Long Term Complications of Diabetes Flashcards
Micro and macro
Name the main system affected by long term complications of diabetes
Cardiovascular
What are the 3 parts of the body mainly affected by micro- and macro- vascular complications?
Eyes
Kidneys
Nerves
Name 3 macrovascular complications of diabetes
Coronary vascular disease
Cerebrovascular disease
Peripheral vascular disease
Name 3 microvascular complications of diabetes
Retinopathy
Nephropathy
Neuropathy
What is present in nearly all people with diabetes?
Dyslipidaemia
Describe HDL, triglyceride and LDL levels in dyslipidaemia (from atherosclerosis)?
HDL cholesterol = lower
Triglyceride = higher
LDL cholesterol = in form of small dense particles which are worse
What happens to LDL particles in dyslipidaemia?
Oxidisation of these particles promotes the features that lead to plaque formation (+ glycation of the particles worsens the effect)
What 2 other features (other than dyslipidaemia) are found in atherosclerosis in diabetes?
Endothelial dysfunction
Hypercoagulation
Name 3 major effects of atherosclerosis in diabetes
Ischaemic cerebrovascular disease - strokes
Ischaemic heart disease - angina, MI, heart failure
Peripheral vascular disease
What is heart failure related to?
Coronary disease and abnormal cardiac myocyte glucose handling
What does peripheral vascular disease cause?
Lower limb ischaemia - leading to ulcers + poor healing of ulcers (possibly lead to amputations)
Name 4 methods of prevention of macrovascular disease in diabetes
- Good diabetes control
- Blood pressure control
- Lipid control
- Lifestyle: smoking cessation, weight, exercise
What are the 2 types of diabetic retinopathy?
Non proliferative
Proliferative
Describe non-proliferative diabetic retinopathy
Retinal capillary dysfunction, platelet dysfunction, blood viscosity abnormality
Describe proliferative diabetic retinopathy
Retinal ischaemia, new blood vessel formation, vitreous haemhorrage, retinal tears/detachment
How is proliferative diabetic retinopathy treated?
Laser photocoagulation
20 years post-diagnosis, what percentage of people with type 1 diabetes will have retinopathy?
100% (some form mild to severe)
20 years post diagnosis, what percentage of those with type 2 diabetes will have retinopathy?
60% (some form mild to severe)
Name 2 other eye effects of diabetes
Glaucoma (50% increase)
Cataracts (3-fold)
How does nephropathy begin?
Microalbuminuria (leak of protein (albumin) starts)
Name 3 boring sounding things in nephropathy contributing to renal dysfunction
Glomerular basement membrane changes
Mesangial tissue proliferation
‘Glormerular hypertension’
What can progressive renal failure progress to if left unchecked?
End-stage renal disease
What happens to the appearance of kidneys in diabetic nephropathy?
They do NOT shrink (one of only kidney conditions where this does not happen)
What percentage of people with diabetes will have some renal effects?
75%
What percentage of people with renal effects will go on to have overt kidney disease that may need treatment?
20%
What is the biggest single cause of end stage renal disease needing renal replacement therapy (dialysis)?
Diabetes
What ultimately happens to 21% of type 1 diabetics and 11% of type 2 diabetics with renal failure?
Death
Name 4 methods of prevention and treatment of nephropathy
Screening of urine for albumin
Diabetes control
Renin-agiotensin system blockade (ACEI, ARB - v gd results, renin inhibition)
Hypertension control
Describe sensory neuropathy in diabetes
Objective loss, particularly in feet and lower legs (subjective symptoms, esp parasthesia)
What can lack of sensation lead to?
Development of neuropathic ulcers, which, alongside macro-vasculature, leads to severe foot infections
Describe autonomic neuropathy in diabetes
Can cause GI effects (stomach, intestines), or CVS (tachycardia, BP fluctuations)
What is important to watch out for in a patient with diabetic neuropathy?
Silent myocardial infarction
What is acronym for foot care in diabetes?
CPR - check, protect, refere
Name 2 other conditions found in diabetics
Erectile dysfunction/sexual dysfunction
Depression
Look at case studies
.
