Long Term Complications - Micro and Macro Flashcards
What are the macrovascular complications associated with diabetes? (prolonged hyperglycaemia)
- Coronary vascular disease
- Cerebrovascular disease
- Peripheral vascular disease
What are the microvascular complications associated with diabetes? (prolonged hyperglycaemia)
- Retinopathy
- Nephropathy
- Neuropathy
What conditions are diabetics predisposed to due to macrovascular atherosclerosis?
- Stroke
- Angina / MI
- Heart Failure (due to coronary disease and abnormal cardiac myocyte glucose handling)
- Lower limb ischaemia causing ulceration
Why do diabetics often not notice that they are developing foot ulcers?
Due to the peripheral neuropathy that is often associated with it, impaired sensation
What is a common complication of diabetic foot ulcers?
Osteomyelitis, infection of the underlying bone
Management of a diabetic foot ulcer?
- Podiatry: debridement & dressings
- Antibiotics to prevent infection (depends)
- Special (appropriate) footwear
What can be a reason for development of complications in diagnosed diabetics with prescribed medication?
Poor drug compliance
- Smoking / other unhealthy practices
What are the two types of diabetic retinopathy? Difference / how are they related?
- Non-proliferative diabetic retinopathy
- Proliferative diabetic retinopathy
- Proliferative is the more advanced form of the disease, occurs after non-proliferative
Changes in the eye / complications due to non-proliferative diabetic retinopathy?
- Weakening / dysfunction of retinal capillaries
- Blood viscosity abnormalities
- Platelet dysfunction (may lead to leakage due to microaneurysms)
Changes in the eye / complications in proliferative diabetic retinopathy?
- Retinal ischaemia
- Formation of new, fragile capillaries
- Vitreous haemorrhage (bleeding into vitreous space)
- Retinal tears / detachments
How is proliferative diabetic neuropathy treated?
Laser photocoagulation
- Cauterization of ocular blood vessels to prevent haemorrhage and further visual issues
Sign of diabetic retinopathy on fundoscopy?
- Cotton wool spot: feathery whitish area on the retina, shows focal infarct
How common is retinopathy in diabetics?
Within 20 years after diagnosis:
- 100% type 1 diabetics have some retinopathy
- 60% for type 2 diabetics
What changes occur in the kidneys during diabetic nephropathy?
- Glomerular basement membrane changes
- Mesangial tissue proliferation
- Glomerular hypertension
Effect of diabetic nephropathy on plasma albumin concentration?
Decreases plasma [albumin]: microalbuminuria
- Albumin leaks through the damaged glomerulus into the urine, loss from plasma
Investigations for suspected diabetic nephropathy?
- Urine [albumin] (should be screened for in diabetics)
Management / prevention of diabetic nephropathy?
- ACE-I or angiotensin receptor blockers (ARBs)
- Hypertension control
What divisions of the nervous system can be affected by diabetic neuropathy?
- Sensory
- Motor
- Autonomic
Where is most sensory loss incurred as a result of diabetic neuropathy? Symptoms and consequences?
- Mostly in the feet and lower legs
- Paresthesia is the main symptom
- Can result in the development of foot ulcers due to loss of sensation
What are some of the possible consequences of autonomic neuropathy as a result of diabetes?
- GI effects (stomach / intestine)
- Tachycardia / BP fluctuations
What is charcot foot?
- Foot condition that may occur in individuals with significant neuropathy
- Causes weakening of the bones in the foot, often weakened enough to fracture. With continued walking the foot then eventually changes shape
- Foot appears large (swelling) and with loss of arch
What are some other conditions diabetics may be predisposed to?
- Erectile dysfunction
- Sexual dysfunction
- Depression
Prognosis for diabetic foot ulcers? Do they tend to heal well?
- Nah pretty bad
- Since patient will most likely continue walking & poorly comply to alternative footwear options a lot of the podiatry treatment focuses on preventing infections / cleaning the wound
