Diabetes chronic complications Flashcards
Microvascular and macrovascular chronic complications with diabetes
Micro (eyes, kidneys, nerves) is specific to diabetes, macro (coronary artery disease etc) is not but is increased risk
Risk factors for retinopathy
Glucose (poor control, rapid control**, duration), hormones, lipids, BP
Risk factors for nephropathy
Glucose (control, duration), hormones, lipids, BP, Familial factors, gender, metabolic factors, smoking, smoking
Pathology of retinopathy
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Classification of retinopathy
Non-Proliferative: mild / moderate / severe. Proliferative: neovascularisation or vitreous hemorrhage. Macular Edema
Retinopathy management
tight glycemic and BP control (esp. ACE-i). lipid lowering (triglycerides - using fibrates). laser photocoagulation. intra-vitreal anti-VEGF (avastin/lucentis) for CSME
Laser photocoagulation details
Pan retinal photocoagulation (PRP) - promote regression and arrest progression of retinal neovascularisation; and Focal. Pretty intense, would be painful w/o anesthetic
Signs and symptoms of nephropathy
Clinical syndrome characterized by: Albuminuria, Hypertension, Progressive decline in renal function. Associated with retinopathy. Proliferative. Severe non-proliferative. DM duration >10 yrs. Typical Biopsy Appearance (rare to do - too obvious)
Albuminuria classification
Normal 20, dipstick positive, bad.
Natural history of untreated diabetic kidney disease
Intermittent microalbuminuria, GFR slowly drops off, eventually becomes full blown kidney disease. Intervention can prevent this and maintain normal kidney fn.
Neuropathy in diabetes
affect peripheral and autonomic senses. 60-70% affected, can lead to ulcers and amputation
Aspects of peripheral diabetic neuropathy
Painful peripheral neuropathy. Distal Symmetrical Sensory Neuropathy: reduced sensation / numbness, glove and stocking distribution
Aspects of autonomic diabetic neuropathy
Resting tachycardia, Postural hypotension, Erectile dysfunction, Abnormal sweating (with eating), Gastroparesis (stomach doesn’t empty), Constipation / diarrhea
2 reasons foot ulcers show up and description
Neuropathic: on bottom; fairly warm feet; no pain, can’t feel pressure, callus builds, more pressure, ulcer develops, then callus falls off and ulcer gets infected. Ischemic: on dorsal/lateral part; painful, cold, pale,
What is Charcot foot?
Don’t sense fractures in feet, just notice it’s swollen, but arch collapses and is majorly at risk for ulcers. Consequence of neuropathy. Better to amputate
How do you test foot sensitivity?
10g monofilament sensation. If you can’t feel it you’re at risk
Macrovascular disease
70-80% of people with DM will die from cardiovascular disease; DM increases risk 2-4 fold; Worse outcomes; other risk factors more common in DM, eg hypertension, obesity, dyslipidemia
Ways to prevent or slow complications of diabetes
Control blood glucose; Control blood pressure: ACE inhibitors/ARB; Control lipids: Statins & Fibrates; Control cardiovascular risk factors: Smoking cessation, aspirin