Diabetes Mellitus 2: Long-term Complications & Treatment

• Here are study notes which include key facts, figures, and entities mentioned in the Diabetes Mellitus NCLEX Practice Exam

Long-term Complications of Diabetes

• Peripheral neuropathy is a long-term complication that can lead to loss of sensation and increased risk of injury.

Diabetic Nephropathy

• Diabetic nephropathy is characterized by microvascular damage to the glomeruli causing albuminuria and potential kidney failure.

Diabetic Retinopathy

• Diabetic retinopathy can lead to glaucoma, which is optic nerve damage, and cataracts, which is lens clouding, both affecting vision.

Autonomic Neuropathy

• Autonomic neuropathy affects involuntary body functions, potentially leading to gastroparesis, erectile dysfunction, and postural hypotension.

Peripheral Vascular Disease (PVD)

• PVD in diabetes results in reduced circulation, increasing the risk for wounds, infection, and potential limb amputation.

Type 2 Diabetes Treatment

• Metformin (Biguanide class) is typically the first-line treatment, reducing hepatic glucose production and increasing muscle glucose uptake.
• Metformin can cause lactic acidosis when combined with contrast dye used in imaging studies; therefore, it should be held for 48 hours after contrast dye procedures.

Sulfonylureas

• Sulfonylureas like glyburide stimulate beta cells in the pancreas to produce more insulin, thus reducing blood glucose.

Alpha-Glucosidase Inhibitors

• Alpha-glucosidase inhibitors (e.g., acarbose) delay carbohydrate absorption, helping control post-meal blood sugar spikes.
• It is best used for patients who have elevated postprandial glucose levels

Incretin Mimetics

• GLP-1 receptor agonists (Incretin mimetics) should not be combined with insulin due to the risk of hypoglycemia.

Insulin Pumps

• MRI scans can damage insulin pumps due to strong magnetic fields; patients should avoid them.
• If the insulin pump malfunctions, patients are at risk for Diabetic Ketoacidosis (DKA) due to insufficient insulin delivery.

Insulin Action

• The phases include:
• Onset, which refers to how quickly insulin starts working.
• Peak, which is when it's most effective.
• Duration, which is how long it lasts.

Dietary Recommendations for Diabetics

• Diet recommendations include non-starchy vegetables and whole grains to help maintain stable blood glucose levels.
• Fiber helps regulate blood glucose by slowing carbohydrate absorption.

Exercise Recommendations for Diabetics

• Regular moderate exercise for 150 minutes per week improves insulin sensitivity and blood sugar control.
• Patients should check their blood sugar more frequently when starting a new exercise program.

Insulin Administration

• Short-acting insulin (clear) should be drawn first before intermediate-acting insulin (cloudy/NPH) to prevent contamination, when drawing up two types of insulin in one syringe.

Diabetic Foot Care

• Walking barefoot increases the risk of injuries and infections due to neuropathy and poor circulation, and should be avoided

Hyperglycemia

• Contact a healthcare provider if blood glucose is above 250 mg/dL despite treatment, due to the increased risk for DKA or HHS
• Persistent hyperglycemia above 250 mg/dL increases the risk for DKA or HHS, requiring medical attention.

Sick Day Management for Diabetics

• Sick day management includes hydration, frequent glucose monitoring, and continuing medications to prevent complications.

Hypoglycemia Treatment

• If a hypoglycemic patient is unconscious, IM glucagon or IV dextrose should be administered immediately.

Insulin Duration

• Long-acting insulin (e.g., glargine, detemir) provides 24-hour basal glucose control.

DPP-4 Inhibitors

• DPP-4 inhibitors increase the risk of pancreatitis, presenting as severe abdominal pain.

Hyperosmolar Hyperglycemic State (HHS)

• HHS causes severe dehydration, requiring IV fluid replacement as the first-line treatment.

Kidney Function Assessment

• Diabetic nephropathy is assessed by serum creatinine and urine albumin to monitor kidney function.

Blood Glucose Control

• Long-term blood sugar control prevents complications like neuropathy, retinopathy, and nephropathy.

Autonomic Neuropathy

• Autonomic neuropathy affects blood pressure regulation, leading to postural hypotension.

Diabetes Management Goals

• The primary goal is to maintain blood sugar levels within the target range to prevent complications.