Diabetes Complications: Overview & Retinopathy Flashcards
what chronic complications are associated with diabetes
macrovascular complication, microvascular complication, cognitive dysfunction/dementia, erectile dysfunction, psychiatric complications
what is meant by macrovascular complications of diabetes
ischaemic heart disease, stroke etc.
what is meant by microvascular complications of diabetes
retinopathy, nephropathy and neuropathy
what should be screened for in annual review of diabetes patients to help identify complications/risk of complications
digital retinal screening, foot risk assessment, Urine albumin: Creatinine ratio, creatinine
describe how HbA1c is related to the relative risk of developing diabetic complications
as HbA1c increases the relative risk increases, especially when above 9-10% HbA1c
microvascular complications not seen in the absence of what
hyperglycaemia
what are some of the consequences of hyperglycaemia
Mitochondrial dysfunction, Reactive oxygen species, inflammation, fibrosis, osmotic damage
briefly describe why excess glucose results in pathology
when there is too much glucose, the mitochondria cannot keep up with glycolysis, so alternative pathways are used through which reactive oxygen species are formed these cause pathology
give some examples of reactive oxygen species that result from hyperglycaemia
sorbitol(osmotic damage), NADPH oxidase, Protein Kinase C(inflammation, fibrosis), RAGE(inflammation)
what different eye pathologies do people with diabetes get
diabetic retinopathy, diabetic macular oedema(Maculopathy), cataracts, glaucoma
describe what cataracts and glaucoma are
cataracts = clouding of the lens glaucoma = increase in fluid pressure in eye leading to optic nerve damage
what are the different stages of retinopathy
mild non-proliferative(background), moderate non-proliferative, severe non-proliferative, proliferative
(progressive complication)
how can haemorrhages be described in retinopathy
as a dot, blot or flame
depends how big
what are cotton wool spots and hard exudates seen in retinopathy
cotton wool spots = fluffy white appearance, ischaemic areas
hard exudates = lipid break down products, deposited in retina
what does IRMA stand for in retinopathy
intra-retinal microvascular abnormalities
precursor to neovascularisation
at what stage of retinopathy do microaneurysms arise
at start, they are not cause for referral or treatment, may go away
what maculopathy would be seen as referrable
hard exudates within 1 disc diameter of the fovea
what affects can bleeding cause in retinopathy
sudden change in vision(can lose vision), floaters(if small), vitreal haemorrhage is big bleed in retina
what is the mainstay of treatment for retinopathy
laser- pan retinal photocoagulation, zaps parts of retina at peripheries killing small parts of retina
(if too much lose some peripheral vision)
what are the benefits of pan retinal photocoagulation
reduces oxygen requirement of retina, reduces ischaemia that is driving retinopathy
what treatment is used for vitreal haemorrhages
vitrectomy
what is the mainstay in treatment for diabetic macular oedema, a common cause of blindness in diabetics
intravitreal anti-VEGF, injected into eye
sometimes need grid laser for macula if doesn’t work
