Diabetes Complications Flashcards
List the major complications of Diabetes?
- Short term
- Long term
Short Term:
Diabetic Ketoacidosis (DKA)
Hyperglycaemic Hyperosmolar State (HHS)
Hypoglycaemia
Long Term:
Macrovascular –> CAD/PAD/Stroke
Microvascular –> Retinopathy, Nephropathy, Neuropathy & PAD
Explain the macrovascular effects of diabetes?
DM accelerates Atherosclerosis
The Excess Glc bind to LDL preventing it from being cleared by liver cells –> Hyperlipidaemia
What is the major consequence of DM’s macrovascular effect?
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
Explain DM’s microvascular effects?
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
What are the consequences of DM’s microvascular effects?
Neuropathies
Retinopathy
Nephropathy
Peripheral Arterial Disease
What are the forms of Diabetic retinopathy?
- Non-proliferative Retinopathy
- Proliferative Retinopathy (occurs after background retinopathy
How do we treat proliferative retinopathy?
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
How does diabetes affect cataracts?
3 time fold in risk of cataracts due to build up of glucose
What are the main types of diabetic neuropathy?
Sensory neuropathies
Motor neuropathies
Autonomic Neuropathy
What is the main danger of peripheral neuropathy?
Foot ulcers that arn’t noticed -> infection -> Amputation
How would you tell if someone has peripheral neuropathy?
Small muscle wasting (e.g. between toes/tendons on foot)
Chronic sensory changes like paraesthesia, burning or numbess
How do we care for a peripheral neuropathy?
Pain relief:
- Capsaisan cream
- Amitriptyline
Protection of feet from ulceration:
- Fitted footwear
- Regular podiatry visits
- Foot screening and risk assessment
What is proximal motor neuropathy?
A type of peripheral neuropathy
Causes weight loss, pain and wasting, mainly in the legs of elderly men
What are the main features of autonomic neuropathies?
Erectile Dysfunction Postural hypotension Gastric stasis -> Recurrent vomiting Diarrhoea Sweating, peripheral oedema & urinary retention
How does diabetic nephropathy arise?
Microvascular damage to glomeruli capillaries causing them to leak proteins into the urine and eventually become unable to filter blood
Whats the progression of Diabetic Nephropathy?
Microalbuminuria
Proteinuria
Glomerular basement membrane changes, Mesangial cell proliferation (cells of the glomerulus) , Glomerular hypertension increase renal impairment
End stage renal disease
How do we manage diabetic nephropathy?
- Glycaemic control
- BP control
- ACE inhibitor slows progression & treats BP
- CVD risk factor control
Difference between non-proliferative and proliferative reticulopathies
Non-proliferative :
- Dyfunction of retinal capillary
- Platelet dysfunction
- Blood viscosity abnormality
Proliferative
- Retinal capillary Ischaemia
- New blood vessel formation
- Vitreous hemoraage
- Retinal tears/detachment
How to treat retinopathies
- Laser photocoagulopathy
- Improve glycaemic control
Impact of diabetes on retinopathy
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
Diabetes and the eye
- Retinopathy
- Glaucoma- 50% increase
- Catarract
Impact of diabetes on the kidneys
- 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
Treatment/prevention for kidney disease
- Screening urine is ESSENTIAL
- Diabetes control
- Hypertension control
- Renin-aldosterone-angiotensin control
Atherosclerotic changes in patients with diabetes
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
