Complications of DM Flashcards
The majority of people with DM die of what?
Heart disease
What are the three major microvascular complications of DM?
DM retinopathy
DM nephropathy
DM neuropathy
What is the MOA of high BG causing damage with DM?
AGE + DAG + Oxidative stress lead to PKC activation, which causes microvascular damage
True or false: DM is the most common cause of blindness in the US
True
What percent of DM vision loss is preventable?
90%
What is the earliest stage of DM retinopathy? What are the two characteristics of this stage?
Non-proliferative phase, characterized by:
- hemorrhages
- cotton wool spots
What is the proliferative stage of DM retinopathy?
Crappy neovascularization d/t small vessel occlusion and hypoxia.
This causes vitreous hemorrhage and retinal detachment
What are the two factors that, if controlled, can prevent DM retinopathy?
HTN
Hyperglycemia
What are the ADA recommendations to prevent retinopathy?
Dilated eye exam annually after 5 years at dgs
What is the treatment for DM retinopathy? How does this work? What happens to vision?
Panretinal xenon/Ar last photocoagulation, which will cauterize the crappy vessels, and the remaining will receive more nutrients
This causes loss of peripheral vision, but spares the macula
What causes the initial increase in GFR in patients with DM?
Glomerular hyperperfusion and hypertrophy, causing thickening of the BM.
What is the first sign of DM nephropathy?
Microalbuminuria
How do you screen for DM nephropathy?
Assess urine albumin and CrCl annually
What is the treatment to prevent DM nephropathy? (3)
ACE inhibitors
ARBS
Reduce protein intake
When should DM I and II pts be screened for nephropathy?
I = annually after 5 years II = annually after diagnosis
If a DM pt’s GFR reduces to 45-60, what should you do?
- Monitor lytes x1 year
- Consider bone testing and referral to nephrology
If a DM pt’s GFR reduces to less than 30, what should you do?
Refer to nephrology
If a DM pt’s GFR reduces to less than 30-44, what should you do?
Monitor eGFR q 3 months
What is the neuropathy distribution like with DM neuropathy?
Stocking glove
How do you assess for DM neuropathy?
Monofilament test
How do you treat neuropathy?
- Glycemic control
- Proper foot care
- Analgesics PRN
What are the 4 drug types that can be used to treat pain that is associated with neuropathy?
- TCA (amitriptyline)
- Gabapentin etc
- Duloxetine
- Topical capsaicin
What is charcot arthropathy?
Severely neuropathic extremity exposed to trauma
What are the ssx of charcot arthropathy? (3)
Edema
Erythema
Warmth
What are the consequences of untreated autonomic neuropathy 2/2 DM?
- Resting tachycardia
- Orthostatic hypotension
- Urinary retention
- ED
True or false: the more aggressive control of DM, the fewer poor outcomes
True
What is the goal HbA1C (AACE vs ADA)?
Less than 6.5% per AACE
Less than 7% per ADA
What are the three specific annual exams for DM pts to prevent complications?
Annual eye exam
Foot exam
Microalbuminuria
True or false: having DM is equivalent to having an MI
True
What are the preventative measures for CVD in DMs?
Exercise
Smoking cessation
ACE inhibitors
When is daily ASA treatment indicated for DM pts? (5 risk factors)
If have risk factor
- family h/o CVD
- HTN
- Smoking
- Dyslipidemia
- Albuminuria
What was the result of the ADVANCE trial?
6.5% vs 7.3% showed lower incidence in nephropathy, but no difference in mortality
What was the result of the ACCORD trial?
Aggressive treatment has a higher incidence of CV death
True or false: aggressive glycemic control has been shown to reduce coronary heart disease in high risk patients
False–not been shown
