Complications of Diabetes Flashcards
What are the microvascular Complications to diabetes?
Retinopathy
Nephropathy
Neuropathy
What are the macrovascular Complications to diabetes?
Stroke
Heart Disease
Peripheral Vascular Dis.
What is non-proliferative Retinopathy?
Retinal capillaries leak protein, lipids or RBCs
Interferes with visual acuity
Microaneurisms, blot hemmhorage, cotton wool spots
What is proliferative Retinopathy?
Small vessel occlusion and retinal hypoxia
Stim growth of new capillaries and fibrous tissue in retina
Vitreous hemmhorage
retinal detachment
How is retinopathy prevented?
Dilated eye exam annually (5y post Dx of DM1 or at Dx of DM2)
Glycemic control
BP Control
WHat is Tx of Retinopathy?
Panretinal xenon/argon laser photocoag macular saring more O2 to survivingtissue Dec angiogenesis Retinal Det surgery Laser for macular edema, dest of new vessels
What causes Diabetic Nephropathy?
Years of chronically elevated blood glucose levels
inadequate screening for kidney disease
High BP
What is the natural history of Nephropathy
Glom hyperperfusion and hypertrophy Thickening of BM normalization of GFR Microablbuminemia Nephropathy ESRD
How can Nephropathy be prevented?
Assess albumin excretion annually
Measure serum creatinine
Glycemic control
Start screening at same time as retinopathy
What is the Tx of Nephropathy?
ACE inhibitors
AT receptor Blockers
Dietary- Protein restriction
Refer to nephrology
Waht is Diabetic Neuropathy?
Distal, symmetrical polyneuropathy
Stocking glove distribution
Sensory motor and Autonomic fibers
What is the Tx for Neuropathy?
Better Glycemic Control Proper foot care -anual foot exam Pain -TCA -Anticonvulsants -Duloxetine -Capsacin
What is the effect of Autonomic Neuropathy?
Dysfunction of Cholinergic, noradrenergic systems Multiple organ systems -Tachycardia -Gastroparesis -Urinary retention -Erectile dysfuncton -Decreased sense of Hypoglycemia
What is the goal level for HbA1c?
6.5-7%
How can the burden of CVD be reduced in Diabetes?
Exercise Stop Smoking One Aspirin a day Agressive Tx of Dyslipidemia HTN Tx ACE inhibition Glycemic Control
