Chronic Complications In Diabetes And Nursing Care PDF Fall 2024

1 CHRONIC COMPLICATIONS IN DIABETES AND NURSING CARE Asst. Prof. Dr. Gizem Yağmur Yalçın Fall 2024 30.10.2024 Mountain presentation by ContestDesign CHRONIC COMPLICATIONS OF DIABETES Macrovascular Complications 1. Atherosclerosis 2. Hypert...

1 CHRONIC COMPLICATIONS IN DIABETES AND NURSING CARE Asst. Prof. Dr. Gizem Yağmur Yalçın Fall 2024 30.10.2024 Mountain presentation by ContestDesign CHRONIC COMPLICATIONS OF DIABETES Macrovascular Complications 1. Atherosclerosis 2. Hypertension 3. Coronary Artery Disease 4. Cerebrovascular Attack 5. Diabetic Foot (We'll cover it in detail in the coming weeks.)  CHRONIC COMPLICATIONS OF DIABETES Diabetes mellitus (DM) is not only a disorder of carbohydrate metabolism, but also a vascular disease that affects vessels of almost all sizes and types. Vascular complications are responsible for most of the morbidity, hospitalizations and deaths that occur in patients with DM. Chronic vascular complications due to diabetes are divided into two as micro and macrovascular according to the size of the vessel involved. Diabetic retinopathy, Diabetic Beckman JA, Creager MA. Vascular Complications of Diabetes. Circulation research. 2016;118(11):1771-85 nephropathy  Macrovascular Complications Cardiovascular disease (CVD) is the most important cause of morbidity and mortality in patients with diabetes. The central pathological mechanism for the development of macrovascular complications is atherosclerosis, which leads to narrowing of the artery walls. Different factors play a role in the pathogenesis of these complications in patients with DM. Beckman JA, Creager MA. Vascular Complications of Diabetes. Circulation research. 2016;118(11):1771-85  What does this table mean? If you have diabetes, your risk of coronary artery disease is increased by 160%. If you have diabetes, your risk of ıschemic heart disease is increased by 127%. International Diabetes Federation. Diabetes Atlas 9th edition 2019. Available at: https://www.diabetesatlas. org/upload/resources/2019/IDF_Atlas_9th_Edition_2019. pdf  If these factors are Risk Faktörleri present in your patient, diabetes complications may develop more Risk Factors for Diabetes Mellitus Macrovascular quickly.Complications Hypertension Insulin Dyslipidema Albuminuria Smoking resistance Family history Obesity of coronary disease All patients with diabetes should be evaluated for cardiovascular risk factors at least once a year and treated if necessary. Türkiye Endokrinoloji ve Metabolizma Derneği DİABETES MELLİTUS VE KOMPLİKASYONLARININ TANI, TEDAVİ VE İZLEM KILAVUZU-2020  Nitric Oxide (NO) secreted Atherosclerosis from the healthy endothelium leads to a decrease in adhesion molecules, a decrease in the passage of inflammatory The effects of diabetes on endothelial cells to the vessel wall, a dysfunction and atherothrombosis initiation and decrease in platelet progression have been demonstrated. adhesion and aggregation, a With hyperglycemia, the formation of reactive decrease in smooth muscle oxygen metabolites (ROM) and insulin-resistant cell (CHD) proliferation and state are toxic to cells. prevents intimal hyperplasia Reactive oxygen metabolites also increase oxidation, facilitating the accumulation of LDL in the vessel wall. As age progresses, the vessel wall become thick Idris I, Thomson GA, Sharma JC. Diabetes mellitus and stroke. Int J Clin Pract 2006;60(1):48-56. http://dx.doi.org/10.1111/j.1368-5031.2006.00682.x Atherosclerosis Dyslipidema The main problem in diabetic dyslipidemia is that the liver synthesizes an excess of VLDL-cholesterol due to insulin resistance. In these patients, even if LDL-cholesterol levels are