Long Term Complications of Diabetes Flashcards
What are the systems affected by long term diabetes?
Large vessels - cardiovascular system
Small vessels - eyes, nerves, kidneys
What are some risk factors for complications in diabetes?
Duration of diabetes Metabolic control Smoking Hypertension Hyperlipidaemia Genetics
What is the main cause of death in DM patients?
Cardiovascular (microvascular) disease
What is peripheral arterial disease?
Atheroma of distant/peripheral arteries that becomes a distal ischaemic causing disease and produces a 40 fold increase of amputation risk
What are some cardiovascular risk factors?
Glucose control Blood pressure Smoking Lipids Proteinuria Family history Gender
What is the glycated haemoglobin target for primary prevention of cardiovascular risk problems in diabetes?
53mmols/mol (7%)
What is the BP target for primary prevention of cardiovascular complications in diabetes?
=/
What drug therapy is given to patients over 40 with diabetes to prevent cardiovascular complications?
Statin therapy
What are the three main pathologies of microvascular disease?
Retinopathy
Neuropathy
Nephropathy
What so the most common cause of blindness in the working age population?
Diabetic retinopathy
Give some examples of retinal abnormalities seen in DM patients
Microaneurysms (dots)
Blot haemorrhages
Hard exudates
Cottone wool spots
What are two treatments for diabetic retinopathy?
Laser photocoagulation - destruction of peripheral ischaemic retina leads to reduction of endothelial growth factors and regression of new vessels
Vitrectomy
What is mononeuritis?
A single nerve palsy
What are theres forms of diabetic neuropathy?
Peripheral neuropathy - diffuse nerve disease
Mononeuritis - single nerve palsy
Autonomic neuropathy
What are some principles of the management of peripheral neuropathy?
Early detection Self care education Protection of the feet Pain relief - capsaisin cream - amitriptyline, gabapentin, duloxetine
What are some principles for the prevention of diabetic foot ulcers?
Foor screening and risk scoring
Patient education on foot care
Trauma avoidance/fitted footwear
Huge morbidity from ulcers
What is acute sensory peripheral neuropathy?
A rapi onset of neuropathic symptoms with precipitating factors including a rapid tightening of control and acute metabolic upset
This may be very severe
What is proximal motor neuropathy?
Also called diabetic amyotrophy, it affects mostly elderly men with type II, and involves wasting, usually of the thigh muscles which is painful and causes weight loss. Although unpleasant the prognosis is good
Which three cranial nerves are most commonly affected by mononeuritis? Which other nerve may also be affected?
III, IV, VI
Peroneal nerve causing acute foot drop
What is autonomic neuropathy? Give the common manifestations and treatments
A pathology of the nerves which affect autonomic functions
Erectile dysfunction is common - viagra, cialis may be helpful
Postural hypotension common - NSAIDs, flucocortisone
Gastric stasis and recurrent vomiting - domperidone
Diarrhoea - loperamide, codeine phosphate
Abnormal sweating, peripheral oedema, urinary retention
Describe diabetic nephropathy. What proportion of type I patients are likely to develop nephropathy after 30 years?
Damage to the structure and function of the meshwork of capillaries which make up the glomerulus, the glomeruli become leaky to larger molecules and eventual reduction in ability to filtrate blood
25%
What is the basic progression of kidney disease?
Normal function to Microalbuminuria to Proteinuria to Impaired Renal Function
Give two ways by which microalbuminuria can be detected
Screening test - first morning urine sample
Definitive test - timed overnight urine collection for albumin excretion rate
What are the principles of management for early kidney disease?
Optimise glycaemic control
Tight BP control - aim for 125/75 in type I
Ace inhibitor therapy slows progression
Cardiovascular risk factor management
Outline the progression of diabetic neuropathy
Microalbuminuria to Proteinuria to Impaired renal function +/- nephrotic syndrome to End stage renal disease
