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Chronic Care Plan - PowerPoint PPT Presentation


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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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Presentation Transcript
slide2

Programme

Long-term complications

1

2

Co-morbid conditions

complications

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

long term complications1

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
screening programmes
Screening programmes

Limited joint mobility (LJM)

neuropathy

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
neuropathy screening

Slide no 8

Neuropathy screening
  • Symptoms
  • Neurological examination
nephropathy

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
nephropathy screening

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)
retinopathy

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
cataract retinal hemorrhage
Cataract / Retinal hemorrhage

Slide no 12

Cataract

Retinal hemorrhage

retinal microvascular complications
Retinal Microvascular Complications

Proliferative retinopathy

Normal retina

co morbid conditions 1

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
co morbid conditions 2

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
other issues

Slide no 20

Other issues
  • Osteopenia
  • Necrobiosis lipoidica diabeticorum
    • Itchy/painful hardened skin patches
  • Lipohypertrophy (if injection sites are not rotated correctly)
  • Lipoatrophy
skin complications of insulin injections
Skin complications of insulin injections

Lipohypertrophy

Lipoatrophy