Chronic Complication of DM -حسين علي نوير Flashcards
when the complication of the DM occur ?
DM 2 ___ the complication happen first time at the diagnosis this because of delayed in diagnosis
DM1- need 5 years to develop the complication
what’re the classification of the complication of the DM ?
1) Macroangiopathic complication as - athescelorosis -coronory heart disease - cerbrovascular disease -peripheral vascular disease
2) Microvascular complication
- retinopathy
- neuropathy
- nephropathy
what’s the most common complication causing death in DM type 1?
the most common cause is the nephropathy
because 30% of DM1 develop nephropathy after 20 years of diagnosis
but if after 20 yeas and didn’t develop anything the chance become only 1% per year
what the cause of the diabetic complications ?
its all originate form hyperglycemia which activate the reactive oxidase species which induce oxidase stress
that lead to heamodymemic changes and vscular damge
by
-causing DNA damage
-alterd in gene expression
-reduce NO
- activate protein kinase C
-increase the AGE formation (dvanced glycation end products (AGEs) are proteins or lipids that become glycated as a result of exposure to sugars.)
How the damage happen to the cells by the hyperglycemia ?
- either because of glycated protein or lipid
- or by the osmotic effect
how to avoid the diabetic retinopathy ?
should every diabetic pt visit the opthomlogist annually
beccuse it cause blindlness in adult between (30-65)
whats the clinical features of the retinopathy ?
1) BACHGROUND
first pt have no clinical features but seen by examin the fundi to see the the
-microanyuresum
- retinal heamorrge with or without deposit of lipid and protein because BV become leaky
2) PREPROLIFERATIVE
now the problem will extend to the vein
- venous beading
-venous loop or reduplication
(A venous loop was defined as a localized looping deviation of the vein from its normal linear course. A venous reduplication was defined as a lo- calized venous segment with two or more reuniting parallel branches.)
- multiple deep and round heamorrge
- cotton wool spot
3) PROFLIFERATIVE beacuse of the ischemai - new BVs are formed - preretinal or viterous hemorrhge - preretinal fiborosis -retinal deatchment
4) MACULOPATHY
when there is exudate with diameter of 1 disc in the center of fovea
+ because of high glucose and osmotic effect lead to destruction of the pericyte
what’re the risk factors of the developing neuropathy ?
1- if poor control of the sugar 2- long stand diabetes 3- pt with hypertension 4- pt with microvascular complication 5-ethincity as asian and indians 6- family history of diabetic nephropathy 7- family history of the hypertension
what the clinical diagnosis of the of the diabetic nephropathy ?
its depond on the precence of the albumin in the urine
and when the alb was 300mg/dl or the albustic + pt will have renal failure
+increase the pressure on the afferent A cause increase the glumerular pressure and also vasoconstriction on the efferent A lead to back pressure on the glumeruli lead to activate the renin cascaed this lead hypertrophy of the membrane and the fenstration will become bigger lead to be leaky to the proteins
what the the earlies change in diabetic nephropathy ?
+ts the microalbnemia which can detect by
- 24 h urine collection it will be (30-299mg/day)
- Alb : creatinine ratio will be (30-300mg/g)
but the proteinuria
- in 24h urine equal or more than 300mg/day
- Alb/ creatinine ratio more than 300
do we need to do screening for diabetic nephropathy ?
yes , we need to do screening for microalbuminuria
for the pt with type 1 anuually from 5 years after the diagnosis
and type 2 annually from the type of diagnosis
- first we do urinalysis if the test (-) we do (spot collection for the microalbuminuria ) if it detect the microalbmenemia
we should exclude anther causes then do the test within (3-6) months if there is 2 test or more are( +) we give treatment if not we advice the pt to do the spot test annually - but if the urinalysis is (+) we should exclude the other causes ant do 24h urine protein which detect the macroalbuneimia so then we need to give the treatment
when we start screening for diabetic nephropathy ?
- type 1 every year after 5 years of diagnosis
- type 2 annually from the time of diagnosis
whats the classification of the neuropathy ?
either
SOMATIC
—————-
1- symmetrical neuropathy which is mainly motor and proximal including the (amylotrophy)
2-asymmetrical neuropathy which is mainly sensory and distal
3- peripheral neuropathy (polyneuropathy)
4- mononeuropathy (mononeuritis multiplex )
1- CVS menifestate as fixed heart rate , tachcardia and arrythemia
2-GIT as gastroparesis , nocturnal diarrhea , constipation
(Gastroparesis is a condition that affects the normal spontaneous movement of the muscles (motility) in your stomach.)
3-Genitourinary as urine retention and erectile dysfunction
4- cause the dry skin ((Sudomotor (from Latin sudor, ‘sweat’ and motor) describes anything that stimulates the sweat glands.))
5- dialted pupil
what’s the meaning of the symmetrical sensory polyneuropathy ?
1- it’s frequently asymptomatic.
2- most common clinical signs are diminished perception of vibration sensation distally ‘glove-and-stocking’
(Numbness or reduced ability to feel pain or temperature changes.)
3-loss of tendon reflexes in the lower limbs
+In symptomatic patients, sensory abnormalities are predominant
4-paresthesias in the feet (and, rarely, in the hands)
5-pain in the lower limbs (dull, aching and/or lancinating, worse at night, and mainly felt on the anterior aspect of the legs),
6- burning sensations in the soles of the feet
7- cutaneous hyperaesthesia
(abnormal increase in sensitivity to stimuli of the sense.)
8-abnormal gait (commonly wide-based)
9-Muscle weakness and wasting develop only in advanced cases, but subclinical motor nerve dysfunction is common
10-toes may be clawed with wasting of the interosseous muscles, which results in increased pressure on the plantar aspects of the metatarsal heads with the development of callus
( area of thickened skin that forms as a response to repeated friction, pressure)skin at these and other pressure points.
11-Electrophysiological tests demonstrate slowing of both motor and sensory conduction, and tests of vibration sensitivity and thermal thresholds are abnormal.
what the cause of the diabetic foot ?
Foot ulcer lesions caused by 1-Motor neuropathy 2-Muscle wasting 3-Sensory loss 4-Ischemia 5-Trauma ? 6-Infection?
