Long term complications micro and macro Flashcards

1
Q

Name some macrovascular complications of diabetes (3)

A

Coronary vascular disease

Cerebrovascular disease - strokes

Peripheral vascular disease - lower limb ischaemia - ulcers (poor healing leads to amputations)

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2
Q

Name some microvascular complications of diabetes (3)

A

Retinopathy
Nephropathy
Neuropathy

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3
Q

Name 3 Cardiovascular problems that can arise from diabetes

A

MI

Heart failure - related to coronary disease and abnormal cardiac myocyte glucose handling

Stroke

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4
Q

Describe what Atherosclerosis is

A

Build up of plaque in your arteries

Involves Macrophages and foam cells, intracellular lipids and extracellular lipid accumulation

Results in fibrotic and calcific layers which damages the surface and exposes it to platelets and clotting

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5
Q

Describe what is meant when you say that people with diabetes have dyslipidaemia

A

People with diabetes have an abnormal level of lipids in their blood

Have lower HDL cholesterol (Good cholesterol)

Higher triglyceride level

LDL cholesterol is in the form of small dense particles which are worse

oxidation of these particles promotes plaque formation + glycation of the particles worsens the effect

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6
Q

How can you prevent macrovascular disease (5)

A
Good diabetes control
Blood pressure control
Lipid control
Smoking cessation
weight/exercise
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7
Q

Foot ulcer care

A

Debridement
Specialist podiatry
Rest and avoidance of pressure on ulcer

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8
Q

What is non-proliferative diabetic retinopathy

A

Early stage of the disease in which symptoms will be mild or nonexistent

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9
Q

What problems might have occurred by the early non-proliferative stages of diabetic retinopathy

A

Retinal capillary dysfunction

Platelet dysfunction

Blood viscosity abnormality

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10
Q

Problems associated with the more progressed proliferative stage of diabetic retinopathy

A

Retinal ischaemia

New blood vessel formation

Vitreous haemorrhage

Retinal tears/detachment

Treatment with laser photocoagulation

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11
Q

Name some other eye effects of diabetes other than retinopathy

A

Glaucoma 50% increase in chance with diabetes

Cataracts

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12
Q

Treatment of diabetic retinopathy

A

Improve glycaemic control

Laser photocoagulation

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13
Q

What is Nephropathy

A

deterioration of proper functioning in the kidneys - in the advanced stages it transforms into end-stage renal disease

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14
Q

Describe the progression of Nephropathy

A

It starts with microalbuminuria - leakage of albumin into urine

Over time, poorly controlled diabetes causes damage to blood vessel clusters in your kidneys that filter waste from your blood.

This can lead to kidney damage and cause high BP. Hypertension causes glomerular hypertension

Progressive renal failure progresses to end-stage renal disease if unchecked.

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15
Q

Impact of diabetic nephropathy

A

75% of people with diabetes have some renal effects, and 20% go on to overt kidney disease that may need treatment.

Diabetes is the biggest single cause of end stage renal disease needing renal replacement therapy (dialysis).

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16
Q

Prevention and treatment of nephropathy (4)

A

Screening of urine for albumin is vital

Diabetes control

Renin-angiotensin system blockade (to reduce BP)- ACE inhibition, angiotensin receptor blockade, renin inhibition.
Very good results in slowing/preventing progression of renal disease (ACE-I, ARB).

Hypertension control

17
Q

Neuropathy: what sensory losses are there associated with diabetes

A

Sensation in the feet and lower legs

Paraesthesia - tingling

18
Q

What can a lack of sensation lead to?

A

The development of neuropathic ulcers.

If you have this alongside poor macro-vasculature this can lead to severe foot infection

19
Q

Autonomic neuropathy symptoms

A

GI effects - stomach/intestines

Cardiovascular - tachycardia, BP fluctuations, silent MI

20
Q

Name 2 conditions that can occur as a result of poorly controlled diabetes

A

Erectile dysfunction/sexual dysfunuction

Depression - possibly twice as common as in the general population