Chronic Complications Of Diabetes Flashcards
name some macrovascular complications of diabetes
IHD, stroke
name 3 microvascular complications of diabetes
neuropathy, nephropathy, retinopathy
name some other complications of diabetes
cognitive dysfunction, erectile dysfunction, psychiatric complications
what is usually done at a patient’s yearly diabetic review ? (3)
digital retinal screening
foot risk assessment
urine albumin/creatine ratio and serum creatine
how do advanced glycation end products form
glucose binds irreversibly to methyl glyoxal
result of the formation of advanced glycation end products
tissue injury and inflammation via stimulation of pro-inflammatory factors e.g. cytokines and complement
what is sorbitol formed from
glucose + aldose reductase
effect of increased flux of glucose through the sorbitol-polyol pathway
sorbitol and fructose accumulate causing changes in vascular permeability, cell proliferation and capillary structure via the stimulation of protein kinase C and TGF-β
what is another name for diabetic eye disease
retinopathy
what is retinopathy
damage to the retina
pathophysiology of non-proliferative retinopathy
damage to the wall of small vessels cause microaneurysms and then intraretinal haemorrhages
blood leaves hard exudates
ischaemia due to occluded vessels cause cotton wool spots
what are the 3 types of haemorrhage associated with diabetic retinopathy
dot, blot and flame
what occurs in proliferative retinopathy
blockage of blood vessels leads to areas of non-perfusion and ischaemia
abnormal blood vessels begin to grow on the surface of the retina -> very fragile
management of retinopathy
laser: panretinal photocoagulation
vitrectomy in a vitreal haemorrhage
how does panretinal photocoagulation work
reduces oxygen requirement of the retina so reduces the ischaemia that is driving the retinopathy
what happens in diabetic macular oedema
retinal thickening and oedema including the macula, hard exudates and macula ischaemia
how is diabetic macular oedema investigated
optical coherence tomography
management of diabetic macular oedema
intravitreal anti-VGEF
name 3 other eye complications of diabetes
earlier development of cataracts
glaucoma is more likely
hyperglycaemia can cause reversibly vision blurring
what is diabetic nephropathy
progressive kidney disease caused by damage to the capillaries in the glomeruli
what are other names for diabetic nephropathy
kimmelsteil-wilson syndrome or nodular glomerulosclerosis
what is diabetic nephropathy characterised by
proteinuria and diffuse scarring of the glomeruli
dipstick investigation of diabetic nephropathy
may show proteinuria
how do we establish microalbuminuria in diabetic nephropathy
ACR <30 or PCR<50
management of diabetic nephropathy
microalbuminuria: ACEi/ARB to decrease filtration proteinuria
should also be started on SLGT2i with microalbuminuria
manage other vascular complications
how do we reduce the risk of diabetic nephropathy
good glycaemic control
complications of diabetic nephropathy
hypertension, decline in renal function, accelerated vascular disease
what is diabetic neuropathy
damage to peripheral nervous tissue
risk factors for diabetic neuropathy
increased length of diabetes, poor glycaemic control, smoking, drinking, mechanical injury
what type of diabetes is neuropathy more commonly associated with
T1DM
what is peripheral neuropathy
symmetrical pain/loss of feeling in hands and feet
what kind of distribution is said to be seen in peripheral neuropathy
glove and stocking
symptoms of peripheral neuropathy
numbness, tingling/burning, sharp pains, sensitivity to touch, loss of balance and coordination
name 4 complications of peripheral neuropathy
foot ulcer
claw foot and callus formation
charcot foot
painless trauma
name a clinical sign that can be seen in peripheral neuropathy
argyll robertson pupil
what is argyll robertson pupil
small bilateral pupils that don’t constrict when exposed to bright light but do constrict when focused on a nearby object
symptoms of charcot foot
acute onset of hot, swollen foot +/- pain
deformation due to destruction of bone if treatment is delayed
radiological consolidation and stabilisation after 6-12 months
investigation of charcot foot
MRI to differentiate between infection
management of charcot foot
minimise bony destruction by keeping pressure off the foot
what does charcot foot predispose patients to
ulceration
what is claw foot
interosseous wasting results in unbalanced traction by the long flexor muscles
why does neuropathy cause callus formation
abnormal distribution of pressure on walking
name 4 drugs that can be used in the management of painful neuropathy
amitriptyline, duloxetine, gabapentin or pregabalin
what can be used to manage painful neuropathy in patients who don’t want systemic treatment
topical capsaicin cream
what is autonomic neuropathy
affects the nerves regulating the heart rate and blood pressure as well as control of internal organs
what is autonomic neuropathy usually associated with
a long history of very poor diabetes
affect of autonomic neuropathy on digestion
gastric slowing
gastroparesis
dysphagia due to oesophagus nerve damage
management of gastroparesis in diabetes
improve glycaemic control
diet: smaller, more frequent meals
metoclopramide (promotility)
anti-nausea
analgesia
management of severe gastroparesis in diabetes
consider botox or a gastric pacemaker
give 2 examples of anti-nausea meds
ondansetron, prochlorperazine
how can autonomic neuropathy affect the sweat glands
lack of thermoregulation
profuse sweating at night or gustatory sweating
what is gustatory sweating
sweating while eating
effects of autonomic neuropathy on the heart and blood vessels
postural hypertension
tachycardia
ECG: loss of R-R variability
what causes proximal neuropathy
damage to the nerves of the lumbosacral plexus
who commonly presents with proximal neuropathy
elderly T2DM
what is proximal neuropathy commonly associated with
weight loss
clinical presentation of proximal neuropathy
pain in the buttocks, hips, thighs or legs followed by variable weakness in the proximal muscles of the lower limbs and then muscle wasting
what is focal neuropathy
sudden weakness in one nerve or a group of nerves
can cause pain
give examples of focal neuropathy
carpal tunnel syndrome, cranial nerve palsy
