18. Long Term Diabetic Complications Flashcards
microvascular complications
retinopathy
nephropathy
neuropathy
take many years to develop
which cells are affected in microvascular complications of diabetes?
retinal endothelial cells
mesangial cells of glomerulus
Schwann and peripheral nerve cells
cells are not able to reduce glucose transport in response to extracellular hyperglycaemia
retinopathy
second most common cause of blindness in those of working age
risk of blindness increases 10-20fold
glaucoma and cataract increased
retinal microcirculation
low density of capillaries
little functional reserve
flow needs to respond to local needs
pericytes = key to local regulation
pathological findings in diabetic retinopathy
loss of pericytes
basement membrane thickening
capillary closure
ischaemia (VEGF production, inc capillary permeability
clinical stages of retinopathy
non-proliferative (background_
proliferative
macular oedema - sight vs non-sight threatening
diabetic retinopathy treatment
good diabetic control
blood pressure control
laser treatment
intra-vitreal anti-VEGF antibody
diabetic neuropathy
affects up to 50%
15% have painful neuropathy
different types of neuropathy
peripheral
mononeuropathy
autonomic neuropathy
+ entrapment neuropathy increased
charcoal foot
bone deformity
good vasculature, but bone grow incorrectly as walk on foot incorrectly (can’t feel)
peripheral neuropathy
affects peripherals: hands and feet
calluses
ulcers
charcoal foot
mononeuropathy
one nerve affected
autonomic neuropathy
gastroparesis postural hypotension erectile dysfunction gustatory sweating diarrhoea
nephropathy
most common cause of ESRD in western world
accounts for 21% T1 deaths and 21% T2 deaths
renal microcirculation
fenestrated glomerular capillaries
basement membrane highly specialised podocytes
pathological findings in diabetic nephropathy
basement membrane thickening
podocyte loss
glomerular sclerosis s
mesangial expansion
nephropathy treatment
blood pressure control
RAAS blockers preferred
glucose control important (less so when proteinuria)
associated with increased CVD risk
ultimately: renal replacement/transplantation
macrovascular disease
IHD, CVD, PVD dramatic increase in risk diabetes T2 have multiple risk factors T1 have long duration of disease presentation depends on vascular bed affected (angina/MI, stroke, PVD)
diabetic foot
most common cause of non-traumatic lower limb amputation
PVD (peripheral vascular disease)
neuropathy
impaired leucocyte function
