• With insulin replacement - can participate in usual activities but at risk of complications

Complications

Short term:

• Hypoglycaemia
• Hyperglycaemia + DKA

Long term:

Chronic exposure to hyperglycaemia causes damage to the endothelial cells of blood vessels. This leads to leaky, malfunctioning vessels that are unable to regenerate. High levels of sugar in the blood also causes suppression of the immune system, and creates an optimal environment for infectious organisms to thrive.

Macrovascular Complications

• Coronary artery disease is a major cause of death in diabetics
  • primary/secondary prevention strategy with optimisation of blood pressure, lipids, weight, smoking and others
• Peripheral ischaemia causes poor healing, ulcers and “diabetic foot”
• Stroke
• Hypertension

Microvascular Complications

Thickening of the capillary and arteriole basement membrane is the cardinal feature of microvascular complications.

• Peripheral neuropathy
  • full examination including footwear, monofilament assessment of neuropathy, vascular assessment +/- dopplers.
  • Ipswich touch test on examination
• Retinopathy
  • annual screening
• Nephropathy - particularly glomerulosclerosis