L4: Microvascular Complication in DM Flashcards
what are microvascular complications of DM?
1) Diabetic Retinopathy
2) Diabetic Nephropathy
3) Diabetic Neuropathy
Mechanism of Hyperglycemia induced Damage
- Increased Polyol - sorbitol Pathway flux
- Increased AGES formation
- Activation of protein kinase C
- Increased Hexosamine pathway flux.
what are Eye complications of DM?
- Catarct
- Retinopathy
Stages of Retinopathy
1) Background
2) Pre-proliferative
3) Proliferative
4) Advanced diabetic eye disease
5) Maculopathy
Mechanism of Cataract in DM
- Non enzymatic glycation of lens protein and subsequent cross linking
- Sorbitol accumulation could also lead to osmotic swelling of the lens but evidence of involvement in cataract formation is less strong
Prevelance & Incidence of Ritonapthy in DM
- DR is the leading cause of blindness in the working population of the Western world
- The prevalence increase with the duration of the disease
- (Few within 5 years, 80 – 100% will have some form of DR after 20 years)
Maculopathy is most common in type ….. patients and can cause severe visual loss
2
Charactes of Background Retinopathy
- Micro aneurysms ( 1st to occur )
- Scattered exudates
- Hemorrhages (flame shaped, Dot and Blot)
- Cotton wool spots (<5)
- Venous dilatations
Charactes of Pre-Proliferative Retinopathy
- Rapid increase in amount of micro aneurysms
- Multiple hemorrhages
- Cotton wool spots (>5)
- Venous beading, looping and duplication
Charactes of Proliferative Retinopathy
- Proliferative Retinopathy
- New vessels (on disc, elsewhere)
- Fibrous proliferation (on disc, elsewhere)
- Hemorrhages (preretinal, vitreous)
Charactes of Advanced Diabetic Eye Disease
- Advanced Diabetic Eye Disease
- Retinal detachment with or without retinal tears.
- Rubeosis iridis.
- Neovascular Glaucoma
Characters of Maculopathy in DM
- Macular edema ( focal or diffuse )
- Ischemic maculopathy
what are other ocular Complications?
Prevelance in Diabetic Nephropathy
- Diabetes has become the most common cause of end stage renal failure in the US and Europe
- 50 % of dialysis patients have DM
- About 20 – 30 % of patients with diabetes develop evidence of nephropathy
- The prevalence of DN is higher in Black Americans than in Whites
Stages of Diabetic Nephropathy
Which Stages of nerphropathy are reversible with TTT?
Incipient nephropathy (reversible with ttt)
Which Stages of Diabetic Nephropathy are Irreversibel with TTT?
Overt nephropathy
What are other Renal Complications of DM?
- Infection: as cystitis, Pyelonephritis & acute necrotizing papillitis
- Increase incidence of renal stones d.t. recurrent infection & stasis
what are types of Diabetic Neuropathy?
what is the most common type of Diabetic Neuropathy?
Sensory Neuropathy
Symptoms of Sensory Neuropathy
Early symptoms of Sensory Neuropathy
pain & paresthesia. It bilateral & symmetrical, starting in the lower limb then upper limb
Late Symptoms of Sensory Neuropathy
stock & glove hyposthesia occur
Tendon Jerk in Sensory Neuropathy
There may be lost ankle & preserved knee jerk
Deep Sensations in Sensory Neuropathy
- There’s loss of deep sensations except muscle sense leading to tender calf
- The earliest sensation to be lost in diabetic neuropathy is vibration sense then 10 gm monofilaments test
Complications in Sensory Neuropathy
Motor Neuropathy in DM
- Distal muscle weakness
- Wrist & foot drop
Symptoms of Autonomic Neuropathy
Autonomic Neuropathy (Another Classification)
Types of Mononeuropathies
Entrapment Neuropathies
Proximal Motor Neuropathy
What are other neurological Complications of DM?
Screening of eye disease in DM
When to refer a Diabetic Patient to an ophthalmologist?
Management of Diabetic Retinopathy
Screening for Nephropathy disease
Why we do screening for Micro albuminuria?
- Increased risk for overt nephropathy
- Increased cardiovascular mortality
- Increased risk of Retinopathy
- Increased all-cause mortality
So Microalbuminuria is an indication for screening for possible vascular disease and aggressive intervention to reduce all cardiovascular risk factors.
Screening test for micro albuminuria
who to Screen For Microalbuminuria
Type 1 Diabetes Type 2 Diabete?
Management of nephropathy in DM
Screening for Neuropathy disease
Management of neuropathy in DM
Complications of DM (PPT)
Definition of Diabetic Nephropathy
Risk Factors of Diabetic Nephropathy
Pathology of Diabetic Nephropathy
Clinical Picture of Diabetic Nephropathy
Investigations in Diabetic Nephropathy
Transient microalbuminuria occurs in the following: …….
1) Exercise
2) Fever
3) Heart failure
4) Poor glycemic control