normal, dense LDL particles are increased. HDL, also called high-density lipoprotein, is defined as good cholesterol because it removes excess cholesterol from the blood. Türkiye Endokrinoloji ve Metabolizma Derneği DİABETES MELLİTUS VE KOMPLİKASYONLARININ TANI, TEDAVİ VE İZLEM KILAVUZU-2020 Hypertension Hypertension is at least 2 times higher in diabetics than in the nondiabetic population. Hypertension is a major risk factor for CVD and microvascular complications. While hypertension is due to diabetic kidney disease in T1DM, it is usually associated with other cardiometabolic risk factors in T2DM Türkiye Endokrinoloji ve Metabolizma Derneği DİABETES MELLİTUS VE KOMPLİKASYONLARININ TANI, TEDAVİ VE İZLEM KILAVUZU-2020 Hypertension In the patient with hypertensive diabetes, the blood pressure target should be individualized. Priority BP target for each patient 15 years and age >30 years End-organ damage (micro or macrovascular) ≥1 CVD risk factor (smoking, HT, early family history of CVD, CKD, obesity) Türkiye Endokrinoloji ve Metabolizma Derneği DİABETES MELLİTUS VE KOMPLİKASYONLARININ TANI, TEDAVİ VE İZLEM KILAVUZU-2020  Cerebrovascular Attack (stroke) Stroke is 2-6 times more common in patients with diabetes compared to non-diabetics and plays a role in approximately 25% of deaths due to diabetes Ischemic stroke is more common than hemorrhagic stroke in patients with diabetes It has been determined that diabetic ischemic stroke patients are younger than ischemic stroke patients without diabetes. Diabetes and Stroke: Epidemiology, Pathophysiology, Pharmaceuticals and Outcomes. Rong Chen, Bruce Ovbiagele and Wuwei Feng. Am J Med Sci. 2016 April ; 351(4): 380–386. doi:10.1016/j.amjms.2016.01.011.  Cerebrovascular Attack Hyperglycemia in stroke patients has been associated with poor outcomes in both ischemic and hemorrhagic strokes. Patients with diabetes have a higher risk of re- stroke after acute ischemic stroke. Diabetes is also associated with increased rates of functional deficits in the long term after stroke. Diabetes and Stroke: Epidemiology, Pathophysiology, Pharmaceuticals and Outcomes. Rong Chen, Bruce Ovbiagele and Wuwei Feng. Am J Med Sci. 2016 April ; 351(4): 380–386. doi:10.1016/j.amjms.2016.01.011.  Cerebrovascular Attack Proper glycemic control: The American Diabetes Association recommends keeping hemoglobin A1c (HbA1c) below 7% in type 2 diabetic patients. Blood pressure control is very important in patients with diabetes. More aggressive BP treatment in patients with diabetes and hypertension reduces the frequency of stroke. In the primary ischemic stroke prevention of patients with certain high risk, such as coronary heart disease or diabetes, treatment of dyslipidemia is recommended in addition to lifestyle changes. (Statin therapy for LDL) Uzuner, Balkan, Günger ve ark. İNMEDE BİRİNCİL KORUMA: TÜRK BEYİN DAMAR HASTALIKLARI DERNEĞİ İNME TANI VE TEDAVİ KILAVUZU – 2015. Türk Beyin Damar Hastalıkları Dergisi 2015; 21(2): 60-67 Nursing Care Blood pressure control Patients' blood pressure should be measured and recorded at each outpatient clinic examination. Patients with high BP should be asked to follow up BP at home. Inpatient and outpatient blood pressure and pulse measurement is recommended to detect postural changes due to autonomic neuropathy, especially in elderly patients. Türkiye Endokrinoloji ve Metabolizma Derneği DİABETES MELLİTUS VE KOMPLİKASYONLARININ TANI, TEDAVİ VE İZLEM KILAVUZU-2020 Diyabet_Tani_ve_Tedavi_Rehberi_2019, ULUSAL DİYABET KONSENSUS GRUBU Nursing Care Ideal BMI Even a 5% reduction in body weight in overweight and insulin- resistant obese individuals reduces insulin resistance and has a positive effect on blood pressure. BMI>25 