Long Term Complications of Diabetes Flashcards
What vessels are affected in macrovascular complications?
Large vessels making up the CV system
What vessels are affected in microvascular complications?
Smaller vessels in the eyes (retinopathy), kidneys (nephropathy) and nerves (neuropathy)
Risk factors for these complications?
Duration of diabetes Metabolic control Smoking Hypertension Hyperlipidaemia
Genetics
What sort of complication is the main cause of death in diabetes?
Macrovascular/Cardiovascular
MI (2-5x), Stroke (3x) and peripheral arterial disease (5x) risks all rise
Explain peripheral arterial disease and the risk that is carries.
It is a diffuse and more distal disease
x40 fold increased risk of amputation
CV risk factors?
Glucose control
BP
Smoking
Lipids
Proteinuria
FHx
Gender
Primary prevention of CV risk ?
Target HbA1x to 53mmols/mol (7%)
Control BP to less than 130/80
Smoking cessation
Statin therapy
Lifestyle choices
How to support smoking cessation?
Nicotine replacement
Drug therapy - Zyban or Champix
What statin is used mainly and in what type of patients?
Simvastatin
Aged 40 or older or in younger patients with significant complications
What sort of vessels specifically does microvascular disease affect?
Arterioles and capillaries
What is the commonest cause of blindness in the working age pop.?
Diabetic retinopathy
How to prevent diabetic retinopathy?
Good glucose control
Tight BP control
Early detection and intervention
Types of retinoptahy?
Background retinopathy (mild, moderate, severe)
Proliferative retinopathy
Maculopathy
Is visual acuity a good guide for detecting retinopathy?
No - regular screening is essential
What retinal abnormalities can be spotted in diabetic complications?
Microaneurysms (dots)
Blot haemorrhages
Hard exudates
Cotton wool spots
New vessel formation
Vitreous haemorrhage
Advanced eye disease
What exactly is proliferative retinopathy?
in proliferative retinopathy ‘new blood vessels’ grow on the surface of the retina and can bleed
Treatment for proliferative retinopathy?
Laser photocoagulation -
Destruction of peripheral ischaemic retina = reduction of endothelial growth factors and regression of new vessels
Vitrectomy
What exactly is diabetic maculopathy?
Exudates and blot hemorrhages at the macula
A macular oedema deforms the macula
Macular ischaemia
Reduced visual acuity - common in type 2
Treatment of maculopathys?
Grid laser therapy
Tight control of glucose and BP
Who is cataracts common in?
Elderly
2x fold increase in diabetes
Poor diabetic control increases risk
Is treatment for cataract successful?
Yes surgery is highly successful - visual acuity after dictates the timing
List some diabetic neuropathies.`
Peripheral neuropathy - diffuse nerve disease
Mononeuritis - single nerve palsy
Autonomic neuropathy
Where does peripheral neuropathy mainly affect? What are the effects? What problems does this raise?
Feet mainly but also hands
Unpleasent chronic symptoms like paraesthiae (pins and needles), burning pain and numbness, but may also be asymptomatic
Small muscle wasting
Feet become insensitive to trauma and can become infected
Management of PERIPHERAL NEUROPATHY
Early detection
Self care education
Protection of feet
Pain relief - capsaisin cream, amitriptyline, gabapentin, duloxetine
