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Endocrinology > Macro/Microcomplications of Diabetes > Flashcards

Macro/Microcomplications of Diabetes Flashcards

1
Q

WHat are microvascular complications?

A

Retinopathy

Nephropathy

neuropathy

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2
Q

What are macrovascular complication examples?

A

cerebrovascular disease

ischaemic heart disease

peripheral vascular disease

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3
Q

What relationship is there between HbA1c and complications?

A

If the management of hyperglycaemia is not good the relative risk for microvasculature complications increase

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4
Q

What is the target of HbA1c which reduced microvascular risk?

A

53 mmol/mol

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5
Q

What relationship is there between hypertension and complications?

A

Rising systolic BP and risk of MI and and microvascular complications

so need to control both hba1c and BP

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6
Q

What other factors ca be risk factors related to the development of microvascular complications?

A

Duration of diabetes

Smoking - endothelial dysfunction

Genetic factors

Hyperlipidaemia

Hyperglycaemic memory - inadequate early control can cause high risk later even if hBA1c has improved

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7
Q

What is Diabetic retinopathy?

A

Visual loss in people with diabetes
blindness in the people of working age

,,,

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8
Q

Why is screening for retinopathy vital?

A

Need to screen them reguarly because diabetic retinopathy is asymptomatic in early stages

So test for background retinopathy = only stage where steps can be taken before treatment ( would improve hbA1c + good blood pressure <130/80 )

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9
Q

What are the three stages of retinopathy?

A
  • Pre-proliferative
  • Proliferative
  • (maculopathy)
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10
Q

What is maculopathy?

A

Will see hard exudates / eodema near macula

Same has retinopathy but near macula

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11
Q

What treatments are used for retinopathy?

A

Before new vessel growth occurs in retina due to ischaemia and these can bleed easily

Panretinal photocoagulation * px will lose some vision due to this treatment

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12
Q

How to treat maculopathy?

A

Oedema: Anti-VEGF injections directly into the eye (VEGF: vascular endothelial growth factor)
Grid photocoagulation

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13
Q

Why is diabetic nephropathy important?

A

associated with progression to end-stage renal failure requiring haemodialysis

Associated with an increased risk of CVS

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14
Q

How to diagnose kidney damage?

A

Urine albumin:creatinine ratio is calculated - ACR

Microalbuminura >2.5 mg/mmol
Protein = ACR >30
Nephrotic range >3000mg/24hours

Look for increased blood pressure, decreased renal function via eGFR, peripheral oedema

= px may be asymptomatic but do look into cardiac risk and drugs

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15
Q

How is proteinuria a sign for nephropathy?

A

GLOMERULUS AFFECTED BY HYPERGLYCAEmIA AND hyperT

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16
Q

Why may ace-inhibitors be given?

A

Prevent angiotenin II

17
Q

What does angiotensin 2 receptor blocker do

A

… ARB

18
Q

If a px has microalbumin/proteinuria and are normotensive how should they be treated?

A
  • ACEi or ARB should be given

no benefit to giving both so give one

19
Q

What is Diabetic Neuropathy?

A

Diabetes is Most common cause of peripheral neuropathy and hence lower limb amputation

Neuropathy results when vasa nervorun get blocked

20
Q

What are Vasa nervorum?

A

Small vessels supplying nerves are called vasa nervorum

21
Q

What are the risk factors for diabetic neuropathy?

A
  • Age
  • Duration
  • Poor glycaemic control
  • Height (taller ppl longer nerves more vulnerable )
  • smoking
  • presence of diabetic retinopathy - already have microvascular damage
22
Q

Why is diabetic neuropathy common in feet?

A

Longest nerve supplies feed

23
Q

What are the issues with neuropathy?

A
  • Pain
  • Danger is that px will not sense injury to the foot e.g. stepping on nail or wound festering and alcerations can result in amputation
24
Q

In an annual foot check what to look out for?

A
  • foot deformity
  • ulceration
  • assess sensation
  • assess foot pulses
25
Q

Why may risk of foot ulceration increase if a/ b?

A

a = reduced sensation to feet

b = poor vascular supply to feet

if both sensations and blood supply so wound wont heal

26
Q

How to manage peripheral neuropathy?

A

regular inspection of feet by affected individual

Good footwear

avoid barefoot walking

podatry and chrpopody if needed

27
Q

How to manage peripheral neuropathy with ulcerations?

A
  • MDT diabetes foot clinic
  • Offloading
  • Revascularisation if concomintant PVD
  • antbiotics if infected
  • arthotic footwear
  • amputation if all else fails
28
Q

What mononeuropathy can occur?

A

usually motor loss e.g. wrist drop, foot drop

double vision due to 3rd nerve palsy

29
Q

What is autonomic neuropathy?

A

Damage to sympathetic and parasmpathetic nerves innverating GI, Bladder and cardiovascular system

30
Q

What GI effects in autonomical neuropathy?

A

Delayed gastric emptying causing nauseia and vomiting

hard to give short acting insulin

constipation / nocturnal diarrhoea

31
Q

What cardiovascular effects in autonomic neuropathy?

A

postural hypotension
collapsing on standing

Cardiac autonomic supply affected: sudden cardiac death

32
Q

What are the macrovascular complication?

A

Cerebrovascular disease
Ichaemic heart disease
Peripheral vascular disease

  • need to look at other factors for these dieseases not just the glycaemic index
33
Q

What are the non-modifiable risk factors for macrovascular disease?

A

Age
Sex
Birthweight
FH/genes

34
Q

What are modifiable risk factors which can be changed for macrovascular disease?

A 
Dyslipidaemia
Hypertension
smoking
diabetes mellitus
central oebsity
35
Q

How to manage cardiovascular risk in diabetes?

A

Smoking support
Blood pressure 140/80 or lower for micro

Lipid profile of total chol <4, LDL<2

discuss lifestyle intervention with treatments for weight

Annual urine ABR ratio screening

36
Q

Why do they tell px to get to 53 not 48?

A

Because 48+ is diagnosis but for a person with diabetes 53 is a good number

Endocrinology (22 decks)

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