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Chronic Care Plan

Chronic Care Plan. Programme. Long-term complications. 1. 2. Co-morbid conditions. Long-term complications. Slide no 4. Complications. Eyes (retinopathy)  blindness Also cataracts Kidneys (nephropathy)  kidney failure Nerves (neuropathy)  decreased pain perception Blood vessels

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Chronic Care Plan

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  1. Chronic Care Plan

  2. Programme Long-term complications 1 2 Co-morbid conditions

  3. Long-term complications

  4. Slide no 4 Complications • Eyes (retinopathy)  blindness • Also cataracts • Kidneys (nephropathy)  kidney failure • Nerves (neuropathy)  decreased pain perception • Blood vessels • Limbs  peripheral vascular disease • Heart  heart attacks • Brain  strokes Amputations

  5. Slide no 5 Long-term complications • Take years to develop • May occur in childhood • Glucose control (HbA1c) related to risk of complications • Early control in childhood important (metabolic memory) • Complications due to injury to blood vessels • Cause of mortality

  6. Screening programmes Limited joint mobility (LJM)

  7. Slide no 7 Neuropathy • Peripheral neuropathy • Painful neuritis • ‘Glove and sticking’ distribution • Loss of sensation • Reduced reflexes • Autonomic neuropathy • Alteration in gastric function (gastroparesis) • Bloating, decreased appetite, constipation, diarrhoea • Palpitations • Urinary retention

  8. Slide no 8 Neuropathy screening • Symptoms • Neurological examination

  9. Slide no 9 Nephropathy • Increase protein excretion • Small increase early  microalbuminuria • Treatment can slow progression • Large amount of protein excretion  macroalbuminuria or proteinuria • Can cause increased blood pressure • Kidney failure • Treatment is dialysis or transplant

  10. Slide no 10 Nephropathy screening • Annual microalbumin tests • Start 5 years after diagnosis or at start of puberty • Monitor blood pressure • Treat microalbuminuria proteinuria and/or high blood pressure with medication • Improve control (i.e. decrease HbA1c)

  11. Slide no 11 Retinopathy • Bleeding and new blood vessels in the eye • 5-10% chance of blindness • Rapid improvement of poor control can cause retinopathy to get worse • Screen from 5 years after diagnosis or at start of puberty • Eye examination • Retinoscopy • Fundus photography is better if available

  12. Cataract / Retinal hemorrhage Slide no 12 Cataract Retinal hemorrhage

  13. Retinal Microvascular Complications Proliferative retinopathy Normal retina

  14. Nonproliferative diabetic retinopathy (NPDR)

  15. Proliferative diabetic retinopathy (PDR)

  16. Post Laser/Severe PDR Treatments

  17. Co-morbid conditions

  18. Slide no 18 Co-morbid conditions (1) • Not caused by diabetes • More common in children & adolescents with diabetes • Common genetic predisposition • Auto-immune disease • Often no clinical symptoms • Need laboratory screening

  19. Slide no 19 Co-morbid conditions (2) • Thyroid dysfunction • Goitre, hypothyroidism, hyperthyroidism • Thyroid function tests, thyroid antibodies • Coeliac disease • Sensitivity to gluten  bowel dysfunction • Often asymptomatic positive transglutaminase or endomysial or gliadin antibodies • Addisons disease • Unexplained decrease in insulin doses, hypoglycaemia, slow growth, fatigue, increased skin pigmentation • Refer for management

  20. Slide no 20 Other issues • Osteopenia • Necrobiosis lipoidica diabeticorum • Itchy/painful hardened skin patches • Lipohypertrophy (if injection sites are not rotated correctly) • Lipoatrophy

  21. Necrobiosis lipoidica diabeticorum

  22. Skin complications of insulin injections Lipohypertrophy Lipoatrophy

  23. Questions

  24. Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S

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