Long Term Complications of Diabetes Flashcards
What do risk of complications worsen with?
Glycaemic state
What are some macrovascular compications of diabetes?
Coronary vascular disease
Cerebrovascular disease
Peripheral vascular disease
What are some microvascular complications with diabetes?
Retinopathy
Nephropathy
Neuropathy
What is atherosclerosis formed from?
- Macrophages and foam cells
- Intracellular lipids
- Extracellular lipid accumulation
- Fibrotic and calcific layers
- Damage to surface, exposure to platelets and clotting
What is the broad term describing a number of conditions including hypercholesteraemia and hyperlipidaemia?
Dyslipidaemia
What affect does dyslipidaemia have on cholesterol and fatty acids?
HDL cholesterol is lower
Triglycerides are higher
LDL cholesterol is in the form of small dense particles which are worse (oxidation of these particles promotes the feature that leads to plaque formation and glycation of the particles worsens this effect)
As well as dyslipidaemia, what else does diabetes cause that leads to CVD?
Endothelial dysfunction
Hypercoagulatibity
What does atherosclerosis lead to in diabetes?
- Ischaemic cerebrovascular disease (strokes)
- Ischaemic heart disease
- Angina, myocardial infarctions, heart failure
- Peripheral vascular disease
- Causes lower limb ischaemia leading to ulcers and poor healing, amputations are potential outcome
What can be done to prevent macrovascular disease in diabetes?
- Good diabetes control
- Blood pressure control
- Lipid control
- Smoking cessation, weight, exercise
What is the general management of diabetes to prevent macrovascular disease?
- Improve glycaemic status
- Optimise lipid levels
- Smoking cessation
- Education, support
- Foot ulcer care
- IV antibiotics
What are the different kinds of retinopathy?
- Non-proliferative diabetic retinopathy
- Retinal capillary dysfunction, platelet dysfunction, blood viscosity abnormality
- Proliferative diabetic retinopathy
- Retinal ischaemia, new blood vessel formation, vitreous haemorrhage, retinal tears/detachment
- Treatment with photocoagulation
What occurs in non-proliferative diabetic retinopathy?
Retinal capillary dysfunction
Platelet dysfunction
Blood viscocity abnormality
What occurs in proliferative diabetic retinopathy?
Retinal ischaemia, new blood vessel formation, vitreous haemorrhage, retinal tearsdetachment
What is the treatment for retinopathy?
Improve glycaemic control
Laser photocoagulation
What is laser photocoagulation?
Eye surgery using a laser to shrink or destroy abnormal structures in the retina
Explain the pathophysiology of diabetes causing nephopathy?
- Microalbuminuria (leak of protein – albumin – starts)
- Glomerular basement membrane changes, mesangial tissue proliferation, glomerular hypertension all contribute to renal dysfunction
- Progressive renal impairment progresses to end stage renal disease if untreated
What is done for prevention and treatment of nephropathy?
Screening of urine is vital
Diabetes control
Renin-angiotensin system blockade
Hypertension control
How can RAAS blockade be done to treat nephropathy?
ACE inhibition
Angiotensin receptor blockage
Renin inhibition
What aspects of the nervous system does neuropathy affect?
Sensory, motor and autonomic
What effects does neuropathy have on the sensory aspect of the nervous system?
- Objective loss, particularly in feet and lower legs, subjective symptoms, especially paresthesia
- Lack of sensation can lead to development of neuropathic ulcers which can lead to severe foot infections
What does lack of sensation due to neuropathy often lead to?
Development of neuropathic ulcers which can lead to severe foot infectons
What effects does neuropathy have on the autonomic nervous system?
Can cause GI effects or CV effects (tachycardia, blood pressure fluctuations)
How is footcare achieved?
Check both feet
Protect feet (if pressure damage/ulcer present)
Refer all patients with a foot ulcer/pressure damage
What can bad foot care lead to?
Charcot foot (weakening of the bones that can occur in people with neuropathy)
What is charcot foot?
Weakning of the bones that can occur in people with neuropathy
Other than CVS complications, what other conditions can diabetes cause?
Erectile dysfunction/sexual dysfunction
Depression
How is microvascular disease prevented?
Screening and preventative measures
How is macrovascular disease prevented?
Controlling risk factors as well as glycaemic status
