Ch 25 Long-term Complications of Diabetes

Question 1 of 5 Place the following events related to hyperglycemia and vascular injury in the proper order. Reduced blood flow Chronic hyperglycemia Endothelial injury Calcified plaque Atherosclerotic plaque 2, 3, 1, 4, 5 3, 2, 1, 4, 5 2, 3, 4, 5, 1 2, 3, 5, 4, 1 3, 2, 1, 5, 4

2, 3, 5, 4, 1

Question 5 of 5 Place the following sequence of events in the proper order. Decreased T cell activity and increased microorganism growth causes infection of the wound. Hyperglycemia causes demyelination of peripheral nerves. Development of infection in wound prolongs healing of the wound, resulting in further damage. Decreased pain sensation results in blister being formed on foot without person being aware. Blister forms into a wound, as blood supply to wounded area is compromised. 2, 4, 3, 1, 5 3, 2, 1, 4, 5 2, 4, 5, 1, 3 3, 2, 4, 1, 5 2, 4, 5, 3, 1

2, 4, 5, 1, 3

Question 3 of 5 What is an initial sign of diabetic nephropathy? Ketones in urine Increased serum osmolarity Albumin in the urine Acidic urine Glucose in urine

Albumin in the urine

Question 2 of 5 You are currently caring for a patient with poorly controlled type 2 diabetes. What long-term complications may be of concern? Select all that apply. Ketoacidosis Blindness Prolonged wound healing Hyperosmolar hyperglycemic syndrome Polyuria

Blindness Prolonged wound healing

Question 3 of 5 Which of the following may be associated with diabetic nephropathy? Select all that apply. Blunted pain response Tingling sensation in extremities Hypertension Albumin in urine Ketones in the urine

Hypertension Albumin in urine

Question 2 of 5 Which conditions may be caused by chronic hyperglycemia? Select all that apply. Retinopathy Neuropathy Increased infection risk Nephropathy Poor wound healing

Retinopathy Neuropathy Increased infection risk Nephropathy Poor wound healing

Question 4 of 5 Which of the following conditions is not a long-term complication associated with diabetes mellitus? Joint and muscle pain. Coronary artery disease Cardiovascular disease Peripheral vascular disease Blindness

Joint and muscle pain.

Question 4 of 5 Chronic hyperglycemia increases__________________________. Select all that apply. activity of T cells demyelination of neurons wound healing visual acuity risk for cardiovascular disease

demyelination of neurons risk for cardiovascular disease

Harold's primary care physician is very concerned about Harold's poor glycemic control. All blood glucose values were elevated during a recent checkup, including fasting blood glucose and A1c. The clinician is worried that hyperglycemia may result in disease development such as myocardial ischemia or stroke, both of which are present in Harold's family history. The physician talks to Harold about how glucose can lead to damage and blockage of blood vessels, which may reduce blood flow to key areas such as the heart and brain.

atherosclerosis CORRECT. High blood glucose levels may damage the endothelium of blood vessels. The damage to the blood vessel initiates an inflammatory response, which may eventually develop into plaque formation. This process leads to atherosclerosis and subsequent decreased flow through the vessel. Glucose regulation helps reduce the risk of atherosclerosis.

Question 1 of 5 Chronic hyperglycemia may cause ____________________. Select all that apply. microvascular angiopathy only macrovascular angiopathy only both microvascular and macrovascular angiopathy damage to peripheral, but not autonomic nervous system damage to both peripheral and autonomic nervous systems

both microvascular and macrovascular angiopathy damage to both peripheral and autonomic nervous systems

Question 4 of 5 In the past few months, Joan's preprandial blood glucose values have been averaging 140 to 155 mg/dL. She has been to her primary care provider several times and has been treated for pneumonia and Candida Vaginitis. Drag and drop the complication related to Sarah's symptoms. autonomic neuropathy lipoatrophy nephropathy retinopathy immunosuppression peripheral neuropathy

immunosuppression CORRECT. Hyperglycemia negatively affects WBC function, making the body less effective at fighting infection. Several infections are more common in the diabetic population including pneumonia, urinary tract infection, and skin and soft tissue infections.

