3: Microvascular complications of diabetes Flashcards
What are the three main microvascular complications of diabetes?
Neuropathy
Nephropathy
Retinopathy
What are the end-stage outcomes of
retinopathy
nephropathy
neuropathy?
Retinopathy - blindness
Nephropathy - dialysis
Neuropathy - amputation
The (better / poorer) your glycaemic control, i.e the higher your level of ___, the greater your risk of microvascular complications.
poor glycaemic control
higher HbA1c levels
more complications
Good glycaemic control should be achieved ___ to avoid microvascular complications.
early
What causes microvascular complications in hyperglycaemia?
Hypoxia
Oxidative stress
Build-up of end products
leading to inflammation
something about mitochondrial dysfunction
What is peripheral neuropathy?
Loss of feeling
Pain
in the hands and feet.
What is autonomic neuropathy?
Damage to autonomic nerves producing:
changes in bowel habit, bladder function, sexual function, sweating, HR, BP…
basically everything controlled by autonomic nerves.
Peripheral neuropathy tends to have a “_____” distribution.
glove and stocking
What kind of pain do patients with peripheral neuropathy have?
Burning / tingly pain
Patients with peripheral neuropathy often develop numbness.
What can this lead to?
Accumulation of injuries (burns, ill-fitting shoes)
What eponymous name is given to the “bag of bones” appearance of a foot in peripheral neuropathy?
Charcot foot
Can drugs treat the loss of sensation in peripheral neuropathy?
No
Pain only
What are the treatment options for painful peripheral neuropathy?
Amitriptyline
Duloxetine
Gabapentin
Pregabalin
i.e atypical analgesics
Topical capsaicin cream
How can Charcot foot be avoided?
Appropriate footwear
Regular checking of feet
What are some presentations of autonomic neuropathy?
Tachycardia
Postural hypotension
Gastroparesis
Dysphagia
Why does gastroparesis pose a concern in diabetics?
Affects blood glucose levels due to abnormal digestion, vomiting, diarrhoea etc.
What drug is commonly used to treat gastroparesis in diabetics with autonomic neuropathy?
Metoclopramide
Improving ___ control often improves the symptoms of diabetes complications.
glycaemic
How is gastroparesis treated?
Dietary - smaller, more frequent meals, low fat and fibre
Promotility drugs (revise these)
Botox
Gastric pacemaker
What are two cardiovascular presentations of autonomic neuropathy?
Hypertension / postural hypotension
Tachycardia
How is peripheral neuropathy screened for?
Hand / foot exam once a year
What other investigations can be done for neuropathy?
Nerve conduction studies, EMG
Heart rate
Ultrasound of bladder for prolonged emptying
Gastric emptying study
What is a kidney complication of diabetes?
Nephropathy
Many patients on ___ also have diabetes.
dialysis
What are the consequences of diabetic nephropathy?
Hypertension > accelerated CVD
Renal dysfunction
How is diabetic nephropathy screened for?
Albumin / creatinine ratio (ACR)
What is the name for an increase in albumin found in the urine, and is an indicator of renal damage?
Microalbuminuria
Renal disease secondary to diabetes accelerates ___ disease.
cardiovascular
What is the blood pressure target for diabetic patients?
< 130 / 80 mmHg
What is the HbA1c target for patients with diabetes?
< 53 mmol/mol
ideally < 48
What is an eye symptom of acute hyperglycaemia?
Visual blurring
Chronically, diabetes can lead to which eye complications?
Retinopathy
Cataracts
Glaucoma
Which structures of the retina are damaged in diabetic neuropathy?
Macula
Fovea (dip within macula)
both responsible for central vision
What are the two stages of diabetic retinopathy?
Non-proliferative
Proliferative (leading to bleeding and vision disturbance)
If no or minor retinopathy is found on retinal screening, what is done?
Rescreening later
If significant retinopathy is found on retinal screening, what is done?
Referral to an opthalmologist
Apart from retinal photographs, what other imaging can be used to view the eye?
Optical coherence tomography
How is retinopathy treated?
Laser treatment
Anti-VEGF injections
What is a complication of diabetes in men?
Erectile dysfunction
