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Complications of diabetes are commonly classi-fied as microvascular, macrovascular, neuropathy,and those associated with pregnancy (AIHW,2007). Microvascular disease or disease of thesmall blood vessels is associated with thickening ofthe basement membranes of the small bloodvessels, for example, nephropathy and retinopathy,whereas macrovascular complications, includingcoronary heart disease, stroke, and peripheralvascular disease, can lead to foot ulcers, gangrene,and amputation (AIHW, 2007; Dunstan et al., 2001;Zimmet, 2003). Neuropathy is damage to nervesand in diabetes can present as peripheral neuro-pathy affecting the nerves in the hands and feet,leading to decreased sensation in hands and feet, oras autonomic neuropathy, which can lead tometabolic abnormalities, erectile dysfunction, andinfections. Complications associated with diabetesduring pregnancy, known as gestational diabetes,include fetal malformations, spontaneous abortions,stillbirth, neonatal hypoglycemia, and other meta-bolic abnormalities, as well as increased obstetricinterventions (Dunstan et al., 2001; Zimmet, 2003).The risk for microvascular complications in Type1 diabetes is similar to that in Type 2 diabetes, afteraccounting for age and duration of diabetes.Macrovascular complications are more commonin Type 2 diabetes. The literature also suggests thatthe effect of diabetes, especially the depressiveeffect, is a factor in determining the quality of lifeand diabetes self (AIHW, 2008; Dunstan et al.,2001; Zimmet, 2003). The general changes insociety toward a more holistic and consumer-oriented approach to caring for people with diabeteshave changed the expectations of health serviceproviders. It is important for these individuals to beperceived and treated by health professionals as“people with a disease” rather than just a disease49 NURSING CARE IN PSYCHOSIS AND METABOLIC INSTABILITY/DIABETES(Dunning, 2003). It is therefore critical that themanagement of this chronic illness is more than amatter of controlling symptoms. To help peoplelearn to live with diabetes and adapt to thepsychological and social changes that this long-term incurable illness brings to the lives of peoplediagnosed with diabetes means health providersneed to change their approach.
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