Diabetic complications Flashcards
What is best way to prevent diabetes complications?
Good glycameic control
What are the micro and macrovascular complications of diabetes
Micro = neuropathy, nephropathy, retinopathy
Macro = vascular e.g. MI, atherosclerosis, stroke
What are types of diabetic retinopathy?
Non-proliferative: little bleeds
Proliferative: production of VEGF leads to new vessels, vitreous haemorrhage
Maculopathy
How are diabetic complications monitored?
Yearly retinal screening
yearly foot checks with 10mg monofilament sensory testing and ABPI
How does retinopathy present?
Blurred vision
What is Rx for diabetic retinopathy?
Observation if mild-preproliferative
If proliferative, laser photocoagulation of bleeds
VEGF inhibitors
Intra-vitreous steroids
What causes diabetic foot disease?
Neuropathy: loss of sensation leads to injury and infection over pressure points e.g. metatarsal heads on sole, can cause Charcot foot
PAD: diabetes is a risk factor for PAD, resulting in critical ischaemia with absent foot pulses
What are Sx of diabetic foot disease?
Loss of sensation in stocking distribution, Charcot foot
Absent foot pulses, reduced ABPI, Sx of intermittent claudication
What Ix in suspected diabetic foot disease?
Doppler
X-ray
ABPI
If possible infection, do swabs for culture
What are complications of diabetic foot disease?
Ulcers (can lead to infection)
Charcot
cellulitis, osteomyelitis, gangrene
How is diabetic foot treated?
Bed rest, therapeutic shoes
Abx if infection
Amputation: indicated for deep infection and abscess, gangrene
How does diabetic nephropathy present and Ix?
Asymptomatic, but ACR > 2.5 is diagnostic of microalbuminuria
How is diabetic nephropathy treated?
Protein restriction
ACEi or ANGII RB
SGLT2 inhibitors are good for protecting kidneys
What are the vascular complications of diabetes?
Athersclerosis
Cerebrovascular disesae
IHD: silent MI
How is vascular disease managed in diabetes?
Statin (even if no IHD)
Aspirin
