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Development of computerized alerts with management strategies for 25 serious drug-drug interactions order domperidone 10mg on-line medicine school. Methodology of an ongoing cheap domperidone 10 mg on-line symptoms adhd, randomized buy cheap domperidone 10mg on line medicine mound texas, controlled trial to improve drug use for elderly patients with chronic heart failure cheap domperidone 10 mg otc symptoms genital herpes. Piloting a pharmacy-based automated adverse drug event monitoring and prevention system. Medication compliance-helping patients through technology: Modern “smart” pillboxes keep memory-short patients on their medical regimen. How to implement smart pump technology in a pediatric hospital setting: The good, the bad and the ugly. A web-based incident reporting system and multidisciplinary collaborative projects for patient safety in a Japanese hospital. Overcoming barriers to the implementation of a pharmacy bar code scanning system for medication dispensing: A case study. A semi-autonomous on-line chemotherapy prescription system Memorial University of Newfoundland (Canada)Editor. Feasibility study for identifying adverse events attributable to vaccination by record linkage. Developing a taxonomy for research in adverse drug events: potholes and signposts. Yakugaku Zasshi - Journal of the Pharmaceutical Society of Japan 2003;123(3):191-200. Detection and prevention of medication errors using real-time bedside nurse charting. Controlling clostridium difficile associated disease using a proactive pharmacy plan. Overview and update of automated dispensing technologies for inpatient and outpatient services. Computerised prescribing: assessing the impact on prescription repeats and on generic substitution of some commonly used antibiotics. Use of computer-generated alerts to identify pediatric patients at risk for nephrotoxicity. The impact of computerized provider order entry systems on inpatient clinical workflow: a literature review. Computerized provider order entry system - does it support the inter-professional medication process? Prescribing with the International Common Denomination in paediatric primary care. Pharmacy involvement in a multi-disciplinary approach to improve medication safety in a community hospital. From danger to safety: A complete redesign of a health system medication management model. Underuse of evidence-based warfarin dosing methods for atrial fibrillation patients. Improving the delivery of care and reducing healthcare costs with the digitization of information. Look before you leap - The impact on pharmacy operations of implementing multiple technologies to decrease medication errors. Computerized provider order entry and prescribing and the evidence for safe practice: update for the clinical nurse specialist. An anesthesia information system designed to provide physician-specific feedback improves timely administration of prophylactic antibiotics. The computer-assisted management programs for antibiotic therapies in connection with an application in geriatrics. Analysis of medication administration errors intercepted by a bar-code medication administration system. Analysis of the online order entry process in an integrated hospital information system. Ordering of continuous renal replacement therapy in a computerized provider order entry system. Implementation of hospital computerized physician order entry systems in a rural state: feasibility and financial impact. A checking system for injectable anticancer drugs using each patient’s own data and its evaluation. Yakugaku Zasshi - Journal of the Pharmaceutical Society of Japan 2002;122(6):389-97. Primary health-care services with a functional ambulatory care clinical pharmacy in a low-income housing project clinic. Leveraging on information technology to enhance patient care: a doctor’s perspective of implementation in a Singapore academic hospital. An analysis of the decision process in the pharmacological treatment of a patient with chronic heart failure by means of a therapy management information system: the experience of the Montescano Heart Failure Unit. External quality assessment for warfarin dosing using computerised decision support software. Characteristics of antimicrobial overrides associated with automated dispensing machines. Computer-generated physician and patient reminders: Tools to improve population adherence to selected preventive services. Improving medication use and outcomes with clinical decision support: A step-by-step guide. Implementation of a computerized system to identify patients with heart failure not receiving reninangiotensin system inhibitor therapy: supporting pharmacist role in adherence to standard of care. Design and implementation of the Indianapolis Network for Patient Care and Research. Does national regulatory mandate of provider order entry portend greater benefit than risk for health care delivery? Run-to-run control of blood glucose concentrations for people with Type 1 diabetes mellitus. Development of an interactive tailored information application to improve patient medication adherence. Opinions on the use of clinical decision support systems for paediatric prescribing in a New Zealand hospital. Implementing renal impairment and geriatric decision support in ambulatory e-prescribing. Reducing unintended consequences of e- prescribing on the path to nuanced prescriptions. Effect of a computerized alert on the management of hypokalemia in hospitalized patients. Evolution and growth of the department of pharmacy at a university teaching hospital. Impact of a prescription action profile on residents’ attitudes and perception of time management in a resident medicine clinic. Electronic prescribing in ambulatory practice: promises, pitfalls, and potential solutions.
