Complications of Diabetes Flashcards
Examples of CHRONIC complications of Diabetes
Microvascular:
- Retinopathy
- Nephropathy
- Neuropathy
Macrovascular:
- Stroke
- Heart Disease
- PVD
The most prevalent microvascular complication of diabetes
Diabetic Retinopathy
Compared to conventional insulin therapy, intensive insulin therapy reduced risk of what complications?
microvascular complications (retinopathy, nephropathy and neuropathy)
Despite reduced risk of retinopathy, What is a common complication of INTENSIVE insulin therapy?
HYPOglycemia
Pathology of Diabetic Retinopathy
NPDR:
- Thickened capillary basement membrane
- Exudates
- Aneurysms
- Hemorrhages
PDR:
- Stenosis –> Ischemia
- Neovascularization (inc. VEGF causing angiogenesis)
Clinical features of NPDR
- IRMA (intraretinal microvascular abnormalities)
- micro-aneurysms
- intraretinal hemorrhages
- hard exudates (lipid)
- Cotton wool spots
- Venous beading
Clinical features of PDR
- Preretinal neovascularization (hallmark of PDR)
- vitreous hemorrhage
- fibrous tissue prolifearation
- traction retinal detachment
- can cause blindness due to Macular Edema
Pathology of PDR
hyperglycemia causes stenosis of retinal microvasculature –> ischemia –> new FRAGILE blood vessels form
Primary cause of vision loss in DR
CSME
Pathology of CSME
permeable vascular walls –> leakage and accumulation of intraretinal fluid
(True/False) ME may occur in all stages of NPDR and PDR
True
Vision loss/blindness in DR results from what two main causes?
- Leakage –> hemorrhage, exudate, vascular leakage –> NPDR/CSME
- Ischemia –> Neovascularization –> PDR
Treatments for Diabetic Retinopathy
- Sugar, lipid, and BP management
- Injected therapies (VEGF inhibitors)
- Laser photocoagulation
- Vitrectomy
Pathogenesis of Diabetic Nephropathy
Chronic hyperglycemia –> glycation of basement membrane –> Thickened BM and efferent arteriole –> hyperfiltration (increased GFR) –> increase in intraglomerular pressure –> glomerular hypertrophy/scarring –> worsening filtration capacity –> nephrotic syndrome
Three major histological changes of DNephro
- Mesangial (cell & matrix) expansion
- Glomerular BM thickening
- Glomerulosclerosis
- Hyalinization
- Kimmelstiel-Wilson nodules
UA findings of DNephro
- Proteinuria (earliest sign of DN)
- Microalbuminuria (30-299mg) –> macroalbuminuria (>300mg) - Decreased GFR in more advanced DN
GFR in ESKD
GFR <15
Leading cause of End-Stage Kidney Disease
Diabetic Nephropathy
Average age onset of ESKD due to DNephro
60
Modifiable contributing factors of DNephro
smoking
hypertension
dyslipidemia
high protein diet
Treatments for Diabetic Nephropathy
- ACE inhibitors/ARBs
- BP management
- low protein diet
ACE inhibitors and ARBs should be started in patients with
- diabetes w/ elevated MA/cr ratio
OR
- diabetes w/ elevated urinary 24 hour protein
OR
- hypertension
Most common form of diabetic neuropathy
Symmetric PERIPHERAL neuropathy
Which nerves are most prone to Diabetic Neuropathy
Longer nerves are most vulnerable (affect feet first –> later on hands)
“stocking-glove” pattern
Examples of symptoms of AUTONOMIC Neuropathy
- Orthostatic hypotension
- Gastroparesis
- ED
What makes diabetics prone to feet/lower extremity problems (ulceration, cellulitis, bony deformity, gangrene, amputation)
- Loss of protective sensation
- PVD (peripheral vascular disease)
- HTN
- Smoking
Relatively painless, progressive and degenerative arthropathy of joints in the foot; associated with diabetes, but also syphilis (tabes dorsalis)
Charcot Foot
Visual inspection of feet, palpation, semmes-weinstein monofilament (poking), and tuning fork can be used to
screen diabetic foot
Treatments for Diabetic Neuropathy
- Pain
- Gabapentin
- Pregabalin
- Duloxetine - Autonomic symptoms
- Anti-emetics for gastroparesis
- Phosphodiesterase (PDE) inhibitors for ED - Specialized footwear (to off load pressure from feet)
Examples of MICROvascular complications of Diabetes (3 total)
- Retinopathy
- Nephropathy
- Neuropathy
Examples of MACROvascular complications of Diabetes (3 total)
- Brain (Cerebrovascular Disease)
- Heart (Coronary Heart Disease)
- Peripheral vessels (Peripheral Artery Disease)
Organ or limb complications of atherosclerosis affecting medium and large vessels
Macrovascular disease
1 cause of mortality in Diabetes
Cardiovascular disease
Macrovascular disease in diabetes is a result of hyperglycemia +
MULTIPLE other risk factors
- HTN
- dyslipidemia
- smoking
- thrombosis
- etc.
Treatment/Preventatives for MACROvascular disease in Diabetics
- Control HTN
- Statins
- Smoking cessation
- Anti-platelet therapy
*sugar control not proven to affect, as opposed to MICROvascular
The relationship between blood sugar control and the reduction for both Macro and Microvascular disease is different (True or False)
True: proven effective for MICROvascular disease, but not MACROvascular
Although controlling blood glucose has NOT been shown to reduce MACROvascular complications, why is it important to control BG?
Early glycemic control resulted reduced LATER MACROvascular events and CV death
What non-vascular complications are associated with diabetes?
- GU infections
- CHF
- Fatty liver (steatohepatitis)
- Cataracts
- Gingivitis
- Chronic mental illness
