Diabetes (Microvascular & Macrovascular Complications) Flashcards
Small vessels of which organs are particularly affected by diabetic microvascular disease?
Retina
Glomeruli
Nerve sheaths
What are the two types of diabetic retinopathy?
Non-proliferative
Proliferative (more common in T2DM)
What are the risk factors for diabetic retinopathy?
Poor glycaemic control
Smoking
Hypertension
Pregnancy
Describe non-proliferative diabetic retinopathy
Usually asymptomatic
Occurs after 8-10y DM
Can progress into proliferative diabetic retinopathy
What features of NPDR can be seen on fundoscopy?
Micro-aneurysms
Exudates
Haemmorhages (dot, blot, flame)
Cotton wool spots
Describe proliferative diabetic retinopathy
Development of new vessels on optic disc/retina, as a response to retinal ischaemia
Fragile vessels, often bleed
Can lead to fibrosis/retinal detachment
Can cause acute angle closure glaucoma (rubeosis iridis)
What other ocular conditions can occur in DM?
Diabetic maculopathy
Glaucoma
Cataract formation
What is diabetic sensorimotor neuropathy?
Damage to vessels supplying nerves leading to eventual damage to/loss of function of peripheral nerves
What neurological syndromes can develop because of DM?
Symmetrical polyneuropathy Acute painful neuropathy Mononeuropathy Diabetic amyotrophy Autonomic neuropathy
Describe symmetrical polyneuropathy
‘glove and stocking’ sensory loss - Vibration, pain, temp loss first
Loss of balance (worse when eyes closed)
Interosseous foot wasting
Foot ulcers
Describe acute painful neuropathy
Burning pains in feet, shins, anterior thighs
Typically worse at night
Associated w/ poor glycaemic control
Treated by improving glycaemic control (3/12)
Describe mononeuropathy
Cranial nerve lesions/isolated peripheral lesions
- CN III, IV & VI (ocular palsies)
- Foot drop (sciatic)
Describe diabetic amyotrophy
Progressive wasting of muscle, typically quadriceps
Variable course
Rare, develops in middle aged men
What are the symptoms of autonomic neuropathy affecting the SNS?
Postural hypotension
Ejaculatory failure
Reduced sweating
Horner’s syndrome
What are the symptoms of autonomic neuropathy affecting the PNS?
Erectile dysfunction
Constipation
Urinary retention
Holmes-Adie pupil
What are the macrovascular complications of DM?
Risk factor in development of atherosclerosis
- 2x risk of stroke
- 4x risk of MI
- 50x risk of amputation for gangrene
What is diabetic foot disease?
DM patients are at a greater risk of PAD/neuropathy and developing infections they cannot clear leading to frequent/severe foot problems
What are the risk factors for diabetic foot disease?
PAD Peripheral neuropathy Previous amputation Previous ulceration Presence of callus Joint deformity Vision/mobility problems Male sex
What are the consequences of diabetic foot disease?
Foot complications common (10%)
0.5-5% diabetics receive major amputation
What is the management of NPDR?
Good glycaemic control
What is the management of PDR?
Pan-retinal photocoagulation
Vitrectomy (if persistent vitreous haemorrhage)
What is diabetic maculopathy?
A specific form of retinopathy affecting the macula
How does diabetic maculopathy present?
Blurring of vision
What is the management of diabetic maculopathy?
Focal laser Mixed maculopathies (focal, diffuse, ischaemic) need complex treatment
