Chronic Diabetes Complications Flashcards
General organs that can be effected in diabetes
Eyes Kidneys Nervous system Cardiovascular systems Diabetic foot
4 mechanisms of glucose-induced damage
Increased polyol pathway flux
Increased intracellular advanced glycation end product (AGE) formation
Activation of protein kinase C
Increased hexosamine pathway flux
3 eye complications of diabetes
Diabetic retinopathy
Cataracts
Glaucoma
Nonproliferative retinopathy
The earliest stage of retinal involvement
Changes: microaneurysms, dot hemorrhages, exudates, and retinal edema
Proliferative retinopathy
The growth of new capillaries and fibrous tissue within the retina and into the vitreous chamber
Preproliferative phase you get arteriolar ischemia (cotton wool spots)
Vision is usually normal until vitreous hemorrhage or retinal detachment occurs
Leading cause of blindness
3 things you can see on an eye exam from diabetic retinopathy
Microaneurysms
Cotton wool spot
Dot-blot hemorrhages
How do you treat diabetic retinopathy
Pan retinal photocoagulation (stop vessels from growing and leaking)
Vitrectomy (for severe proliferative with vitreous hemorrhage)
Intravitreal anti-VEGF therapy for patients with clinically significant macular edema
Aspirin
3 ways to prevent diabetic retinopathy
Good glycemic control
Good blood pressure control
Smoking cessation
When is the first time you should do an eye exam in
- T1D
- T2D
- Within 5 years after diagnosis
2. At the time of diagnosis
3 renal complications of diabetes
Diabetic nephropathy
Infection
Renal tubular necrosis
Risk factors for diabetic nephropathy
Family history of diabetes Black race Certain ethnicities Higher systemic BP Evidence of hyperfiltration early in course of disease Poor glycemic control Smoking Obesity, OCP and older age may also be risk factors
6 clues suggesting nondiabetic renal disease
Onset of proteinuria less than 5 years from documented onset of T1D
Acute onset of renal disease
Active urine sediment with red cells/cellular casts
In T1D, the absence of diabetic retinopathy or neuropathy
Signs/symptoms of another systemic disease
Reduction in GFR within 2-3 months of ACEIs/ARBs
How to treat/prevent diabetic nephropathy (4 ways)
Good glycemic control
Good BP control
Treat hyperlipidemia
If progressed, renal replacement therapy and renal transplantation
Causes of transient proteinuria
Febrile illness UTI Recent major exercise Decompensated CHF Menstruation Acute severe elevation in blood sugar/pressure
What is diabetic neuropathy
Involvement of the peripheral and autonomic NS
Categorized into distinct syndromes
Risk factors of diabetic neuropathy
Glucose control Duration of diabetes Damage to blood vessels Mechanical injury to nerves Autoimmune factors Genetic susceptibility Lifestyle factors (smoking, diet)
Symmetric sensory polyneuropathy
Most common form of diabetic neuropathy
Sensory involvement usually occurs first (associated with decreased perception of vibration and temperature)
Paresthesia/dysthesia may occur and usually affect distal lower extremities and hands
Pain can range from mild to severe
2 ways to screen for peripheral neuropathy
Tuning fork to test for vibrations
Microfilament thing to feel 10 points
4 complications of sensory polyneuropathy
Ulcers
Charcot arthropathy
Dislocation and stress fractures
Amputation
3 ways to treat symmetric polyneuropathy
Glucose control
Pain control
Foot care
CV system complications of diabetes
Heart disease (ischemic heart disease, cardiomyopathy)
Peripheral vascular disease
Cerebrovascular disease
ABCDES for vascular protection
A: A1C B: BP C: Cholestrol D: drugs to protect the heart E: exercise/eating healthy S: smoking cessation and management of stress
How do you get a diabetic foot ulcer
Combo of neuropathy and angiopathy
What drug class can be used to reduce CV risk in adults with certain risk factors?
Statins