Pelvic examination is basic to the evaluation of the lower abdominal pain in females generic domperidone 10 mg with mastercard treatment canker sore. The examiner looks for cervical dis- charge or motion tenderness discount domperidone 10 mg without prescription medications diabetic neuropathy, adnexal masses 10mg domperidone mastercard medications ocd, and signs of pregnancy and its complications cheap domperidone 10mg with mastercard medicine wheel. This requires a bimanual and speculum exami- nation of the vagina and cervix, at which time important smears and cultures of exudates can be obtained. In either gender, inspection and analysis of the stool for gross or occult blood, enteric pathogens, toxins (Clostridium difficile), and leuko- cytes may be indicated. Basic Laboratory and Imaging Tests Standard laboratory blood tests, urine analysis, and imaging studies complete the initial assessment of significant abdominal pain. Abdominal Pain 385 An abnormal leukocyte count and differential may suggest infection, other forms of inflammation, or hematologic neoplasia, while anemia may signal acute or chronic blood loss or an underlying chronic disease. Platelet abnormalities, together with other coagulation studies, may reflect coagulopathic states and the underlying conditions that produce them. The routine blood or serum multichannel chemical analyses provide a broad spectrum of useful information, and, in par- ticular, they may point to hepatobiliary or renal disease. In women of childbearing age, a b-human chorionic gonadotropin level is a useful screening test for pregnancy and its complications. A clean caught or catheter-obtained urine specimen showing proteinuria, leukocytes, erythrocytes, or bacteria implies primary urinary tract disease. The abdominal films are most useful for demonstrating abnormal gas pat- terns and calcifications. Dilated bowel containing air-fluid levels is characteristic of mechanical obstruction or paralytic ileus. The upright chest and abdominal x-rays usually can identify free air within the peri- toneal cavity, implying perforation of a gas-containing viscus. Free air is seen most easily between the right hemidiaphragm and the liver on upright films. In patients who cannot assume the upright position, a left lateral decubitis film shows free air between the lateral liver and right abdominal wall. Rarely, gas may be seen in the biliary tree, within the bowel wall, and in the portal vein. The latter two findings are indicative of a gas-producing infection of the intestinal wall with exten- sion to the draining portal veins. Biliary tract gas occurs as a result of enteral-biliary fistula, although gas-producing infection of the gall- bladder is another possibility. A right lower quadrant appendicolith often is associated with appendicitis, a stone in the course of the ureters with renal colic, calcifications in the pancreas with chronic pancreati- tis, and radiopaque gallstones with cholecystitis. Last, an electrocardiogram should be performed on most patients over the age of 50 or younger patients with a history of heart disease or symptoms that may occur with both intraabdominal disorders and myocardial ischemia. The basic laboratory studies not only are useful for establishing a working diagnosis, but they also are useful for detecting comorbid con- ditions that would affect management decisions and for establishing a baseline against which further events can be compared. Synthesis of an Initial Diagnosis Developing a reasonable initial diagnosis requires answers to the clin- ical questions posed by the unique patient being considered: 386 A. What is the primary pathogenic process, and has it progressed to a secondary process? Infancy and early childhood is the haven for congenital and, to a lesser degree, infectious diseases, while, in the aged, neoplastic and degen- erative cardiovascular diseases predominate. Young and middle-aged adults are more likely to exhibit the consequences of substance abuse, alcoholism, sexually transmitted diseases, and trauma. Preex- isting chronic diseases and medications used for their management may predispose the patient to certain disorders, as do certain occupa- tional, dietary, and behavioral practices. The subjective (S) and objective (O) data obtained from the history, physical examination, and laboratory studies are integrated to reach an initial assessment (A) of the clinical problem. This is the working or initial diagnosis from which a reasoned management plan (P) can be formulated. If the initial assessment is that a surgi- cally treatable, catastrophic, life-threatening emergency