Diabetes Complications Flashcards
What are the two groups of complications ?
MICROvascular - small vessels
MACROvascular - large vessels
What are the MICROvascular complications?
- Diabetic Retinopathy (eyes)
- Diabetic Neuropathy (nerves)
- Diabetic Nephropathy (kidneys)
(no preventative drug treatment)
What is retinopathy?
- High blood sugar causes micro-thrombi in the retina.
- The capillaries become blocked
- No drug treatment – laser therapy
- Irreversible – leads to blindness
- yearly optician appointments
What is proliferative retinopathy?
new vessels form and leak blood into vitreous blocking light entry
What is non-prolferative retinopathy?
no new vessels form
What is the risk of blindness in diabetic patients?
25 times higher
What are the 3 mechanisms of retinopathy?
- Increased retinal blood flow due to impaired autoregulation
- Increased sorbitol production resulting oxidative stress, increased cell osmolality and swelling, and eventual cell rupture and death
- Advanced glycosylation end products (i.e. glucose combined with free amino acid or serum/tissue proteins) results in damage to microvasculature
What is neuropathy?
- High blood sugars leads to reduced blood flow and death of nerves
- Most common is peripheral neuropathy
- Often results in diabetic foot ulcers
- Regular foot checks
- Foot clinic
- Treat symptoms (pain, unusual sensation)
What can be given to treat symptoms of neuropathy?
Anti-depressants -
- Duloxetine
- Amitriptyline
Anti-convulsants -
- Gabapentin
- Pregabalin
Topical -
- Capsacin based
creams/gels
Short term options -
- Tramadol
Avoid -
- NSAIDS
- Long-term opiates
What are diabetic foot ulcers?
- A complication of neuropathy
- Lack of sensation increases risk of damage to feet
- High blood sugars increase infection risk and reduce healing
- Require prolonged antibiotic courses
- May result in amputations
What are other neuropathic conditions?
- Gastroparesis (treated with erythromycin, metoclopramide or domperidone)
- Erectile dysfunction (treated with phosphodiesterase type 5 inhibitors e.g. sildenafil)
- Diabetic diarrhoea (treated with loperamide)
Loss of bladder control - Arrhythmias
- Lack of or excessive sweating
What is nephropathy?
- Linked to poor glucose control and poor blood pressure control
- Nephrons become thickened and scarred so less effective
- Kidney function becomes progressively worse
- may need dialysis
What is the treatment for nephropathy?
- Good control of blood pressure
- Ideally with an ACE or ARB
What are MACROvascular complications?
- High insulin levels are associated with atherosclerosis
- Diabetes related dyslipidaemia also speeds up the atherosclerotic process
- Result:
- Myocardial infarctions
- Ischaemic Strokes
- Vascular disease
What is the prevention of macrovascular conditions?
- Control of cholesterol
- Control of blood pressure
- If evidence of cardiovascular disease:
Consider aspirin 75mg OD (NOT for primary prevention) - And…you guessed it
Control of blood sugars!
