Complications of DM Flashcards
What are the main complications of DM?
DKA Vascular disease Nephropathy Diabetic retinopathy Cataracts Diabetic foot Neuropathy
What are the macrovascular complications of DM?
Atherosclerosis -> stroke, IHD (MI), PVD
What are the most common causes of premature death in treated patients?
CV problems
CKD
Infections
How would u assess a diabetic patient for PVD?
- History - sx - intermittent claudication + rest pain
2 Signs - diminished/absent pedal pulses, cold feet, poor skin and nails, absence of hair on feet and legs - Doppler US
How do you reduce the risk of PVD in DM?
- Aggressive control of BP
- Smoking cessation (major RF)
- Statin
- ACEi/ARB - if one other major CV RF
What are the microvascular complications?
- Diabetic retinopathy
- Nephropathy
- Neuropathy
how long does it take for microvascular complications to manifest after diagnosis in young pts?
10-20yrs
why do microvascular complications take less time to present in older patients?
probs had unrecognised DM for months or years before diagnosis
Why is it so important to prevent diabetic retinopathy?
causes blindness!! (leading cause worldwide)
how is the risk of blindness reduced in dM?
Keep HbA1c below 7%
Annual retinal screening (mandatory)
What are the features of background retinopathy?
microaneurysms - dots
haemorrhages - blots
hard exudates - lipid deposits
What are the features of pre-proliferative retinopathy?
cotton wools spots - infarcts
haemorrhages
venous beading
What occurs in proliferative retinopathy?
new vessels form
When should you suspect maculopathy?
reduced visual acuity
What is the treatment of maculopathy?
laser therapy
Explain the pathophysiology of diabetic nephropathy?
thickening of BM -> glomerular damage due to poor glycemic control -> microalbuminuria
How is a diagnosis made for diabetic nephropathy?
Urine:creatinine ratio >3
Albuminuria -> persistent proteinuria
Normochromic normocytic anaemia
Raised ESR
What is the treatment of diabetic nephropathy
BP treatment - ACEi or ARBs
Avoid oral hypoglycaemics excreted by the kidney e.g. metformin
Reduce insulin dosage as sensitivity increased
What is the commonest form of diabetic neuropathy ?
Distal symmetrical neuropathy
What are some of the manifestations of diabetic neuropathy?
pain - allodyna, paraesthesia, burning at night
autonomic - postural hypotension, gastroparesis, diarrhoea, constipation, incontinence, ED
Insensitivity - glove and stocking sensory loss
Mononeuritis multiplex
Diabetic amyotrophy
What is mononeuritis multiplex?
simultaneous malfunction of two or more peripheral nerves in separate areas of the body
What is diabetic amyotrophy?
What would u see on examination?
Painful asymmetrical wasting of quads and other pelvifemorad muscles
Diminished or absent knee reflexes
What is the treatment of glove and stocking ?
paracetamol Amitriptyline Anticonvulsants Opiates- tramadol Avoiding weight bearing
What is a consequence of sensory loss?
Diabetic foot ulceration
What is the management of diabetic foot ulceration?
- Foot screening
- Check feet daily + shoes for sharp bodies
- Keep feet away from heat
What are the four main threats to skin and subcut tissue?
- infection
- Ischaemia
- Abnormal pressure - keep non weight bearing
- Wound environment - give dressings to absorb or remove exudes, maintain moisture
What types of infections does diabetes particularly confer a risk to?
Urinary tract infections
Skin infections - cellulitis, boils, abscesses
