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endocrine > Diabetes Complications > Flashcards

Diabetes Complications Flashcards

1
Q

List the major complications of Diabetes?

  • Short term
  • Long term
A

Short Term:
Diabetic Ketoacidosis (DKA)
Hyperglycaemic Hyperosmolar State (HHS)
Hypoglycaemia

Long Term:
Macrovascular –> CAD/PAD/Stroke
Microvascular –> Retinopathy, Nephropathy, Neuropathy & PAD

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2
Q

Explain the macrovascular effects of diabetes?

A

DM accelerates Atherosclerosis

The Excess Glc bind to LDL preventing it from being cleared by liver cells –> Hyperlipidaemia

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3
Q

What is the major consequence of DM’s macrovascular effect?

A

Increased risk of athermatous diseases:
cerebrovascular disease: stroke/ TIA
cardiovascular disease: MI/ angina/ cardiac failure
Peripheral vascular disease: lower leg Ischaemia, leg and foot ulcers

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4
Q

Explain DM’s microvascular effects?

A

DM triggers the Hyaline Change in areterioles/capillaries by:

  • Glycosylating collagen in the subendothelial space allowing it bind albumin from the plasma
  • Glycosylating basal lamina proteins allowing them to bind and cross-link

These mechanisms cause a build up of proteins in the vessel wall causing narrowing

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5
Q

What are the consequences of DM’s microvascular effects?

A

Neuropathies
Retinopathy
Nephropathy
Peripheral Arterial Disease

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6
Q

What are the forms of Diabetic retinopathy?

A
  • Non-proliferative Retinopathy

- Proliferative Retinopathy (occurs after background retinopathy

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7
Q

How do we treat proliferative retinopathy?

A

We can do a vitrectomy if theres a vitreous haemorrhage

Laser photocoagulation destroys ischaemic retina, reducing Endothelial Growth Factors causing the new vessels to regress

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8
Q

How does diabetes affect cataracts?

A

3 time fold in risk of cataracts due to build up of glucose

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9
Q

What are the main types of diabetic neuropathy?

A

Sensory neuropathies
Motor neuropathies
Autonomic Neuropathy

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10
Q

What is the main danger of peripheral neuropathy?

A

Foot ulcers that arn’t noticed -> infection -> Amputation

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11
Q

How would you tell if someone has peripheral neuropathy?

A

Small muscle wasting (e.g. between toes/tendons on foot)

Chronic sensory changes like paraesthesia, burning or numbess

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12
Q

How do we care for a peripheral neuropathy?

A

Pain relief:

  • Capsaisan cream
  • Amitriptyline

Protection of feet from ulceration:

  • Fitted footwear
  • Regular podiatry visits
  • Foot screening and risk assessment
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13
Q

What is proximal motor neuropathy?

A

A type of peripheral neuropathy

Causes weight loss, pain and wasting, mainly in the legs of elderly men

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14
Q

What are the main features of autonomic neuropathies?

A 
Erectile Dysfunction
Postural hypotension
Gastric stasis -> Recurrent vomiting
Diarrhoea
Sweating, peripheral oedema & urinary retention
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15
Q

How does diabetic nephropathy arise?

A

Microvascular damage to glomeruli capillaries causing them to leak proteins into the urine and eventually become unable to filter blood

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16
Q

Whats the progression of Diabetic Nephropathy?

A

Microalbuminuria
Proteinuria
Glomerular basement membrane changes, Mesangial cell proliferation (cells of the glomerulus) , Glomerular hypertension increase renal impairment
End stage renal disease

17
Q

How do we manage diabetic nephropathy?

A
  • Glycaemic control
  • BP control
  • ACE inhibitor slows progression & treats BP
  • CVD risk factor control
18
Q

Difference between non-proliferative and proliferative reticulopathies

A

Non-proliferative :

  • Dyfunction of retinal capillary
  • Platelet dysfunction
  • Blood viscosity abnormality

Proliferative

  • Retinal capillary Ischaemia
  • New blood vessel formation
  • Vitreous hemoraage
  • Retinal tears/detachment
19
Q

How to treat retinopathies

A
  • Laser photocoagulopathy

- Improve glycaemic control

20
Q

Impact of diabetes on retinopathy

A

After 20 years from diagnosis:

  • 100% of people with type 1 diabetes will have retinopathy
  • 60% of people with type 2 diabetes will have retinopathy
  • 7% of patients who are registered as blind have diabetic retinopathy
21
Q

Diabetes and the eye

A
  • Retinopathy
  • Glaucoma- 50% increase
  • Catarract
22
Q

Impact of diabetes on the kidneys

A
  • 75% of people with diabetes will have some sort of damage to the kidneys
  • 20% of people with diabetes will go on to need some sort of renal treatment e.g. dialysis
  • Renal failure leads to death in 21% of people with type 1 and 11% of people with type 2 diabetes
  • Diabetes is the single biggest cause for end stage renal disease
23
Q

Treatment/prevention for kidney disease

A
  • Screening urine is ESSENTIAL
  • Diabetes control
  • Hypertension control
  • Renin-aldosterone-angiotensin control
24
Q

Atherosclerotic changes in patients with diabetes

A

Dislipidemia: abnormal amounts of fat in the blood
-Higher LDLs cholesterol
-Higher TAGs
-Lower HDLs cholesterol – in the form of small, dense particles
Endothelial dysfunction
Hypercoagulability

endocrine (25 decks)

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