Complications of diabetes Flashcards
Hba1c and fasting glucose for diabetes
> 48 mol/dL and >7mmol/dL
Polyol pathway
Excess glucose phosphorylated by hexokinase
Sorbitol converted to fructose via sorbitol dehydrogenase
NADH depletion protects against oxidative stress
Microvascular complications
Heart disease
cerebrovascular disease
Peripheral vascular disease
Microvascular complications
Retinopathy
Neuropathy
Nephropathy
Cardiomyopathy
Risk factors for retinopathy
Long duration of diabetes
Poor control
Hypertension
genetic factors
Retinopathy screening
High resolution images of macula and disc
Dilated pupils
Preventing diabetes complications
Glucose control
BP control
Lipid control
Treatment for diabetic retinopathy
Laser photocoagulation
Anti-VEGF
Risk factors for nephropathy
- Duration of diabetes - plateau of prevalence 16-21 years
- Glycaemic control
- Hypertension
- Ethnicity
- Genetics
Screening for nephropathy
Annual review of serum creatinine and eGFR
Urine albumin (early detection )
ACR >3mg/mmol
How do we use ACR?
Albumin:creatinine ration
Predicts cardiovascular risk
Prescribe statins
Statin dosage eGFR <60
Atorvastatin 20mg daily
preventing nephropathy
BP and glucose control
RAS blockade - ACEi or ARB is first line for hypertension in diabetes
Bilateral motor-sensory peripheral neuropathy
Tingling toes
Claw toes
Foot drop
Isolated neuropathy
Diabetic amyotrophy
CN palsies
Carpal tunnel syndrome
Autonomic neuropathy
Gastroparesis, diarrhoea/constipation
Atonic bladder
Gustatory sweating
Death
Motor neuropathy sx
High arch and claw toes
Sx neuropathic foot
Ulcers
Charcot joint
Pain
Foot disease
Ischaemic foot - prone to ulceration at toes and MTP 1 and 5
Screening - inspection, pulses and sensation
Tx: debridement of callus, orthotic footwear, podiatry
Ulceration tx
Debridement
Dressings
Offloading
ABs
Ischaemia tx
Antiplatelets BP control Cholesterol control Blood glucose control Angioplasty Bypass grafting
Neuropathy tx
Amitriptyline gabapentin Pregabalin Duloxetine Opioids
Macrovascular complications
- Stroke
- Ischaemic heart disease
- Peripheral vascular disease - claudication, gangrene, amputation
- Screening - annual review of pulses etc
- Screening for heart disease - enquire about angina, SOB etc
- Cerebrovascular disease sx - enquire about sx (loss of power or sensation, dysphagia