is present, an immediate surgical intervention is indicated. Catastrophic Surgical Abdominal Emergencies Major Intraabdominal Bleeding Aneurysmal disease of major arteries is the most common etiology for nontraumatic severe intraabdominal bleeding. To avoid the high mortality of aortic aneurysm rupture associated with shock no matter how treated, a prompt diagnosis based on a high level of suspicion is required. The temptation to transport the patient to the radiology depart- ment for confirmatory imaging studies or attempts at prolonged preop- erative resuscitation should be avoided. Recognition and treatment of a worrisome aneurysm before it ruptures is clearly the best course. Other potential sources of intraabdominal bleeding are iliac and vis- ceral aneurysms, notably of the hepatic and splenic arteries, the latter often rupturing during pregnancy. Still other sources of intraabdominal apoplexy are ruptured ectopic pregnancy; spontaneous rupture of the spleen; hemorrhage into and from necrosing neoplastic lesions of the liver, kidneys, and adrenal glands; and hemorrhagic pancreatitis. Spontaneous intra- and retroperitoneal bleeding also may occur after minimal, often unrecognized, trauma in patients with coagulopathies. Wise Acute thromboembolic occlusion of major mesenteric arteries with intestinal infarction is a dramatic event with rapidly progressive life- threatening consequences. The initial abdominal pain is sudden, severe, and diffuse, with an associated transient hyperperistaltic response. Typically, the pain remains constant and quite severe, in con- trast to the few, if any, abdominal physical findings. This acute embolic syndrome requires prompt diagnosis, laparotomy, and, where indicated, embolec- tomy and/or resection of necrotic bowel. Thrombotic occlusion of mesenteric arteries and veins also can be associated with heart failure, hypoperfusion, or shock. Case Discussion The patient in Case 1 requires resuscitation and, most likely, operative treatment. His irregular heart rate and medication list lead one to believe that he has an atrial fibrillation. In addition, his recent myocar- dial infarction and coronary artery bypass procedure highlight under- lying cardiac disease. Performing an angiogram and thrombolitic therapy is an option if he does not develop peritonitis and his overall clinical picture improves with fluid resuscitation; however, he is at great risk for transmural ischemia that will require resection in the operating room. Gastrointestinal Perforation and Generalized Peritonitis Another disastrous scenario is generalized peritonitis due to a free perforation of a hollow viscus containing noxious or infectious mate- rial. Duodenal and gastric ulcers are the most common cause of per- foration of the gastrointestinal tract in adults. Although many of these patients have a history of ulcer or at least have experienced several days of epigastric discomfort prior to a perforation, it is not unusual for acute perforation to occur unexpectedly. The perforation is heralded by the sudden onset of severe general- ized abdominal pain and anterior wall muscle guarding.
Syndromes
- Bleeding
- Chills
- Bronchoscopy
- Doppler ultrasonography (occasionally performed)
- When did the pain start?
- 24-hour urine protein
- Pelvic ultrasound (women only)
- Kidney function tests
- Narrow, small, or recessed mouth with crowded teeth
- Have you recently given birth, had surgery, or experienced trauma on or near the vagina or uterus?
Bad breath in the morning is due to such hidden tooth infections order 10 mg domperidone free shipping medicine effects, not a deficiency of mouthwash! Jerome: If your dentist tells you that mercury and other metals will not cause any problems buy 10 mg domperidone visa symptoms 9 days past iui, you will not be able to change his or her mind domperidone 10 mg without prescription medications in spanish. Ask for the panoramic X-ray rather than the usual series of 14 to 16 small X-rays (called full mouth series) buy cheap domperidone 10mg line medicine cabinet home depot. This lets the dentist see impacted teeth, root frag- ments, bits of mercury buried in the bone and deep infections. Cavitations are visible in a panoramic X-ray that may not be seen in a full mouth series. Unfortunately, many people are in a tight financial position because of the cost of years of ineffective treatment, trying to get well. Jerome: It is quite all right to have temporary crowns placed on all teeth that need them in the first visit. It is common to find a crowned tooth to be very weak and not worth replacing the crown, particularly