Macrovascular Complications Flashcards
Macrovascular complications of diabetes refers to… (4)
- Early widespread atherosclerosis
- Ischaemic Heart Disease
- Cerebrovascular disease
- Peripheral vascular disease
Sequence of atherosclerosis? start with initial lesion
Initial lesion Fatty streak Intermediate lesion Atheroma Fibroatheroma Complicated lesion
Things that damage arteries? (9)
Fasting glucose above 6mmol/L HDL less than 1 Waist circumference Hypertension Insulin resistance Inflammation CRP Adipocytokines Urine Microalbumin
HYPERGLYCAEMIA IS ASSOCIATED WITH SIGNIFICANTLY REDUCED XX
Life expectancy
MICROVASCULAR DISEASE CAUSES X; MACROVASCULAR DISEASE CAUSES X AND Y
X - morbidity
Y - mortality
MACROVASCULAR DISEASE IS A X DISEASE AND IS COMMONLY PRESENT IN Y ARTERIAL BEDS
X - SYSTEMIC
Y - MULTIPLE
The major cause of morbidity and mortality in diabetes are…
- ISCHAEMIC HEART DISEASE
Difference between diabetic and normal CEREBROVASCULAR DISEASE
Occurs much earlier in diabetics
PERIPHERAL VASCULAR DISEASE contributes to …
diabetic foot problems with neuropathy
- RENAL ARTERY STENOSIS may contribute to…
hypertension and renal failure
TREATMENT TARGETED TO HYPERGLYCAEMIA ALONE HAS X EFFECT ON INCREASED RISK OF CVD
MINOR
What must be managed to prevent diabetic macrovascular disease
MULTIPLE RISK FACTORS
what contributes first to diabetic macrovascular disease, insulin resistance or hyperglycaemia
insulin resistance
NON-MODIFIABLE RISK FACTORS FOR MACROVASCULAR DISEASE:
Age
sex
birth weight
Family history/Genes
MODIFIABLE RISK FACTORS FOR MACROVASCULAR DISEASE:
Dyslipidaemia
High blood pressure
Smoking
Diabetes
COMPLICATIONS OF DIABETES PREDISPOSING TO FOOT DISEASE?
- NEUROPATHY; sensory, motor and autonomic
2. PERIPHERAL VASCULAR DISEASE
8 STEPS IN THE PATHWAY TO FOOT ULCERATION: (starting with distal sensory neuropathy)
- Distal sensory neuropathy
- Motor neuropathy
- Limited joint mobility- can’t put hands flat together in prayer position
- Autonomic neuropathy
- Peripheral vascular disease
- Trauma - repeat§ed minor/discrete episode
- Reduced resistance to infection due to affected white cell function
- Other diabetic complications e.g. retinopathy
Describe THE NEUROPATHIC FOOT: (5)
Numb, warm, dry, palpable foot pulses, ulcers at points of high pressure loading
Describe THE ISCHAEMIC FOOT: (3)
Cold, pulseless, ulcers at the foot margins
Describe THE NEURO-ISCHAEMIC FOOT: (5)
Numb, cold, dry, pulseless, ulcers at points of high pressure loading and foot margins
What 4 things do you look for when assessing the neuropathic foot
- Appearance- Deformity, callus
- Feel- Hot/cold, dry
- Foot pulses- dorsalis pedis, posterior tibial pulse
- Neuropathy- vibration sensation, temperature, ankle jerk, fine touch sensation
PREVENTATIVE MANAGEMENT FOR NEUROPATHIC FOOT (8)
- Control diabetes
- Inspect feet daily
- Have feet measured when buying shoes
- Buy shoes with laces and square toe box
- Inspect inside of shoes for foreign objects
- Cut nails straight across
- Care with heat
- Never walk barefoot
MANAGEMENT OF FOOT ULCERATION: (5)
- Relief of pressure: Bed rest (risk of DVT, heel ulceration) Redistribution of pressure Total contact cast - Antibiotics, possibly long term Due to osteomyelitis risk - Debridement - Revascularisation: Angioplasty Arterial bypass surgery - Amputation
