Macro/Microcomplications of Diabetes Flashcards
WHat are microvascular complications?
Retinopathy
Nephropathy
neuropathy
What are macrovascular complication examples?
cerebrovascular disease
ischaemic heart disease
peripheral vascular disease
What relationship is there between HbA1c and complications?
If the management of hyperglycaemia is not good the relative risk for microvasculature complications increase
What is the target of HbA1c which reduced microvascular risk?
53 mmol/mol
What relationship is there between hypertension and complications?
Rising systolic BP and risk of MI and and microvascular complications
so need to control both hba1c and BP
What other factors ca be risk factors related to the development of microvascular complications?
Duration of diabetes
Smoking - endothelial dysfunction
Genetic factors
Hyperlipidaemia
Hyperglycaemic memory - inadequate early control can cause high risk later even if hBA1c has improved
What is Diabetic retinopathy?
Visual loss in people with diabetes
blindness in the people of working age
,,,
Why is screening for retinopathy vital?
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 )
What are the three stages of retinopathy?
- Pre-proliferative
- Proliferative
- (maculopathy)
What is maculopathy?
Will see hard exudates / eodema near macula
Same has retinopathy but near macula
What treatments are used for retinopathy?
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
How to treat maculopathy?
Oedema: Anti-VEGF injections directly into the eye (VEGF: vascular endothelial growth factor)
Grid photocoagulation
Why is diabetic nephropathy important?
associated with progression to end-stage renal failure requiring haemodialysis
Associated with an increased risk of CVS
How to diagnose kidney damage?
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
How is proteinuria a sign for nephropathy?
GLOMERULUS AFFECTED BY HYPERGLYCAEmIA AND hyperT
Why may ace-inhibitors be given?
Prevent angiotenin II
What does angiotensin 2 receptor blocker do
… ARB
If a px has microalbumin/proteinuria and are normotensive how should they be treated?
- ACEi or ARB should be given
no benefit to giving both so give one
What is Diabetic Neuropathy?
Diabetes is Most common cause of peripheral neuropathy and hence lower limb amputation
Neuropathy results when vasa nervorun get blocked
What are Vasa nervorum?
Small vessels supplying nerves are called vasa nervorum
What are the risk factors for diabetic neuropathy?
- Age
- Duration
- Poor glycaemic control
- Height (taller ppl longer nerves more vulnerable )
- smoking
- presence of diabetic retinopathy - already have microvascular damage
Why is diabetic neuropathy common in feet?
Longest nerve supplies feed
What are the issues with neuropathy?
- 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
In an annual foot check what to look out for?
- foot deformity
- ulceration
- assess sensation
- assess foot pulses
Why may risk of foot ulceration increase if a/ b?
a = reduced sensation to feet
b = poor vascular supply to feet
if both sensations and blood supply so wound wont heal
How to manage peripheral neuropathy?
regular inspection of feet by affected individual
Good footwear
avoid barefoot walking
podatry and chrpopody if needed
How to manage peripheral neuropathy with ulcerations?
- MDT diabetes foot clinic
- Offloading
- Revascularisation if concomintant PVD
- antbiotics if infected
- arthotic footwear
- amputation if all else fails
What mononeuropathy can occur?
usually motor loss e.g. wrist drop, foot drop
double vision due to 3rd nerve palsy
What is autonomic neuropathy?
Damage to sympathetic and parasmpathetic nerves innverating GI, Bladder and cardiovascular system
What GI effects in autonomical neuropathy?
Delayed gastric emptying causing nauseia and vomiting
hard to give short acting insulin
constipation / nocturnal diarrhoea
What cardiovascular effects in autonomic neuropathy?
postural hypotension
collapsing on standing
Cardiac autonomic supply affected: sudden cardiac death
What are the macrovascular complication?
Cerebrovascular disease
Ichaemic heart disease
Peripheral vascular disease
- need to look at other factors for these dieseases not just the glycaemic index
What are the non-modifiable risk factors for macrovascular disease?
Age
Sex
Birthweight
FH/genes
What are modifiable risk factors which can be changed for macrovascular disease?
Dyslipidaemia Hypertension smoking diabetes mellitus central oebsity
How to manage cardiovascular risk in diabetes?
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
Why do they tell px to get to 53 not 48?
Because 48+ is diagnosis but for a person with diabetes 53 is a good number
