Macrovascular complications Flashcards
Explain the progression of atherosclrosis
What is the main reason for death and associated mobidities in diabetis?
Mainly macrovascular complications account for it:
- 80% of associated deaths
- many associated complications
What is the role of blood lipid levels in the deveopment of atherosclerosis?
It is super important and the drivine factor for atherosclerosis
What are the risk factors for development of atherosclrosis?
- High glucose levels
- low HDL
- Hypertension
- waist circumference
In research (no clinical relevance):
- Insulin resistance
Inflammation CRP
Adipocytokines
Urine Microalbumin
What are the main macrovascular complications in someone with DM?
- Ishcaemic heart disease
- Cerebrovascular
- Renal artery stenosis
- Peripheral vascular disease
Explain the connection between IHD and DM
With DM the risk for IHD +MI increases significantly –> causes over 50% of total deaths in Diabetis
–> Not the blood sugar levels are the main problem, but the dyslipidaemia and HTN
What are the modifiable risk factors for IHD?
Modifiable
•Dyslipidaemia
•High blood pressure
- Smoking
- Diabetes (Type 2)
Which parts of the body are affected by macrovascular disease in diabetis?
It affects all arterial beds in the body –> multisystemic disease
What are the main complcations of diabetis predisposing to diabetic foot disease?
- Neuropathy
- Peripheral vascular diseae
Explain the epidemiology of diabetic foot disease and its influence on the NHS:
- About 5-7 % of people with diabetis present with diabetic ulceration
- Risk of amputation up to 60× in diabetes. Poor subsequent prognosis
- •10 % of NHS bed occupancy due to diabetes related problems (50% foot disease)
Explain the pathway to foot ulceration
- Sensory neuropathy (e.g. shoes don’t fit properly–> damage feet)
- Motor neuropthy
- leading to loss of shape of foot
- direct harm: knuckles of feet at risk
- indirect: problems in weith balance in diabetis –> too much weight on great toe metatosal head (starting point for 50% of diabetic feet
- leading to loss of shape of foot
- Glycosilation of tendons –> limited joint motility–> no proper bending of feet in walking
- Autonomic neuropathy
- dry feet due to loss of innervation to sweat and grease glands
- Peripheral vascular disease
- decreased blood supply to feet
- 1.Trauma - repeated minor/discrete episode
- cannot senst floor/retinopahty?
- 2.Reduced resistance to infection
- 3.Other diabetic complications eg. retinopathy
What are the different types of foot ulceration in a diabetic foot?
- The neuropathic foot - numb, warm, dry, palpable foot pulses, ulcers at points of high pressure loading.
- The ischaemic foot - cold, pulseless, ulcers at the foot margins.
- The neuro-ischaemic foot - numb, cold, dry, pulseless, ulcers at points of high pressure loading and at foot margins
What is a neuropathic foot ulcer?
- numb –> no sensation
- warm
- dry (no autonomic supply)
- food pulsure palpable
- ulcers form at points of high loading
What is an ischaemic foot?
- cold
- no palpable pulse
- ulcers are at extremities (toes)
What is a neuro-ischaemic foot?
Has lost both: sensory innervation and blood supply
- numb
- cold
- dry
- pulseless
- ulcers at points of high pressure loading and at foot margins.
How would you assess the foot of a diabetic foot?
Just describe everything:
- Appearance - ? Deformity ? Callus
- Feel - ? Hot/cold ? Dry
- Foot pulses
- –dorsalis pedis / posterior tibial pulse
- Neuropathy
- –vibration sensation, temperature, ankle jerk reflex, fine touch sensation
How do you manage a patient with a diabetic foot?
Just like every other management:
- Hyperglycaemia
- Hypertension
- Dyslipidaemia
- Stop smoking
- Education
How could you prevent the developement of a diabetic foot?
- 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
- attend chiropodist
- cut nails straight across
- care with heat
- never walk barefoot
Who is involved in the care of a diabetic patient with a diabetic foot?
Multidisciplinary team approach:
How do you manage a diabetic foot?
- Relief of pressure (because loss of sensation no pain tells patient to stop)
- –bed rest (risk of DVT, heel ulceration)
- –redistribution of pressure/total contact cast
- Antibiotics, possibly long term
- Debridement (remove of necrotic tissue)
- Revascularization
- –angioplasty
- –arterial bypass surgery
- Amputation
How does a diabetic foot look like?
Charcow foot: Shape deformaty:
- ulceration form
- expecially in middle of the foot
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