COMPLICATIONS OF DIABETES

 

  1. Retinopathy: Type 1>Type 2. Can present to ER with change in vision. Possibilities are:
     
      1. Vitrous Hemorrhage
      2. Retinal Detachment
      3. Cataract / Glaucoma
        Development of non-proliferative and proliferative retinopathy is not dependent on type of DM, but rather number of years with the disease.
         
  2. Neuropathy- 70-80% of pts. Type 2 > Type 1. This can present with following:
     
      1. Peripheral Neuropathy that presents with symmetrical , bilateral, feet > hands parasthesias nights. Pt shows ¯ pinprick/vibration, thenar muscle wasting. Treatment c/o amitriptylin 25- 50mg qhs.
         
      2. Mononeuropathy that can involve C III, IV,VI (diplopias), femoral nerve, etc. These usually resolve in few months without any therapy or may not resolve at all.
      3. Autonomic Neuropathy:
         
        • GI: manifests with gastroparesis (treated with metoclopramide, H2 blockers), diarrhea (needs w/u). GI w/u includes solid + liquid gastric emptying study by nuclear medicine as an outpatient.
           
        • GU: manifests with impotence, neurogenic bladder.
           
        • Postural Hypotension: manifests with dizziness, lightheadedness, syncope. Treatment is PO fluids, avoidance of sudden position changes, pressure stocking to avoid blood pooling. Occasionally fluodrocortisone 0.1 mg qd or NaCl 2g qid may be needed.
           
  3. PVD:  may manifest with skin ulcers, skin atrophy, loss of hair on the  LE.
     
  4.  CAD: may manifest with silent MI
     
  5.  Foot Ulcers: - Commonly are multimicrobial and broad spectrum antibiotics to cover G+ and G - should  be used. Pseudomonas coverage is a must. Also do not forget to R/O osteomyelitis.
     
  6. Nephropathy:- Occurs in 15% of pts. More common in Type 1 only b/c the disease is present for  longer  than in Type 2. Proteinuria manifests way before  GFR and is treated by decreasing proteins  in diet and by  adding ACE-i  for both Type 1 & 2. If pt develops HTN, ACE-i is a   drug of  choice. UTI must be  treated aggressively. Note! if pt needs IV contrast study, hydrate pt well before  and after study and check BUN/Cr. prior to discharge.
     
  7. Charcot joint: - joint deformities, particularly evident on feet.

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