Endo 18: Macrovacular complications (NO SLIDES) Flashcards
What are the 4 main macrovascular conditions related to diabetes ?
- Ischaemic Heart Disease
- Cerebrovascular disease
- renal artery stenosis
- peripheral vascular disease
Hyperglycemia is associated with significantly increased/ reduced life expectancy
Hyperglycemia is associated with significantly reduced life expectancy
Microvascular diseases causes morbidly whereas macrovascular disease causes:
Microvascular diseases causes morbidly whereas macrovascular disease causes:
- morbidity AND
- mortality
Macrovascular Disease is a systemic/ local disease and is commonly present in single/ multiple arterial beds
Macrovascular Disease is a systemic disease and is commonly present in multiple arterial beds
What is the major cause of morbidity + mortality in diabetes?
- ischemic heart disease
What is the effect of renal artery stenosis ?
- contributes to hypertension + renal failure
Treatment targeted to hyperglycaemia alone has minor/major effect on increased risk of cardiovascular disease
Treatment targeted to hyperglycaemia alone has minor effect on increased risk of cardiovascular disease
What are major risk factors for macrovacular disease?
a) non modifiable:
What are major risk factors for macrovacular disease?
a) non modifiable:
- age
- sex
- birth weight
- Family history / genes
What are major risk factors for macrovacular disease?
a) modifiable:
What are major risk factors for macrovacular disease?
a) modifiable:
- dyslipidaemia
- HBP
- smoking
- diabetes
What is the link between statin + macrovascular disease?
taking a statin has significant reduction in macrovascular disease risk
describe the process of formation of complicated lesion
initial lesion fatty streak intermediate lesion atheroma fibroatheroma complicated lesion
What are features of metabolic syndrome ?
- > 6 fasting glucose level
- increase waist circumference M > 102, W > 88)
- HDL (M <1.0 , W <1.3)
- Hypertension
- Insulin resistance, inflammation CRP, adipocytokines, urine microalbumin
What is the effect of metabolic syndrome with reference to insulin?
causes insulin resistance
In diabetes, there is an increase/ decrease in cardiovascular events
there is a greater/ lesser risk for women
In diabetes, there is an increase in cardiovascular events
there is a greater risk for women
macrovascular diseases are:
- Heart diseases
- stroke
- and peripheral vascular diseases
note: controlling ONLY sugar levels contributes to prevention of macrovascular diseases only to a small extent
treating cholesterol with STATIN = very effective in preventing stroke/ MI
treating HBP = very effective
–> reduces risk of ischemic Heart Disease
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new: what is the effect of canakinumab administration
- reduces inflammation, without decrease in lipid conc
- lowered risk of recurrent cardiovascular events
- but increased risk of infection –> so not USED
what contributes to diabetic foot disease?
- neuropathy
2. peripheral vascular disease
how would you test fo peripheral neuropathy?
microfilament examination
List some pathways to ulceration of the foot
there are 8 potential answers
- sensory neuropathy
- motor neuropathy
- limited join mobility
- autonomic neuropathy
- peripheral vascular disease
- trauma
- reduced resistance to infection e.g yeast infection / bacterial infection
- other diabetic complications e.g retinopathy –> e.g can’t see –> more stubbing of foot
What are the 2 types of Foot ulceration
- neuropathic foot
- -> numb, dry, dry, ulcers at e.g ball of foot (pt of high pressure loading) , absent reflexes - ischemic foot
- -> cold, pulseless, ulcers at foot margins
how would you manage the diabetic foot?
- manage hyperglycemia
- manage hypertension
- manage dyslipidaemia
- stop smoking
- education
- relieve pressure –> bed rest, retribution of pressure/ total contact cast
- give antibiotics –> if infected
- debridement –> remove dead tissues
- revascularisation -> angioplasty/ arterial bypass surgery
- amputatation
What re some methods of preventative management of diabetic foot disease?
- control diabetes
- inspect feet daily
- buy shoes with laces + square toe box
- inspect inside of shoes for foreign objects
- cut nails straight across (not too short)
- care with heat
note: diabetic foot = painless
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