Long Term Complications of DM Flashcards
What is the main system affected with macrovascular disease in DM?
CVS
What are the main areas affected with microvascular disease in DM?
Eyes
Nerves
Kidneys
What are the complication risk factors of DM?
Duration of DM Metabolic control Smoking Hypertension Hyperlipidaemia Genetics
What is the main cause of death in DM?
MI
What is the increased risk of stroke in DM?
3x
What is the increased risk of peripheral arterial disease in DM?
x5
What is the increased risk of amputation in DM?
40x fold
What are cardiovascular risk factors?
Glucose control BP Smoking Lipids Proteinuria Family history Males
What is the primary prevention for CV risk reduction?
Target HbA1-c to 53 mmol/mol Control BP 130/80 Smoking cessation Stain therapy - simvostatin Lifestyle choices
What are the main microvascular diseases in DM?
Retinopathy
Neuropathy
Nephropathy
What is the commonest cause of blindness in the working age population?
Diabetic retinopathy
How is diabetic retinopathy preventable?
Good glucose control
Tight BP control
Early detection and intervention
What are some retinal abnormalities in DM?
Microaneurysms (dots)
Blot haemorrhages
Hard exudates
Cotton wool spots
New vessel formation
Vitreous haemorrhage
Advanced eye disease
How is proliferative retinopathy treated?
Laser photocoagulation
destruction of peripheral ischaemic retina leads to reduction of endothelial growth factors and regression of new vessels
Who is cataract common in?
Elderly
What is the increased risk of cataract in DM?
2 fold
How does poor glycaemic control affect cataract?
Increases the risk
What is the treatment for cataract?
Surgery
Where does peripheral neuropathy typically affect in DM?
Feet
What can the feet be insensitive to in DM with damage?
Trauma
What are at a major risk in DM?
Feet
How is peripheral neuropathy managed?
Early detection
Self care education
Protection of feet
Pain relief
How are ulcer prevented in DM?
Foot screening and risk scoring Patient education on foot care Regular podiatry for those at high risk Trauma avoidance Fitted footwear
What are things you need to remember about feet and DM?
Impaired circulation Impaired sensation Impaired vision Foot shape changes Abnormal pressures
Means at risk feet!
Who are mainly affected by proximal motor neuropathy?
Elderly men
Type 2 DM
What are some presentations of autonomic neuropathy?
Erectile dysfunction Postural hypotension Gastric stasis and recurrent vomiting Diarrhoea Abnormal sweating Peripheral oedema Urinary retention
Which cranial nerves are mainly affected in mononeuritis?
III
IV
CI
How is early kidney disease detected?
Increase in microalbuminuria
Proteinuria
What is the screening test for microalbuminuria?
Urine sample
What is the definitive test for microalbuminaemia?
Timed over night urine collection for albumin excretion rate
What is diabetic nephropathy?
Damage to the structure and function of the meshwork of capillaries which make up the glomerulus
Glomeruli become leaky to larger molecules and eventual reduction in ability to filtrate blood.
How is early kidney disease managed?
Optimise glycaemic control
Tight BP control
ACE inhibitor therapy slows progression
CVS risk managed
