2- diabetic complications Flashcards
what are some main chronic complications of diabetes?
- macrovascular (IHD, stroke)
- microvascular (neuropathy, nephropathy, retinopathy)
- cognitive dysfunction like dementia
- erectile dysfunction
- psychiatric
- microalbuminuria (kidney disease)
what causes microvascular complications in diabetes?
normally = glucose metabolised by glycolysis and makes lots of ATP in citric acid cycle
hyperglycaemia = glucose metabolised in glycolysis but then big blockage traffic jam at citric acid cycle cause so much glucose. this means that it goes through lots of alternative pathways making toxic effects like osmotic damages, reactive oxygen species and inflammation etc
what is retinopathy?
= umbrella term for diseases affecting retina
- diabetic retinopathy
- diabetic macular oedema (maculopathy)
- clouding of lens
- glaucoma (increase in fluid pressure in eye leading to optic nerve damage)
- acute hyperglycaemia= visual blurring
how often do people have retina screening if
a) have no signs
b) have some signs of damage?
a) 2 years
b) 1 year
what are
a) types of haemorrhages
b) cotton wool spots
c) hard exudates
d) IRMA (intraretinal microvascular abnormalities)
e) neovascularization
on retinal screening?
a) dot, blot, flame
b) ischaemic areas
c) lipid breakdown products
d) dilated, torturous capillaries that are precursors to new blood vessels (more stable than neovascularizations)
e) when not enough oxygen →body makes more blood vessels = poorly formed blood vessels though so are very high risk of haemorrhage (bad)
what is outcome for each stage of retinopathy?
mild nonproliferative = rescreen in 12 months
moderate nonproliferative = rescreen in 6 months
severe nonproliferative = refer
proliferative = refer
what is outcome if see
a) hard exudates?
b) blot haemorrhage within 1 disc diameter of fovea?
a) 6 month rescreen
b) refer
what is treatment of retinopathy?
laser = pan retinal photocoagulation
→they zap the retina, best treatment
→go around edge of retina (as don’t need edge to see), destroy retina so reduce oxygen requirement as less of it. basically destroy bits that don’t matter so bits that do matter can get oxygen
= reduces ischaemia that drives retinopathy
what is diabetic macular oedema? how diagnosed & treatment?
= type of maculopathy (disease of macula) where macula swollen with fluid due to leaky blood vessels caused by diabetes
→diagnosed with OCT (optic coherence tomography) = shows if any lifting or distorting of retina
treatment →injections of anti-VEGF (vascular endothelial growth factor) like ranibizumab, sometimes laser too (but can’t destroy macula because that’s how you see so would go blind)
what is nephropathy?
= progressive kidney disease caused by damage to capillaries in kidneys glomeruli
→scarring of kidney characterised by proteinuria - nodular glomerulosclerosis
*in diabetes = filtration system leaks protein in urine
microalbuminuria = incipient nephropathy
proteinuria = overt nephropathy
what is diagnosis of nephropathy?
- egFR below 60 - twice, 3 months apart = reduced kidney function
- elevated urine protein (albumin) = leaky kidneys
*need one or 2 or both for diagnosis
what is eGFR?
estimated glomerular filtration rate = how much filtrates in 1 min. normally 120ml per min
what is ACR and PCR? normal ACR?
ACR = albumin : creatinine ratio
PCR = protein : creatinine ratio
*normal ACR = less than 2.5 in men and less than 3.5 in women
what is urine creatinine?
how concentrated urine is (if drink a lot then lower creatinine)
what is ACR and PCR for diagnosis of microalbuminuria?
ACR = below 30
PCR = below 50
