CH 25 Long-term Complications of Diabetes

Place the following sequence of events in the proper order. 1.Decreased T cell activity and increased microorganism growth causes infection. 2.Hyperglycemia causes demyelination of peripheral nerves. 3.Development of infection prolongs wound healing, resulting in further damage. 4.Decreased pain sensation results in blister forming on foot and going unnoticed. 5.Blister develops into a wound, as blood supply to the area is compromised.

2, 4, 5, 1, 3

Bill was diagnosed with diabetes 12 years ago. Three months ago, he was diagnosed with hypertension.Drag and drop the long-term complication that could both contribute to and also be made worse by hypertension. atherosclerosis autonomic neuropathy insulin purging 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.

Up until college, Tina demonstrated excellent glucose regulation through diet, exercise, and insulin usage. Lately, Tina has exhibited much poorer glucose regulation and has been losing weight attributing it to using less insulin. Identify the term that best describes the reason for Tina's poor glucose regulation and weight loss. atherosclerosis autonomic neuropathy insulin purging lipoatrophy nephropathy retinopathy immunosuppression peripheral neuropathy

Insulin purging -Correct. Some patients with T1DM will attempt to regulate weight by reducing insulin usage, 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.

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

2, 3, 5, 4, 1

What is an initial sign of diabetic nephropathy? Glucose in urine Ketones in urine Albumin in the urine Acidic urine

Albumin in the urine

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

Hypertension Albumin in urine

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

Joint and muscle pain.

You are currently caring for a patient with poorly controlled type 2 diabetes mellitus (T2DM). What long-term complications are of concern? Select all that apply. Ketoacidosis Kidney damage Prolonged wound healing Hyperosmolar hyperglycemic syndrome Blindness

Kidney damage Blindness Prolonged wound healing

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

demyelination of neurons risk for cardiovascular disease

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

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

In the past few months, Joan's preprandial blood glucose values have averaged 140 to 155 mg/dL. She has been treated for pneumonia and Candida vaginitis. Identify the complication that Joan may be experiencing. atherosclerosis insulin purging 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. Identify the term that best describes Mike's experience. atherosclerosis autonomic neuropathy insulin purging lipoatrophy nephropathy retinopathy immunosuppression peripheral neuropathy

lipoatrophy. Correct. 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.

She has been experiencing some burning in her feet & pain that spreads up her legs. Sarah has been on an insulin regimen for diabetes for 10 years.Identify the complication related to Sarah's symptoms. atherosclerosis autonomic neuropathy insulin purging 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.

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

Retinopathy Neuropathy Increased infection risk Nephropathy Poor wound healing

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

autonomic neuropathy

All blood glucose values were elevated, including fasting blood glucose and A1c. The clinician is worried that hyperglycemia may result in disease development such as myocardial ischemia or stroke, 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.Identify the term that best describes the damage high glucose levels may cause in blood vessels.

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.

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. Identify the complication related to George's symptoms and illnesses. atherosclerosis autonomic neuropathy insulin purging 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.

A fundoscopic examination showed macular edema and "cotton wool spots" indicating damaged areas. Identify the complication that causes these changes. atherosclerosis autonomic neuropathy insulin purging 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."