Diabetes Complications Flashcards
Long term complications of Diabetes are split into 2 major categories. What are these?
Macrovascular
Microvascular
Explain the pathogenesis macrovascular effects of diabetes? [3]
DM accelerates Atherosclerosis [1]
The Excess Glc bind to LDL preventing it from being cleared by liver cells [1] –> Hyperlipidaemia [1]
What is the major consequence of DM’s macrovascular effect? [4]
Increased risk of atheromatous diseases including CAD, MI, PAD & stroke
Explain the pathogenesis microvascular effects of diabetes? [4]
DM triggers the Hyaline Change in areterioles/capillaries by: [1]
- Glycosylating collagen in the subendothelial space allowing it bind albumin from the plasma [1]
- Glycosylating basal lamina proteins allowing them to bind and cross-link [1]
These mechanisms cause a build up of proteins in the vessel wall causing narrowing [1]
What are the consequences of DM’s microvascular effects? [4]
Neuropathies
Retinopathy
Nephropathy
Peripheral Arterial Disease
What are the forms of Diabetic retinopathy? [3]
- Background Retinopathy
- Proliferative Retinopathy (occurs after background retinopathy)
- Maculopathy (exudate/haemorrhage specfically at the macula)
What signs would you see on fundoscopy for background and proliferative retinopathy and how would they differ? [6]
Background (Pre-proliferative):
- Microaneurysms (blocked vessels)
- Hard Exudates
- Cotton wool spots (retinal infarcts)
Proliferative:
Cotton wool spots +
- VEGF from damaged vessels –> Proliferation
- Vitreous hemorrhage (potential complication of proliferation)
How does diabetes affect cataracts?
It doubles risk of cataracts due to build up of glucose
What are the main types of diabetic neuropathy? [3]
Peripheral Neuropathies (primarily the feet) including acute sensory peripheral neuropathy and proximal motor neuropathy.
Mononeuritis
Autonomic Neuropathy
What is the main danger of peripheral neuropathy? [3]
Foot ulcers that go unnoticed -> infection -> Amputation
Signs of peripheral neuropathy? [2]
Small muscle wasting (e.g. between toes/tendons on foot)
Chronic sensory changes like paraesthesia, burning or numbess
What is Acute Sensory Peripheral Neuropathy?
Describe the course of an episode of acute sensory peripheral neuropathy?
What can it be precipitated by [2]
A type of peripheral neuropathy caused by Diabetes [1]
Its a rapid onset of neuro symptoms that can be severe followed by a gradual recovery [1]
Can be precipitated by rapid tightening of Glc control
Acute metabolic upset
What is proximal motor neuropathy [1]
Accompanying symptoms [3]
Epidemiology [1]
A type of peripheral neuropathy
Causes weight loss, pain and wasting
Epidemiology: in the legs of elderly men
What are the main nerves affected by diabetic mononeuritis [5]
Describe the course that this problem usually follows [2]
Motor ocular nerves (III, IV, VI)
Peroneal Nerve (acute foot drop)
They have acute onset and slow recovery
What are the main features of autonomic neuropathies? [7]
Erectile Dysfunction Postural hypotension Gastric stasis -> Recurrent vomiting Diarrhoea Sweating Peripheral oedema Urinary retention
