Long term complications of diabetes Flashcards
What is affected with large vessels and small vessels in diabetes?
large = cardiovascular small = kidneys, eyes, nerves
Complication risk factors for diabetes
hyperlipidaemia metabolic/glycaemic control hypertension smoking duration of diabetes genetics
What does peripheral arterial disease lead to an increased risk of?
amputation
Cardiovascular risk factors - modifiable and non modifiable
modifiable = smoking, glycaemic control, bp control, lipids
non modifiable - age, gender, family, proteinuria
Primary prevention of CV risk reduction
smoking cessation target HbA1c control blood pressure lifestyle choices statin therapy - simvastatin
What is microvascular disease affecting?
arterioles and capillaries
3 types of diabetic retinopathy
background retinopathy
proliferative retinopathy
maculopathy
Why is visual acuity a poor guide for diabetic retinopathy?
need regular screening for other complications
Retinal abnormalities in diabetes
microaneurysms - dot hard exudates blot haemorrhages cotton wool spots new vessel formation advanced eye disease vitreous haemorrhage
2 treatments of proliferative retinopathy
laser photocoagulation
vitrectomy
How does laser photocoagulation work?
destruction of peripheral ischaemic retina leads to reduction of endothelial growth factors and regression of new vessels
Describe diabetic maculopathy
macula exudate, blot haemorrhages and ischaemia
oedema behind macula and reduce visual acuity
Cataracts
common in elderly, clouding of lens and increased in diabetes with poor glycaemic control
high correction with surgery and visual acuity determines timing
3 types of diabetic neuropathy
peripheral neuropathy
mononeuritis
autonomic neuropathy
Peripheral neuropathy
glove and stocking - feet
insensitive to trauma, paraesthesia, burning pain and numbness
loss of muscle between toes
risk of diabetic foot ulcer
4 ways to help peripheral neuropathy and at risk feet
early detection
protection of feet
self care education
pain relief eg capscain cream, amytriptiline
Ways to reduce ulcer prevention
foot screening and risk scoring patient education on foot care regular podiatry for those at risk trauma avoidance/fitted footwear huge morbidity from ulcers
Charcot foot
Condition causing weakening of bones in people with neuropathy
Remember feet - signs of at risk feet
impaired circulation impaired sensation impaired vision foot shape changes abnormal pressure
2 precipitating factors of acute sensory peripheral neuropathy
rapid tightening of control eg planning pregnancy
acute metabolic upset
Proximal motor neuropathy
elderly men - type 2 DM
wasting of thigh muscles, weight loss, painful
Mononeuritis
mainly affect ocular nerves - CN 3,4,6
acute foot drop - peroneal nerve
vascular event
Autonomic neuropathy symptoms
erectile dysfunction postural hypotension diarrhoea gastric stasis and recurrent vomiting abnormal sweating, peripheral oedema, urinary retention
How is autonomic neuropathy diagnosed?
symptoms and pattern
abnormal ECG
What happens in diabetic nephropathy?
damage to structure and function of meshwork of capillaries which make up glomerulus
glomeruli become leaky to larger molecules and eventual reduction in ability to filtrate blood
How to detect kidney disease?
microalbuminuria
screening test - urine sample
definitive test - overnight urine for albumin excretion rate
Management of early kidney disease
optimise glycaemic control
tight bp control
ACEI therapy
cardiovascular risk progression
