complications of diabetes Flashcards
chronic complications of diabetes
- macrovascular
- microvascular
- cognitive dysfunction/dementia
- erectile dysfunction
- psychiatric
what annual screening for diabetes
- digital retinal screening
- foot risk assessment
- urine albumin
what does excess glucose cause to happen
mitochondrial dysfunction
-reactive oxygen species produced
which pathway can glucose then be directed down
the polyol pathway
-producing sorbitol
what does sorbitol cause
osmotic damage
-then reactive oxygen species
what happens in the pentose phosphate pathway
GDP turns into NADPH oxidase which is harmful
what happens in the hexosamine pathway
F6P turns into UDP-GlcNAC which causes inflammation and fibrosis
what can happen to G3P
turns into diacyl glycerol which activates protein kinase C
when excess glucose is converted to AGE what happens
they bind to receptors of age which then can trigger an inflammatory response which results in reactive oxygen species
what eye pathologies do people with diabetes get
- diabetic retinopathy
- macular oedema
- cataract clouding
- glaucoma (increase in fluid pressure)
- visual blurring
what are the four stages of retinopathy
- mild non-proliferative
- moderate non-proliferative
- severe non-proliferative
- proliferative
what are cotton wool spots
ischaemic areas
what are hard exudates
lipid break down products
what is IRMA
intra-retinal microvascular abnormalities
sign of bleeding in the eye
significant loss of vision in one eye
treatment of retinopathy
- laser (mainstay)
- vitrectomy (if a vitreal haemorrhage)
mainstay of treatment for diabetic macular oedema
intravitreal Anti-VEGF
what is diabetic nephropathy
a progressive kidney disease caused by damage to the capillaries in the kidney’s glomeruli.
-characterised by the proteinuria and diffuse scarring of the glomeruli
what are some complications of diabetic nephropathy
- development of hypertension
- relentless decline in renal function
- accelerated vascular disease
is dipstick positive or negative for microalbuminuria
negative
dipstick positive or negative for proteinuria
positive
what can give false positives for microalbuminuria
- menstruation
- vaginal discharge
- UTI
- pregnancy
- other illness
- non-diabetic renal disease
what should you do after microalbuminuria is identified
- check for retinopathy
- investigate other causes of renal pathology
- screen for peripheral vascular disease
- discourage smoking
- tighten glycemic control
- assess fasting lipid profile
- screen and treat hypertension
- screen for ischaemic heart disease
- monitor serum creatine
what are the different types of neuropathy
- peripheral
- proximal
- autonomic
- focal neuropathy
signs of proximal neuropathy
-pain in the thighs, hips or buttocks leading to weakness in the legs
signs of autonomic neuropathy
- changes in bowel
- bladder function
- sexual response
- heart rate
- blood pressure
what is focal neuropathy
sudden weakness in one nerve or group of nerves causing muscle weakness or pain
risk factors for neuropathy
- increased length of diabetes
- poor glycaemic control
- type 1 diabetes
- high cholesterol/lipids
- smoking
- alcohol
- inherited traits
- mechanical injury
symptoms of peripheral neuropathy
- numbness
- tingling
- burning
- sharp pains or cramps
- sensitivity to touch
- loss of balance and coordination
what is charcot arthropathy
- destructive inflammatory process
- fractures/bony destruction
- deformity of the foot
presentation of charcot arthropathy
-hot swollen foot
treatment for charcot arthropathy
- non-weight bearing
- total contact cast
- aircast boot
treatment options for painful neuropathy
- amitriptyline
- duloxetine
- gabapentin
- pregabalin
how does autonomic neuropathy affect the gut
- constipation/diarrhea
- gastroparesis
- bloating
- loss of appetite
- oesophagus nerve damage
how can autonomic neuropathy affect sweat glands
- affects nerves
- body can’t regulate temperature as it should
- can cause profuse sweating
symptoms of cardiovascular autonomic neuropathy
- blood pressure may drop sharply after sitting or standing
- heart rate may stay high
