHERAL VD

40 50 % NON-TRAUMATICAMPUTATION


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Nonproliferatif

Mild & most common

Blood vessel in retina become weak &swell or bulges or fatty deposits

Doesnt affect in the vision unless

Responsible for sharpest visionProliferatif

Tiny blood vessel are damage, bleed or

close off New & fragile of blood vessel in retina may

bleed


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If bleeding is heavy or occurs in the certain

it can obscure your vision

New blood vessel (neo vascularisation)also can form scar tissue can push & pull

on your retina and distour vision

Special treatment by an optalmologist wthLaser or Vitrectomy

Important to cath the disease early so that

it can be treated


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Sign & symptom

Spiders cobweb or tiny specks floating in an eye

A gray shadow in the filed vision

Blurred vision

Blurred word while reading

A dark or empty spot in the center vision

Dark streaks or red film that block vision

Eye pain

Flahes or light or rings around objects

Srait line that appear distorted

Vision loss


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How is it Treated? (retinopathy)

Reguler eye examinations to identity problemearly

Laser procedure to seal weak blood vessel

In most cases only one eye is treated at a time may several treatments pain

Bleedin in the middle eye need surgicalprocedure to remove the blood an replace with

clear fluid Detached (ablatio) retina by scar tissue requires

surgery to position the retina in place


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Nephropathy

Inside kidney are million tiny blood vessel filter waste from the blood disposed tourine

DM can damage this delicate filteringsystem, before developed any symptom

More 3/10 type 1 DM nephropathy

1/10 type 2 DM nephropathy Type DM younger, longer have DM higher

risk of kidney damage


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Sign & symptom

Swelling of ankles, feet and hands

Shortness of breath

High blood pressure

Confusion or difficulty concentrating

Poor appetite

Nausea and vomiting

Dry, itchy skin

Fatigue


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How is treated? (nephropathy)

Treatment depends on how advance thedisease is. Keeping BG level normal can preventyour condition from getting worse, possiblyimprove.

ACE inhibitors may help hypertension & heart

problem ARB can improve kidney function and decrease

microalbuminuria

Low pretein diet seems to reduce workload of

kidney (consult doctors & dietician) Severe damage with (ESRD) transplant,

Hemodialyse or CAPD (continous ambulatoryperitoneal dialyse)


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Neuropathy

Have an intricate network of nerves runs

throughout the body, connecting brain to

muscles, skin and other organs.

Brain senses pain, control the muscles,

and perform automatic task such as

breathing and digestion

Neuropathy affect 6/10 type 2 DM


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Sign & symptom

Many kind of nerve damage

Weakened muscles & an unsteady walk

Autonomic nerves can increase heart rate

& perspiration level In men can interfere to ability erection

In sensory nerves damage unable

detect sensation such as pain, warmth,coolness and texture


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Sign & symptom

Commonly damage often in the legs, less in thearm

Tingling feeling, numbness, pain or combination

these sensation

Burning pain comes and goes

Discomfort as a crawling sensation

Begin in tips of toe or finger or both and

gradualy spread upward Damage nerve in toe, if untreated can lose of all

sensation high risk for injury without realizing


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Sign & symptom

Foot care very important

If lost feeling in the feet and not to check

them each day, may not realize have a cut

or open wound until serious infection

The main cause of amputations in DM

60.000 amputation each year in DM


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How is it treated? (neuropathy)

Good BG control will reduce your symptoms

To relieve pain: pain reliever or antidepressantor

antiseizure medication

Capsaicin cream (hot pepper extract) Other therapy: accupuncture, biofeedback and

relaxation techniques

Type 2 DM patients

dont burn themself whenbathing or electric blanket or heating pad. Guard

against frost bite in cold temperature


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Heart and blood vessel

DM dramatically increased your risk of developing

one of many cardiovascular problems, including: Chest pain (angina)

Heart attack

Stroke

Narrowing of the arteries (legs and brain poorblood circulation) peripheral vascular disease

High blood pressure

DM can damage mayor arteries (supply heart &brain) easier for fatty deposits (plaques) increase pressure in arteries & reduce bloodcirculation


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Sign & symptom

Symptoms heart disease vary. Early stage produce nosymptom. Later may include:

Shortnss of breath

Pain of the chest, jaw or arm

Fatigue or weakness Swelling (edema)

Lightaheadness

Rapid or irreguler heart beat (palpitation)

Excessive perspirationPeople with DM are particular risk for silent (asymptomatic) heart attacks without typical symtomps (painless)


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How it is treated?

Many forms of heart disease are treatedwith medicationto prevent symptom fromworsening

If accumulation of plaques in the arteriesmay procedure angioplasty to openarteries sometimes bypass arteriessurgery

To prevent including healthy diet, moreexercise, stopping smoking, losing weight(if over weight)


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Risk of infection

High BG impaired function the immunecells to fight off germ & bacteriainfection

Location: mouth, gums, lungs, skin, feet,bladder and genital

High BG damage nerve otherwisealert infection

damage nerves to control bladder

sensation

fail alert bladder is full

overstreched lose muscle tone abilityyo empty completely bacteria may grow infection


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Sign and symptom

Many vary depending location of infection

Low grade fever

Gum : red and bleeding

Bladder: frequent urination, urgency and

burning sensation

Vagina: itching &/or discharge in vagina Foot: redness & pus are warning an

infection


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How it is treated?

Antibiotic to kill bacteria

A foot injury: procedure to clean the

injured area and remove infected tissue

Reduce risk of gum disease by brushing

and flossing the teeth regularly

Reduce risk of bladder infection by going

the bathroom regularly and making sure to

empty the bladder


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MEDICATION of IMPOTENCE

I. Sildenafil (Viagra, Androz, Edegra,Silagra) isnt effectivefor everyone

1hour before activity effective 4 hours

II. Alprostadil (synthetic of prostaglandin E-1)

not a pill self intraurethral (a grain rice)or self injection therapy (5-20 minutes before and 1 hour

erection)

III. Vacuum device

IV. Penile implanta. semirigid, benabled rod (permanent erection)

b. inflantable (with pump in scrotum produce an erectiononly when you want)

V. Counseling (if psychologycal factors)


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Preventing complication Tight BG control normal or near-normal

Diabetes Control and Complication Trial(DCCT): Tight BG control reduce 50% risk ofmany complication

United Kingdom Prospective Diabetes Study

(UKPDS):Keep BG normal: 1/4 fewer complications (eyes,kidneys and nerves) and reduce risk of heartdisease

Kumamoto study: the intensive insulin therapyhave delay in the start and progression of eye,kidney and nerve complication

SELF CARE


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SELF CARE:

Reducing risk of complication

Have a yearly physical examination

Get a yearly eye examination

See the dentist regularly

Keep up to date vaccination (flu, pneumonia) Care the feet

Dont smoke

Take a daily aspirin

Monitor blood pressure

Manage stress


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complication of dm

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