if you are already having a partial made and could include this tooth in it. The metal is ground up very finely and added to the plastic in order to make it harder, give it sheen, color, etc. Jerome: Dentists are not commonly given information on these metals used in plastics. Their effects on the body from dentalware 21 Call the American Dental Association at (800) 621-8099 (Illinois (800) 572-8309, Alaska or Hawaii (800) 621-3291). Members can ask for the Bureau of Library Services, non-members ask for Public Infor- mation. Jerome: These are the acceptable plastics; they can be procured at any dental lab. The new ones are very much superior to those used 10 years ago and they will continue to improve. They do, however, contain enough barium or zirconium to make them visible on X-rays. Hopefully, a barium-free va- riety will become available soon to remove this health risk. Jerome: Many people (and dentists too) believe that porcelain is a good substitute for plastic. Porcelain is aluminum oxide with other metals added to get different colors (shades). Jerome for his contributions to this section, and his pioneering work in metal- free dentistry. Horrors Of Metal Dentistry Why are highly toxic metals put in materials for our mouths? Just decades ago lead was commonly found in paint, and until recently in gasoline. The government sets standards of toxicity, but those “standards” change as more research is done (and more people speak out). You can do better than the government by dropping your standard for toxic metals to zero! Opponents cite scientific studies that implicate mercury amalgams as disease causing. Cad- mium is five times as toxic as lead, and is strongly linked to high blood pressure. Occasionally, thallium and germanium are found together in mercury amalgam tooth fillings. If you are in a wheelchair without a very reliable diagnosis, have all the metal removed from your mouth. Try to have them analyzed for thallium using the most sensitive methods available, possibly at a research institute or university. Effects are cumulative and with continuous exposure toxicity occurs at much lower levels. The periph- eral nervous system can be severely affected with dying-back of the longest sensory and motor fibers. Acute poisoning has followed the ingestion of toxic quantities of a thallium-bearing depilatory and accidental or suicidal ingestion of rat poison. Acute poisoning results in swelling of the feet and legs, arthralgia, vomiting, insomnia, hyperesthesia and paresthesia [numbness] of the hands and feet, mental confusion, polyneuritis with severe pains in the legs and loins, partial paralysis of the legs with reaction of degeneration, angina-like pains, nephritis, wasting and weakness, and lymphocytosis and eosinophilia. Thallium pollution frightens me more than lead, cadmium and mercury combined, because it is completely unsuspected. For instance chromium is an essential element of glucose tolerance 24 Dangerous Properties of Industrial Materials, 7th ed. It is volume 10 of a series called Metal Ions in Biological Systems, edited by Helmut Sigel. Their brilliant work and discussion was largely responsible for my pursuit of the whole subject of cancer. Dental Rewards After your mouth is metal and infection- free, notice whether your sinus condition, ear-ringing, enlarged neck glands, headache, enlarged spleen, bloated condition, knee pain, foot pain, hip pain, dizziness, aching bones Fig. So go back to your dentist, to search for a hidden infection under one or more of your teeth, or where your teeth once were! You may be keeping them glossy by the constant polishing action of your toothpaste. In breast cancer, es- pecially, you find that metals from dentalware have dissolved and ac- cumulated in the breast. They will leave the breast if you clear them out of your mouth (and diet, body, home). Buy hot cereals that say “no salt added,” like cream of wheat, steel cut oats or old fashioned 26 oats, millet, corn meal, cream of rice, or Wheatena. Cook it 26 Rolled oats have 235 mcg nickel per serving of 4 ounces, picked up from the rollers, according to Food Values 14th ed. I have only found nickel in the "one-minute" or "instant" variety of oats, however. Could the researchers have accidentally transferred the bacteria from the shell to the inside while they were testing? Eating fish can give you a lot of calcium, but it is in the tiny bones hidden in the fish. Just cook two or three vegetables for lunch and eat them with butter and salt or homemade sauces. Thyme and fenugreek, together, make a flavorful combination you can purchase in capsules.
