diabetes complication Flashcards
relationship of risk with rising HbA1c
risk of microvascular complication:
highest=retinopathy
nephropathy,
lowest=neuropathy
also risk-microalbuminuria
target HbA1c to reduce complications?
53mmol/mol
what is a risk of hypertension (increasing blood pressure)
MI
microvascular complication
other factors that increase risk of microvascular complications
duration of diabetes
smoking
genetic factors
hyperlipidaemia
hyperglycaemic memory
mechanism of damage that cause microvascular complications
Hyperglycaemia
- Increased mitochondrial superoxide free radicals in endothelium
- Form glycated plasma proteins. Then form advanced glycation end products (AGEs)
3.Activation of inflammatory pathways
4.Damaged endothelium cause ‘Leaky’ capillaries/Ischaemia/microvascular complications
3 factors that increase inflammatory signalling cascade in mechanism of damage
AGE–rage
oxidative stress
hypoxia
background retinopathy
hard exudates (cheese colour, lipid)
microaneurysms (small dots)
blot haemorrhages
pre-proliferative retinopathy
cotton wool spots- soft exudates =retinal ischaemia
haemorrhages (chunkier)
proliferative retinopathy
visible new vessels
on disc/elsewhere in retina
maculopathy
hard exudates/oedema near macula
same as background but near macula
can threaten vision
cotton wool spots can also be seen
treatment of retinopathy and maculopathy
background-continued annual surveillance
pre-proliferative -early panretinal photocoagulation
proliferative -panretinal photocoagulation
diabetic maculopathy-
oedema: anti-VEGF injection in eye
grid photocoagulation
annual urine sample for ACR
what is microalbuminuria, what is proteinuria
what to give pt’s with this
Microalbuminuria
>3 mg/mmol
Proteinuria = ACR > 30mg/mmol
either ACEi/ARB-even if normotensive
what cause false positive for UARC
Fever, urine infection
what happens when you get UACR positive
repeated to confirm microalbuminuria
mechanism of diabetic nephropathy
- diabetes=hyperglycaemia and hypertension
2.glomerular hypertension
- proteinuria
4.glomerular and interstitial fibrosis
- GFR declines
- renal failure
management of diabetic nephrapathy-HbA1c to what? What med? target BP? Lifestyle treatment? what to do if pt also have T2DM
HbA1c under 53
ACEi/ARB
reduce BP to 130/80mmHg
stop smoking
start SGLT-2 inhibitor if T2DM
diabetic neuropathy when it occurs and name of blood vessel supplying verve
when vasa nervorum gets blocked
diabetic foot ulceration what to look for in annual checks
annual foot check:
-foot deformity/ulceration
-sensation
-foot pulse
risks of foot ulcerations in pts with:
peripheral neuropathy
-reduced sensation to feet
-poor vascular supply to feet
management of diabetic foot disease peripheral neuropathy and peripheral neuropathy with ulceration
peripheral neuropathy
1. Regular inspection of feet by affected individual
2. Good footwear
3. Avoid barefoot walking
Podiatry and chiropody if needed
Peripheral neuropathy with ulceration
1.Multidisciplinary diabetes foot clinic
2.Offloading
3.Revascularisation if concomitant PVD(peripheral vascular disease)
4.Antibiotics if infected
5.Orthotic footwear
6.Amputation if all else fails
mononeuropathy
-sudden motor loss-ie wrist/foot drop
cranial nerve palsy -double vision-(cn3)
autonomic neuropathy
damage to sympathetic/parasympathetic nerve innervating:
1.GI
delayed gastric emptying-N+V
constipation/nocturnal diarrhoea
2.CV
-posturap hypotension
sudden cardiac death
