Pathophysiology of Diabetes Nephropathy and Atherosclerosis

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HND701 Pathophysiology of Diabetes

Due: 1st June 2012
Student name: Marie Sansotta-Allen Student number: 212234644 Word count:
Essay – 3292, Citations/quotes/contents page - 700, References –1328

Table of ContentsPage
Introduction2
Diabetes Nephropathy3
Risk factors4
Pathophysiology of Diabetes Nephropathy5
Diabetes Nephropathy Management7
Glycaemic Control7
ACE/ARBs8
Blood pressure control8
Atherosclerosis9
Risk Factors9
Pathophysiology of Atherosclerosis10
Atherosclerosis Management12
Diabetes Clinic12
Hyperlipidaemia12
Statins12
Smoking Cessation13
Conclusion13
References15

Introduction
Diabetes is a silent killer! Diabetes is a lifelong progressive condition with the natural potential for the development of numerous diverse complications. These complications can arise from damage to the microvascular (small blood vessels) system and present as neuropathy, retinopathy and nephropathy or damage to the macrovascular (large blood vessels) system and present as dyslipidaemia, atherosclerosis and hypertension. Nathan & Delhanty (2005, p.42) maintains that these complications may be present at the time of diabetes mellitus diagnosis and refer to diabetes as a ‘silent killer” as diabetes can go unnoticed until a major health event occurs.

Diabetes is a major risk factor in the development of diabetes nephropathy and atherosclerosis. The person with diabetes (PWD) is at increased risk of mortality and morbidity than the general population but these are further increased in the presence of complications. There is a crossover in pathophysiology of both nephropathy and atherosclerosis and the choice of these diabetes complications for this paper is purposeful as they have persistent hyperglycaemia over time as a common denominator (Fowler 2008; Chadban et al. 2009, pp.32). The severity of hyperglycaemia and presence of hypertension were in evidence in the U.K. Prospective Diabetes Study (UKPDS) (Adler et al. 2003, pp.225-232). Hypertension from nephropathy also influences cardiovascular risk by exacerbating atherosclerosis. Although both type 1 diabetes (T1D) and type 2 diabetes(T2D) are affected by complications, the focus of this paper will be on T2D.

Firstly, analysis on the microvascular complication of diabetes nephropathy will be discussed and secondly, the macrovascualr complication of atherosclerosis. Major risk factors associated with these complications will be discussed along with the pathophysiological processes of diabetes nephropathy and atherosclerosis. Management strategies for treating diabetes nephropathy and atherosclerosis complications will be discussed with one treatment strategy for each condition which may be delivered by a diabetes educator. The role of risk management for diabetes complications is to take a proactive multifactorial approach with better glycaemic and blood pressure control, the most common two strategies utilised. For the PWD making strategies sustainable achieves better outcomes (Thomas et al. 2006, pp. 140-144)

Diabetes patient education of diabetic complications has proven to have beneficial positive health outcomes (Colagiuri et al. 2009, p.7). Promoting self-monitoring of blood glucose(SMBG), lifestyle education(diet, exercise, smoking and alcohol cessation) and increase in knowledge are some of the benchmarks. The National Consensus Report was introduced to address desired key outcomes and avoid criticism (Colagiuri et al. 2009, p.8). In Australia Diabetes Educators work within their scope of practice to deliver patient education; in this paper the delivery of management strategies is within the scope of the diabetes educator(DE) and nursing practice.

DIABETES NEPHROPATHY
Diabetes nephropathy is a common microvascular...
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