Complications of diabetes Flashcards
What are the four general types of diabetes complications?
Macrovascular: IHD/Stroke
Microvascular: neuropathy/nephropathy/retinopathy
Erectile dysfunction
Psychiatric
What is the pathogenesis of diabetic neuropathy?
small blood vessels that provide nerves are damaged due to high blood glucose levels
What are the different types of diabetic neuropathy?
Peripheral: pain/loss feeling in hands/feet
Autonomic: changes in bowel/bladder function, sexual response, sweating, heart rate, BP
Proximal: pain in thighs/hips/buttocks leading to weakness in legs
Focal: sudden weakness in one nerve or a group of nerves
Describe the symptoms of diabetic neuropathy?
- numbness/tingling/pain in toes/feet/legs/hands/arms/fingers
- foot ulcers
- muscle wasting
- indigestion or constipation
- dizziness/faintness due to postural hypotension
- urination problems
- erectile dysfunction/vaginal dryness
- weakness standing/climbing stairs
Describe how autonomic neuropathy can affect bowels?
- gastric slowing/frequency (constipation/diarrhoea)
- gastroparesis (can cause fluctuating BG): metoclopramide/domperidone/erythromycin
- oesophagus nerve damage (dysphagia)
= weight loss
what is gustatory sweating? why is this experienced in diabetic neuropathy?
autonomic nerve dysfunction = dysregulation of body temp. and profuse sweating at night or while eating = gustatory sweating
How does autonomic neuropathy affect BP and HR?
BP - postural hypotension
HR - may not rise and fall in response to normal bodily functions and physical activity
How can autonomic neuropathy affect the eyes?
pupils less reactive to light
-may not see well when a light is turned on in a dark room or driving at night
what is a charcot foot?
- occurs in significant neuropathy
- the bones, joints and soft tissues of foot and ankle become inflamed and lead to varying degree and patterns of bone destruction, subluxation, dislocation and deformity
- hallmark is midfoot collapse = rocker-bottom foot
What are the diagnostic tools for diabetic neuropathy?
- nerve conduction studies or electromyography
- heart rate variability
- USS of bladder other parts urinary tract (normal function and bladder emptying)
- gastric emptying studies
What factors increase the risk of diabetic neuropathy?
- disease progression
- glycaemic control
- T1DM
- high lipid/cholesterol
- smoking
- alcohol
- inherited traits (genes)
- mechanical injury
What is the treatment for painful diabetic neuropathy?
- simple analgesia
- TCAs
- Gabapentin
- duloxetine/pregabalin
- strong opioids
Diabetic nephropathy: what is this AKA?
kimmelsteil-wilson syndrome
nodular glomerulosclerosis
Describe the pathophysiology of diabetic nephropathy?
-Hyperglycaemia = hyperfiltration and hyperperfusion which results in microalbuminaemia
-There’s increased afferent arteriole dilatation due to a dysfunction in the vasoconstrictive regulatory response
=increased intraglomerular pressure
= mesangial cell expansion
= decreased GFR, reduction in surface area for filtration = beginning of renal failure
as this process continues, glomerular basement membrane thickens = nodular glomerular sclerosis
Consequences: development of HTN, decline in renal function, accelerated vascular disease
When are patients screened for diabetic nephropathy?
all patients aged 12 or over, at diagnosis and annually
