Complications Of DM Flashcards
What are the three macro vascular and microvascular complications of DM?
Micro: retinopathy, neuropathy, nephropathy
Macro: CVD, ischaemic heart disease, peripheral vascular disease
What factors can lead to complications of DM?
Smoking
Hypertension
Hyperlipidaemia
Genetics
Duration of diabetes
What is the mechanism of damage in microvascular complications?
RF increasing free radicals in endothelium leading to formation of glycated end products and activating inflammatory pathways = damage to endothelium
Why is detecting diabetic retinopathy hard and what can be done to combat this?
At early stages its asymptomatic
Do yearly checks
What are the three stages of retinopathy?
Background retinopathy
Pre-proliferative retinopathy
Proliferative retinopathy
How do the following retinopathies present on screening:
Background
Pre-proliferative
Proliferative
Background: hard exudates, tiny black dots (microaneurysm), red spots (haemorrhages)
Pre: soft exudates, haemorrhage
Proliferative: new vessels on retina or optic disc
How do the following retinopathies present on screening:
Background
Pre-proliferative
Proliferative
Background: hard exudates, tiny black dots (microaneurysm), red spots (haemorrhages)
Pre: soft exudates, haemorrhage
Proliferative: new vessels on retina or optic disc
What is maculopathy?
How does it affect vision?
Same thing as background retinopathy but on the macula- will affect central vision eg reading
Hard exudates near macula/on macula
How do you treat retinopathies and maculopathy?
Background: continued annual surveillance
Pre: photocoagulation
Proliferative: photocoagulation
Maculopathy: anti-VEGF or photocoagulation
What is photocoagulation?
What are the disadvantages of panretinal photocoagulation?
Laser burns growth of new vessels on retina
Can destroy peripheral vision
How do you screen for diabetic nephropathy?
What is the earliest sign of diabetic nephropathy?
Urine screening for protein using albumin:créatine ratio
Microalbuminurea
What is the mechanism for diabetic nephropathy?
How is the eGFR affected?
Glomerular hypertension leads to proteins being pushed through (proteinurea)
This means there is too much protein to be reabsorbed causing glomerular fibrosis and lower eGFR
How do you treat diabetic nephropathy?
ACE inhibitors to reduce hypertension in glomerulus
Stop smoking
Start SLGT-2 inhibitors
Tighter gylcaemic control
How does diabetic neuropathy happen?
What part of the body is most affected by it?
Therefore what is the most common complication of DN?
Damage to the blood vessels that supply the nerves called vasa
Nervousum
Feet- as these are the longest nerves
Foot ulceration
What do you look for in a foot check?
Foot deformity and ulceration
Sensation
Foot pulses
