The American Diabetes Association (2021i) recommends that adults with type 1 diabetes have their first eye exam within five years of diagnosis. Persons with type 2 diabetes should get the initial eye exam soon after receiving a diagnosis. After the initial exam. The ADA recommends that all people with diabetes get an annual eye exam. Patients who have no evidence of retinopathy for one or more annual eye exams and glycemia is well controlled, then screening every one to two years may be considered. The early stage of diabetic retinopathy may not require treatment. However, as the disease progresses, treatment is generally needed. Proliferative diabetic retinopathy requires prompt treatment (Mayo Clinic, 2021b). Focal laser treatment Also known as photocoagulation, focal laser treatment can stop or slow the leakage of blood or fluid in the eye. This procedure is performed in the office setting or at an eye clinic and is generally done in a single session. Vision may be blurry for a day after the procedure, and the patients may see small spots in their visual field for several weeks (University of Michigan Health, 2020). Scatter laser treatment Also known as panretinal photocoagulation, this treatment can shrink abnormal blood vessels. Also performed in an office or eye clinic setting, this procedure involves treating affected areas with scattered laser burns. The burns cause the abnormal blood vessels to shrink and scar. Scatter laser treatment is usually done Diabetic nephropathy Diabetic nephropathy refers to damage to the kidneys caused by diabetes. Not all diabetics develop diabetic nephropathy. Diabetics who are at higher risk for its development include persons with hypertension, elevated cholesterol, smoking history, and uncontrolled blood glucose (ADA, 2021i). Diabetic nephropathy does not produce symptoms in its early stages. Therefore, testing urine for the presence of albumin is very important so that kidney damage can be detected as soon as possible. Early kidney damage may be reversed (ADA, 2021g; 2021i). Symptoms, when they appear, are not particularly specific. Fluid retention and edema, loss of sleep, loss of appetite, nausea and vomiting, weakness, and trouble concentrating are reported (ADA, 2020g; 2021i). The primary treatment for diabetic nephropathy is to lower blood pressure. ACE inhibitors are recommended for most people who have hypertension, diabetes, and renal disease. Cholesterol and triglyceride levels must also be controlled; statins are generally prescribed (ADA, 2021g; 2021i). Resources There are a number of resources that may be helpful for patients, families, and healthcare professionals. ● American Association of Diabetes Educators https://journals. lww.com/nursing/Fulltext/2019/11000/Online_resources_for_ patients_with_diabetes.19.aspx ● American Diabetes Association https://www.diabetes.org/ resources Conclusion Diabetes mellitus is a chronic disease that affects millions of people of all ages in the United States and around the world. It has the potential to cause complications that can affect all facets of a person’s life as well as placing significant financial burden on patients, families, and society. But by adhering to individualized treatment regimens that rely on pharmacological therapy, diet, exercise, and healthy lifestyle habits, persons with diabetes can lead long, productive lives. It is important to note that patients and families need a significant amount of education to carry out prescribed management interventions. They also need emotional support and referrals to mental health professionals as needed. The health care community must remember that dealing with a chronic illness places a great deal of stress not only on patients and loved ones but also on society as a whole. The costs of a chronic disease
in two or more sessions and causes blurred vision for about a day after the procedure. Some loss of peripheral vision or night vision after undergoing the procedure is possible (University of Michigan Health, 2020). Vitrectomy A vitrectomy is performed to remove blood from the middle of the eye (vitreous) as well as any scar tissue that is pulling on the retina. A vitrectomy is performed in a surgical center or hospital using local or general anesthesia. A tiny incision is made in the eye through which scar tissue and blood are removed and replaced with a saline solution to maintain the normal shape of the eye. A gas bubble may be placed in the cavity of the eye to help reattach the retina. If so, the patient may need to remain prone (face down) for several days until the gas bubble dissipates. An eye patch is worn, and medicated eye drops instilled for a few days or weeks. Vitrectomy may be followed or accompanied by laser treatment (Johns Hopkins Medicine, n.d.b). Nursing Considerations: Patients treated with Scatter Laser procedures or vitrectomy may be extremely anxious for the fear of both pain and the possible complete loss of vision. Coaching, information about the procedures, and possible pre-mediation for anxiety should be considered. Patients required to remain prone for extended periods may also present nursing care challenges for eating and elimination. As with most complications, the best way to prevent diabetic nephropathy is to control blood glucose levels. Blood pressure management, a healthy diet, regular physical exercise, and adhering to prescribed medication schedules are all extremely important. A low protein diet may be recommended (ADA, 2021g; 2021i). Self-Assessment Quiz Question #10 All of the following statements pertaining to diabetic nephropathy are true EXCEPT: a. Risk factors for the development of diabetic nephropathy include hypertension, smoking, and elevated cholesterol. b. Diabetic nephropathy produces symptoms even in its early stages. c. Symptoms of diabetic nephropathy are not particularly specific. d. The primary treatment for diabetic nephropathy is to lower blood pressure. ● Association of Diabetes Care & Education Specialists https:// www.diabeteseducator.org/living-with-diabetes ● Centers for Disease Control and Prevention https://www.cdc. gov/diabetes/professional-info/index.html ● DiabetesCare.net http://www.diabetescare.net/resources ● Johns Hopkins Medicine https://www.hopkinsmedicine.org/ gim/faculty-resources/core_resources/Patient%20Handouts/ can be overwhelming. Sick time away from work can impact employers and work colleagues. Effective management of diabetes also helps to prevent or reduce the occurrence of complications associated with the disease. Complications can range from mild inconveniences to serious consequences, including kidney failure, vision loss, and cardiovascular disease. The importance of taking every possible step to control blood glucose levels cannot be overemphasized. But achieving and maintaining such control can be a challenge. The constant need to monitor blood glucose levels, exercise, monitor one’s weight, and adhere to dietary mandates can be frustrating. The realization that such lifestyle mandates are lifelong can make some people disregard treatment recommendations. Thus, it is important that ongoing support and encouragement are provided by the health care team.
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