kg/m2; At least 5-7% weight loss should be targeted within 3-6 months. The initial body weight of the patient can be reduced by 5-7% with structured programs focused on lifestyle change, including less than 30% of the energy from fats, regular physical activity and regular monitoring. Reducing 500-750 kcal from daily energy intake provides a reduction in body weight by 2-3 kg per month. Türkiye Endokrinoloji ve Metabolizma Derneği DİABETES MELLİTUS VE KOMPLİKASYONLARININ TANI, TEDAVİ VE İZLEM KILAVUZU-2020 Diyabet_Tani_ve_Tedavi_Rehberi_2019, ULUSAL DİYABET KONSENSUS GRUBU Nursing Care Nutrition In normotensive and hypertensive individuals, reducing sodium intake with a diet rich in fruits, vegetables, and low-fat dairy products lowers BP values. If the ≥ Blood Pressure (BP) is 130/80 mmHg; It may be desirable to take salt more restrictively (< 1.5 g/day). The diet should be rich in vegetables and fruits, contain fiber, and be low in saturated fats and red meat. A diet rich in vegetables and fruits, whole grains, and nuts may reduce the risk of CVD in individuals with diabetes. Türkiye Endokrinoloji ve Metabolizma Derneği DİABETES MELLİTUS VE KOMPLİKASYONLARININ TANI, TEDAVİ VE İZLEM KILAVUZU-2020 Diyabet_Tani_ve_Tedavi_Rehberi_2019, ULUSAL DİYABET KONSENSUS GRUBU Nursing Care Exercise Regular exercise reduces cardiovascular risk factors by improving blood glucose control, contributing to reduced insulin resistance and weight control. Activity should be individualized (regular exercise in accordance with their age and capacity). In patients with a high risk of CVD and sedentary life, it is recommended to perform an exercise ECG before starting exercise. In general, 3 days a week, moderate-intensity activities (such as walking, jogging, cycling, swimming) ≥3 days a week Warm-up and cool-down exercises should not be neglected before and after exercise. Adequate fluid intake should be ensured before and during exercise. Türkiye Endokrinoloji ve Metabolizma Derneği DİABETES MELLİTUS VE KOMPLİKASYONLARININ TANI, TEDAVİ VE İZLEM KILAVUZU-2020 Diyabet_Tani_ve_Tedavi_Rehberi_2019, ULUSAL DİYABET KONSENSUS GRUBU Hemşirelik Bakımı Exercise It is inconvenient to do the exercise on a very empty stomach or immediately after eating. It is reported that the exercises performed in the morning hours will be less risky in terms of hypoglycemia than the exercises performed in the afternoon due to the higher cortisol level at that time. Although the patient's conditions are decisive in this regard, it can be recommended to be done ideally 1-3 hours after the main meal. Türkiye Endokrinoloji ve Metabolizma Derneği DİABETES MELLİTUS VE KOMPLİKASYONLARININ TANI, TEDAVİ VE İZLEM KILAVUZU-2020 Diyabet_Tani_ve_Tedavi_Rehberi_2019, ULUSAL DİYABET KONSENSUS GRUBU Nursing Care It should be aimed to quit smoking and limit alcohol consumption. A healthy and balanced social life, adequate sleep duration and stress prevention are extremely important for healthy blood pressure and glycemia control. Türkiye Endokrinoloji ve Metabolizma Derneği DİABETES MELLİTUS VE KOMPLİKASYONLARININ TANI, TEDAVİ VE İZLEM KILAVUZU-2020 Diyabet_Tani_ve_Tedavi_Rehberi_2019, ULUSAL DİYABET KONSENSUS GRUBU  Patient and Family Education Alarm states You should educate the patient and his/her relatives about life-threatening complications. When they see these symptoms, emergency help should be called immediately. International Diabetes Federation. Diabetes Atlas 9th edition 2019. Available at: https://www.diabetesatlas. org/upload/resources/2019/IDF_Atlas_9th_Edition_2019. pdf TEMD DİABETES MELLİTUS ÇALIŞMA VE EĞİTİM GRUBU HASTA EĞİTİM KİTAPÇIKLARI SERİSİ, Diyabet ve Kalp Damar Hastalıkları Kitapçığı, Sayı 10 HAVE A BREAK