Complications of DM Flashcards
What are the Macrovascular complications of DM?
‘Silent MI’ - Due to autonomic neuropathy
Peripheral vascular disease - Claudication, foot ulcers
Stroke
How can you manage the risk of Macrovascular complications of DM?
Manage CV risk factors
- BP (aim
What can happen in the feet of Diabetics?
Neuropathy
Ischaemia
What ischaemic complications can occur in Diabetic feet?
Absent pulses - do ABPI
Ulcers - Can be vascular or neuropathic
What are the features of a venous ulcer?
Shallow
Sloped sides
What are the features of an arterial ulcer?
Deep
Punched out
What are the features of Vascular ulcers?
Painful
Peripheral of foot eg toes
What are the features of Neuropathic ulcers?
Painless
Pressure areas
Loss of protective sensation
Usually due to injury or infection in area that doesn’t heal
What is Charcot’s /foot? (Neuropathic joints)
Progressive degeneration of a weight bearing joint
Bony destruction, bone resorption, and eventual deformity.
Onset is usually insidious
Can happen in any condition that leads to decreased sensation eg spinal cord injury
Thought to be due to reduced blood flow and repetitive microtraumas
What is the management of Diabetic foot?
Regular foot checks
Comfortable shoes
Treat any infection
Surgery if abscess, gangrene or deep infection
What is the pathophysiology of Diabetic nephropathy?
Hyperglycaemia → nephron loss and glomerulosclerosis
What are the features of Diabetic nephropathy?
Microalbuminaemia
Urine albumin creatinine ratio ≥30mg/mM
What is the pathophysiology of Diabetic retinopathy, cataracts and maculopathy?
Microvascular disease → retinal ischaemia → ↑VEGF
↑ VEGF → new vessel formation
What are the features of background retinopathy?
- Dots: microaneurysms
- Blot haemorrhages
- Hard exudates: yellow lipid patches
What are the features of pre proliferative retinopathy?
- Cotton-wool spots (retinal infarcts)
- Venous beading
- Haemorrhages
What are the features of proliferative retinopathy?
- New vessels
- Pre-retinal or vitreous haemorrhage
What are the features of Maculopathy?
- ↓ acuity may be only sign
- Hard exudates within the macula
What is the pathophysiology of Diabetic neuropathy?
Metabolic - Glycosylation of nerves
Ischaemic - Loss of vasa nervorum (small blood vessels supplying the nerves)
What neuopathy occurs in Diabetics?
Symmetric sensory polyneuropathy - Glove + Stocking pattern
Autonomic
What is the presentation of Symmetric sensory polyneuropathy in Diabetics?
Glove + Stocking loss of all modalities Absent ankle jerks Numbness Tingling Pain (Worse at night)
What is the management of Glove + Stocking neuropathy in Diabetics?
Paracetamol
SSRI
Amitryptilline
Gabapentin
What is the presentation of autonomic neuropathy in diabetics?
Postural hypotension (Fludrocortisone) GORD/Bloating Diarrhoea (Codeine phosphate) Urinary retention Erectile dysfunction
