Complications of DM 1 W1 Flashcards
Treatment aims
Initially to control/treat the symptoms of diabetes and minimise the occurrence of hypoglycaemia
Long-term to prevent development or slow the progression of complications associated with the disease
Two major categories of diabetic complications
One’s caused by microvascular disease
One caused by secondary two macrovascular disease
Microvascular disease effect
Eyes/retinopathy
Kidneys/nephropathy
Nerves/neuropathy
Macrovascular disease effect
Blood pressure/hypertension
Blood lipids/hyperlipidaemia
Two major trials of management of diabetes
The diabetes control and complications trial
The United Kingdom perspective diabetes study
Major controllable risk factors
Uncontrolled/raised blood glucose - persistent hyperglycaemia
Uncontrolled/raised blood pressure - persistent hypertension
HbA1c relationship with CV risk
For every one percent increase in glycaemia/HbA1c:
- 21% increase in diabetes related deaths
- 14% increase in myocardial infraction
- 43% increase in peripheral vascular disease
Why are the eyes/kidneys and nerves vulnerable to damage?
Because the endothelial cells of the retina kidney and peripheral nervous system allow glucose to enter the cells even in the absence of insulin
Diabetic eye disease
Blurred vision
Cataracts at an earlier age
Glucoma which is resistant to treatment
And most commonly written apathy
Diabetic retinopathy
Most common cause of blindness in people age 30 to 65 in the UK
Can be present in one third of newly diagnosed type two diabetics
Start a small haemorrhages and abnormal spots of hardened leaked fluids
Progresses to infraction of the retina
Risk factors for diabetic retinopathy
- Hyperglycaemia
- Hypertension
- Duration of diabetes
- Hypercholesteraemia
- Pregnancy
- Rapid improvement in control of blood sugar (in a site threatening disease you must stabilise the retina before improving glycaemic control)
Prevention and treatment of diabetic retinopathy
Development or progress progression can be prevented by:
- Good glycaemic control (blood glucose)
- Effective management of hypertension
- Avoidance of smoking
- Regular screening
- Laser treatment to seal off the leaking blood vessels
Diabetic nephropathy
Leading cause of N stage renal failure in Westworld
Occurs 10 to 25 years after onset of diabetes
Responsible for more than one third of patience starting renal replacement therapy
Once dialysis is required most patients will also have other complications such as retinopathy, neuropathy and autonomic dysfunction
Proteinuria
Presence of protein in urine (mainly albumin)
Common sign of renal disease
Detected using urine dipstick
Microalbuminauria
Presence of small amounts of albumin in the urine
Detected with specialist dipsticks
Early indicator of diabetic nephropathy
Check allium creatinine ratio
Prevention and treatment of diabetic nephropathy
Improve control of blood glucose to slow progression
Aim for a HbA1c of less than or equal to 48mmol/L (6.5%)
Or less than 53 (7%) if a Type II taking oral medication which causes hypoglycaemia
Type one NICE targets
<80 years old:
- ACR <70mg/mmol = <140/90
- ACR ratio >70mg/mmol = <130/80
> 80 years old:
- <150/90 regardless of ACR
Type two NICE targets
<80 years old:
- ACR <70mg/mmol = <140/90
- ACR ratio >70mg/mmol = <150/80
> 80 years old:
- <150/90
Same targe as non-diabetics
Treatment – high blood pressure
Aggressive control of blood pressure
Start with a ACEI/ARB as they are Reno protective
Usually requires multiple drug therapy
If target blood pressure is not achieved, then add further drugs as per nice guidelines for hypertension
SGLT2Is e.g. dapagliflozin
Licensed for CKD inpatient both with and without type two
Appropriate type two(not type one) who are taking optimise dose of a CEI/ARB with ACR between 3 and 30mg/mmol
Licensed for CKD inpatient both with and without type two
Appropriate type two(not type one) who are taking optimise dose of a CEI/ARB with ACR between 3 and 30mg/mmol