The nurse instructs the patient and family to report to the surgeon any change in the color of stools 10mg domperidone mastercard symptoms joint pain, because this may indicate complications generic domperidone 10mg free shipping symptoms bone cancer. Gastrointestinal symptoms safe 10 mg domperidone medications 44 175, although not common generic domperidone 10mg with amex medicine nobel prize 2015, may occur with manipulation of the intestines during surgery. After laparoscopic cholecystectomy, the nurse assesses the patient for loss of appetite, vomiting, pain, distention of the abdomen, and temperature elevation. These may indicate infection or disruption of the gastrointestinal tract and should be reported to the surgeon promptly. Because the patient is discharged soon after laparoscopic surgery, the patient and family are instructed verbally and in writing about the importance of reporting these symptoms promptly. Promoting Home and Community-Based Care Teaching Patients Self-Care The nurse instructs the patient about the medications that are prescribed (vitamins, anticholinergics, and antispasmodics) and their actions. It also is important to inform the patient and family about symptoms that should be reported to the physician, including jaundice, dark urine, pale-colored stools, pruritus, and signs of inflammation and infection, such as pain or fever. This is the result of a continual trickle of bile through the choledochoduodenal junction after cholecystectomy. Usually, such frequency diminishes over a period of a few weeks to several months. If a patient is discharged from the hospital with a drainage tube still in place, the patient and family need instructions about its management. The nurse instructs them in proper care of the drainage tube and the importance of reporting to the surgeon 95 promptly any changes in the amount or characteristics of drainage. Managing Pain You may experience pain or discomfort in your right shoulder from the gas used to inflate your abdominal area during surgery. Sitting upright in bed or a chair, walking, or use of a heating pad may ease the discomfort. Managing Follow-Up Care Make an appointment with your surgeon for 7 to 10 days after discharge. This is an abnormal response in which antibodies are directed against normal tissues of the body, responding to these tissues as if they were foreign. When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes. In addition, fat breakdown occurs, resulting in an increased production of ketone bodies, which are the byproducts of fat breakdown. Type 2 Diabetes Mellitus • Accounts for 90% of patients with diabetes • Usually occurs in people over 40 years of age • 80-90% of patients are overweight Etiology and Pathophysiology • Pancreas continues to produce some endogenous insulin • Insulin produced is either insufficient or poorly utilized by the tissues • Insulin resistance –Body tissues do not respond to insulin –Results in hyperglycemia • Inappropriate glucose production by the liver –Not considered a primary factor in the development of type 2 diabetes Normally, insulin binds to special receptors on cell surfaces and initiates a series of reactions involved in glucose metabolism. In type 2 diabetes, these intracellular reactions are diminished, making insulin less effective at stimulating glucose uptake by the tissues and at regulating glucose release by the liver. However, if the beta cells cannot keep up with the increased demand for insulin, the glucose level rises, and type 2 diabetes develops. One consequence of undetected diabetes is that long-term diabetes complications (eg, eye disease, peripheral neuropathy, peripheral vascular disease) may have developed before the actual diagnosis of diabetes is made Etiology (not well know) –Genetic factors –Increased weight. Secondary Diabetes • Results from another medical condition or due to the treatment of a medical condition that causes abnormal blood glucose levels –Cushing syndrome –Hyperthyroidism –Parenteral nutrition Clinical Manifestations Diabetes Mellitus • Polyuria • Polydipsia (excessive thirst) • Polyphagia • In Type I –Weight loss –Ketoacidosis Polyphagia (increased appetite) resulting from the catabolic state induced by insulin deficiency and the breakdown of proteins and fats Other symptoms include fatigue and weakness, sudden vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to heal, and recurrent infections. Plasma glucose values are 10% to 15% higher than whole blood glucose 103 values, and it is crucial for patients with diabetes to know whether their monitor and strips provide whole blood or plasma results Assessing the Patient with Diabetes • History: Symptoms related to the diagnosis of diabetes: Symptoms of hyperglycemia Symptoms of hypoglycemia Frequency, timing, severity, and resolution Results of blood glucose monitoring Status, symptoms, and management of chronic complications of diabetes: Eye; kidney; nerve; genitourinary and sexual, bladder, and gastrointestinal Cardiac; peripheral vascular; foot complications associated with diabetes Adherence to/ability to follow prescribed dietary management plan Adherence to prescribed exercise regimen Adherence to/ability to follow prescribed pharmacologic treatment (insulin or oral antidiabetic agents) Use of tobacco, alcohol, and prescribed and over-the-counter medications/drugs Lifestyle, cultural, psychosocial, and economic factors that may affect diabetes treatment Effects of diabetes or its complications on functional status (eg, mobility, vision) Physical