Mike has T1DM and has used insulin injections since his diagnosis 6 years ago. He uses an insulin analogue and a large indented area has developed around his preferred injection site.

lipoatrophy. Loss of subcutaneous fat near insulin injection sites can occur, especially with the usage of insulin analogues. Mike should be counseled to make certain he rotates his injection site to reduce the likelihood of developing lipoatrophy.

Question 5 of 5 Bill was diagnosed with diabetes 12 years ago. Three months ago, he was diagnosed with hypertension. Drag and drop the long-term complication could both contribute to and also be made worse by hypertension. autonomic neuropathy lipoatrophy nephropathy retinopathy immunosuppression peripheral neuropathy

nephropathy CORRECT. Hyperglycemia can injure the capillaries of the glomeruli of the kidneys. One of the initial signs of this damage is the presence of albumin in the urine. Eventually, so much damage occurs to the glomeruli that proteins may also begin to appear in the urine. The damage and resulting changes to the glomerulus lead to renal dysfunction. Renal dysfunction is a source of hypertension, which further damages the glomeruli. This damage then continues in a cyclical manner.

Question 3 of 5 Sarah has made an appointment with her primary care provider because she has been experiencing some burning in her feet. She also has pain that spreads up her legs. Sarah has been on an insulin regimen for diabetes for 10 years. Drag and drop the complication related to Sarah's symptoms. autonomic neuropathy lipoatrophy nephropathy retinopathy immunosuppression peripheral neuropathy

peripheral neuropathy CORRECT. In peripheral neuropathy, the arterioles that supply the nerves are damaged, resulting in reduced blood flow and neuron demyelination. Symptoms include burning, pain, and sensory loss in the feet and lower extremities. Peripheral neuropathy can also blunt pain, masking symptoms of more serious conditions, such as myocardial infarction.

Question 2 of 5 Mark was diagnosed with type 2 diabetes 15 years ago. Recently, a fundoscopic examination showed macular edema and "cotton wool spots." Drag and drop the complication that causes these changes. autonomic neuropathy lipoatrophy nephropathy retinopathy immunosuppression peripheral neuropathy

retinopathy CORRECT. In diabetic retinopathy, damage to the retinal artery endothelium leads to inflammation, which eventually leads to occlusion of the arterioles, leading to ischemia. Signs of retinopathy include microaneurysms, hemorrhages, edema, exudates, and "cotton wool spots."

Tina is an 18-year-old college student who was diagnosed with type 1 diabetes mellitus (T1DM) 8 years ago. Up until college, Tina demonstrated excellent glucose regulation through diet, exercise, and insulin usage. Lately, however, Tina has exhibited much poorer glucose regulation and has been losing weight. She attributes her weight loss to using less insulin. She states she feels great and is happy to be avoiding the "freshmen fifteen," the common weight gain of college freshmen.

Insulin purging Some patients with T1DM will attempt to regulate weight by reducing insulin usage. This process is known as "insulin purging." By reducing insulin usage, or skipping insulin doses altogether, weight loss is stimulated by inducing lipolysis and less utilization and storage of glucose. Insulin purging can be very dangerous because it leads to poor glycemic control and increased risk for diabetic ketoacidosis.

Question 5 of 5 Gastrointestinal problems, bladder control issues, and sweating dysregulation may occur in individuals with diabetes as a result of _____________________. peripheral neuropathy poor wound healing suppression of T cell function autonomic neuropathy retinopathy

autonomic neuropathy

Question 1 of 5 George has been managing his diabetes for 20 years. His recent check-up revealed the following: He has had bouts of alternating constipation and diarrhea. He complains of being too hot when he goes outdoors in the summer and admits he is sweating less. He has been treated for urinary tract infections twice in the past year. Drag and drop the complication related to George's symptoms and illnesses. autonomic neuropathy lipoatrophy nephropathy retinopathy immunosuppression peripheral neuropathy

autonomic neuropathy CORRECT. Autonomic neuropathy involves dysfunction of the sympathetic and parasympathetic nervous systems. This dysfunction has system-wide effects. Effects include tachycardia, postural hypotension, gastroparesis (which may cause anorexia, bloating, diarrhea or constipation), bladder and bowel dysfunction, and blunted ability to perspire (which affects heat regulation). In addition, autonomic neuropathy can mask the signals of hypoglycemia.