Endo: Macrovascular and Microvascular Complications of Diabetes Flashcards
which are the microvascular complications of DM?
- nephropathy
- retinopathy
- neuropathy
what does diabetes cause in the kidney
- augmented mesangial matrix production
- endothelial NO loss
- VEGF upregulation
these cause advanced glomerular injury and tubulointerstitial damage
define diabetic nephropathy
a decrease in kidnet function with time as a result of uncontrolled diabetes and aggravated by a number of other associated factors
how does diabetic nephropathy progress when it gets more severe
- hypertension increases as kidney function drops
- albumin excretion peaks at stage 4 but then decreases as the kidney fails
- GFR goes down the toilet
risk factors for diabetic nephropathy
- genetic predisposition
- race
- age
- obesity
- smoking
- increased glomerular filtration rate
- glycaemic control
- blood pressure
- oral contraceptive
how can you monitor nephropathy
- urine protein dipstick
- renal profile
what are management steps that you use in all nephropathy patients?
glycaemic and hypertension control
when do you start treating hyperlipidaemia and making protein and salt dietary restrictions
Stage 3 onwards
when do you refer to a nephrologist?
Stage 5
what is another name for Stage 5 nephropathy?
end-stage renal failure
what are the stages of retinopathy
- non-proliferative diabetic retinopathy
- pre-proliferative diabetic retinopathy
- proliferative retinopathy
features of non-proliferative diabetic retinopathy
pericyte loss, basement membrane thickening, vascular leakage, alterations in blood flow, tissue hypoxia
features of pre-proliferative retinopathy
hypoxia, oedema, microaneurysms, soft exudates, venous bleeding
features of proliferative retinopathy
angiogenesis, fibrovascular ridge retinal detachment, blindness
types of diabetic neuropathy
peripheral and autonomic (GI, CVS, GU)
what are the macrovascular complications of DM?
MI, stroke and PVD
risk factors to CVD in T2DM
- smoking
- obesity
- hypertension
- hyperlipidaemia
- hyperglycaemia
what are the leading cause of death in diabetics?
macrovascular complications like MI, CVA and PVD
management of hyperlipidaemia in diabetics
always give a statin because the combination of the two is far deadlier than in a person having high cholesterol only
management of DM to prevent these from happening
- tight control of glycaemia as well as BP
- dietary and lifestyle changes
- exercise
- medication
- control dyslipidaemia
management of DM complications
- screen regularly
- involve ophthalmology, podiatry and nephrology
- provide necessary support services
- positively motivate and empower patient
what is necrobiosis lipodica?
atrophic yellow plaques associated with telengiectasia due to hyaline degeneration of collagen
what can cause duputren’s contracture?
glycation of the collagen and soft tissues with thickening and loss of elasticity
what is cheiroarthropathy?
limited joint mobility which is mainly found in diabetics
what causes cheiroarthropathy?
deposition of advanced glycation endproducts in collagen of periarticular tissues
what is cheiroarthropathy associated with?
advanced retinal and renal lesions
characteristics of diabetic dermopathy
red papules which scale over and leave atrophic brown scars