examination Blood pressure (sitting and standing to detect orthostatic changes) Body mass index (height and weight) Fundoscopic examination and visual acuity Foot examination (lesions, signs of infection, pulses) Skin examination (lesions and insulin-injection sites) Neurologic examination Vibratory and sensory examination using monofilament Deep tendon reflexes Oral examination • Laboratory Examination • Need for Referrals 104 105 Diabetes Mellitus Collaborative Care • Goals of diabetes management: –Reduce symptoms –Promote well-being –Prevent acute complications –Delay onset and progression of long-term complications Nutritional Therapy –Overall objectives • Assist people in making changes in nutrition and exercise habits that will lead to improved metabolic control • Control of total caloric intake to attain or maintain a reasonable body weight, control of blood glucose levels, and normalization of lipids and blood pressure to prevent heart disease. Nutrition, meal planning, and weight control are the foundation of diabetes management. Alcohol may decrease the normal physiologic reactions in the body that produce glucose (gluconeogenesis). These effects are useful in diabetes in relation to losing weight, easing stress, and maintaining a feeling of well-being. Exercise also alters blood lipid concentrations, increasing levels of high-density lipoproteins and decreasing total cholesterol and triglyceride levels. Exercise/ Precautions • Don‘t exercise if blood glucose > 250 mg/dL or if there is ketone bodies in the urine. The liver then releases more glucose, and the result is an increase in the blood glucose level –Several small carbohydrate snacks can be taken to prevent hypoglycemia • Before exercising • At the end of the exercise with strenuous exercise • At the time with strenuous exercise • Deduce them from total daily calories –May need to reduce inlsulin dose The physiologic decrease in circulating insulin that normally occurs with exercise cannot occur in patients treated with insulin. Initially, patients who require insulin should be taught to eat a 15-g carbohydrate snack (a fruit exchange) or a snack of complex carbohydrates with a protein before engaging in moderate exercise, to prevent unexpected hypoglycemia. Drug Therapy: Insulin • Exogenous insulin: –Required for type 1 diabetes –Prescribed for the patient with type 2 diabetes who cannot control blood glucose by other means • Types of insulin –Human insulin • Most widely used type of insulin • Cost-effective ¯ Likelihood of allergic reaction Human insulin preparations have a shorter duration of action than insulin from animal sources because the presence of animal proteins triggers an immune response that results in the binding of animal insulin, which slows its availability. Names include Humulin N, Novolin N, Humulin L, Novolin L –Long-acting: Ultralente, Lantus Onset 6-8h, peak 12-16 h and lasts 20-30h. When they do occur, there is an immediate local skin reaction that gradually spreads into generalized urticaria (hives). The treatment is desensitization, with small doses of insulin administered in gradually increasing amounts. Lipodystrophy refers to a localized reaction, in the form of either lipoatrophy or lipohypertrophy, occurring at the site of insulin injections. Lipoatrophy is loss of subcutaneous fat; it appears as slight dimpling or more serious pitting of subcutaneous fat. Resistance to Injected Insulin –Most patients have some degree of insulin resistance at one time or another. Simple pathophysiology –Basic definition of diabetes (having a high blood glucose level) –Normal blood glucose ranges –Effect of insulin and exercise (decrease glucose) –Effect of food and stress, including illness and infections (increase glucose) –Basic treatment approaches 2. Treatment modalities –Administration of medications –Meal planning (food groups, timing of meals) 116 –Monitoring of blood glucose and urine ketones 3. Recognition, treatment, and prevention of acute complications –Hypoglycemia –Hyperglycemia 4. Pragmatic information –Where to buy and store insulin, syringes, and glucose monitoring supplies –When and how to contact the physician Diabetes Mellitus Patient education • Planning In-Depth and Continuing Education –Foot care –Eye care –General hygiene (eg, skin care, oral hygiene) –Risk factor management (eg, control of blood pressure and blood lipid levels, normalizing blood glucose levels) Diabetes Mellitus Misconceptions Related to Insulin Treatment 1. Once insulin injections are started (for treatment of type 2 diabetes), they can never be discontinued 2. If increasing doses of insulin are needed to control the blood glucose, the diabetes must be getting ―worse‖ 3. There is extreme danger in injecting insulin if there are any air bubbles in the syringe 6. Conversely, patients who frequently have a glucose level in the low range of normal (eg, 80 to 100 mg/dL) may be asymptomatic when the blood glucose falls slowly to less than 50 mg/dL. Macrovascular Complications • Macrocirculation –Blood vessel walls thicken, sclerose, and become occluded by plaque that adheres to the vessel walls. Therefore, diabetes itself is seen as an independent risk factor for accelerated atherosclerosis. Other potential factors that may play a role in diabetes-related atherosclerosis include platelet and clotting factor abnormalities, decreased flexibility of red blood cells, decreased oxygen release, changes in the arterial wall related to hyperglycemia, and possibly hyperinsulinemia.
