DM - Complications Flashcards
For every 1% decrease in HbA, there is a ___% decrease in mortality and ____% decrease in microvascular complications
21%, 37%
1 cause of chronic kidney disease (CKD),
ESRD, & CKD requiring renal replacement
therapy (aka Dialysis)
Diabetic Nephropathy
Most common cause of Nephrotic Syndrome
40% of DM II
30% of DM I
Nephrotic Syndrome
- Loss of protein from plasma into urine
2° ↑ glomerular permeability - Leads to generalized edema,
hypoalbuminemia, hyperlipidemia, &
frank proteinuria (detectable with urine
dipstick)
Etiology/Pathogenesis of Diabetic nephropathy
Glomerular Damage
↓
leaking protein into urine
↓
Hypoalbuminemia
Hypoalbuminemia process
↓osmotic pressure
↑ edema
↓ vascular volume
↓ blood pressure
↑ kidney renin production
↑ aldosterone
↑ sodium & water retention
↑ intravascular fluid
↑ edema
40% of patients with diabetes develop diabetic ____
nephropathy
T/F Smoking accelerates the decline in renal function
T
Annual assessments for Diabetic nephropathy
- Serum Creatinine (Cr) to determine eGFR
- Urine Albumin & Cr to determine
Albumin/Cr ratio - Begin annual screening 5 years after diagnosis of DM I or At diagnosis of DM II or DM I
When Management of Diabetic Nephropathy requires Nephrologist referral
✅ Atypical presentation
✅ Rapid decline in eGFR OR albuminuria progression
✅ Stage 4 CKD
Management of Diabetic Nephropathy
- Smoking cessation
- RAAS blockade for albuminuria
- Nephrologist referral
1 cause of preventable blindness in adults
Diabetic Retinopathy
Epidemiology of Diabetic Retinopathy
- 86% of DM I
- 40% of DM II
Risk Factors of Diabetic Retinopathy
- African-American, Hispanic, South Asian
- ↓ age at Dx of DM
- HTN
- Dyslipidemia
- Pregnancy
- Puberty
- Cataract surgery
Clinical Presentation of Diabetic Retinopathy
- *Often Asymptomatic!
- Blurred or double vision
- ↓ field of vision
- Seeing dark spots
- Pressure or pain in eyes
- ↓ vision in dim light
- Sudden blindness (rare)
