Macrovascular Complications of Diabetes Flashcards
What are the main macrovascular disease in diabetes?
Early widespread atherosclerosis
Ischaemic heart disease
Cerebrovascular disease
Peripheral vascular disease
What are the initial cells that develop in atherosclerosis?
Isolated foam cells
What are the stages of actherosclerosis?
Initial lesion Fatty streak Intermediate Atheroma Fibroatheroma Complicated
Whats is atherosclerosis associated with?
Dyslipidaemia (high LDL, low HDL)
When atheroma stage is reached, what is the growth in?
Smooth muscle
In earlier atherosclerosis what is growth in?
Fat
How is cardiovascular disease linked to diabetes?
Hyperglycaemia greatly increases the risk cardiovascular disease
Out of morbidity and mortality, what do microvascular and macrovascular complications cause?
Microvascular: causes morbidity
Macrovascular: causes morbidity and mortality
How does post MI survival differ in those living with diabetes vs without?
Survival is a lot lower if they are living with diabetes
How does risk of CHD differ with ethnicity?
Risk is a lot higher in some ethnicities eg higher in south asians than white caucasians
What is the major cause of morbidity and mortality in diabetes?
Ischaemic heart disease
What is the relationship between cerebrovascular disease and diabetes?
Occurs earlier in those living w diabetes
Is more widespread
What does renal artery stenosis contribute to?
Hypertension and renal failure
How does treatment for hyperglycaemia affect cardiovascular risks?
Doesn’t reduce the risk much, doesn’t reduce mortality either
How does renal artery stenosis occur?
Atherosclerosis
How does insulin resistance affect risk of complications?
Resistance even before hyperglycaemia contributes to increased risk
What are the non modifiable risk factors for macrovascular disease?
Age
Sex
Birth weight
Family history/genes
What are the modifiable risk factors for macrovascular disease?
Dyslipidaemia
High BP
Smoking
Diabetes
How do we treat those with diabetes to reduce risk of macrovascular complications?
Agressive treatment of multiple risk factors eg lipids, BP
How does life expectancy change when there is multifactorial intervention?
Many years of life are gained (7.9 yrs average)
What 2 main targets are managed to reduce macro vascular disease?
BP
Lipids
What complication of diabetes is a major reason for bedstay in the UK?
Diabetic foot
Describe the pathway to foot ulceration
Sensory neuropathy Motor neuropathy Limited joint mobility Autonomic neuropathy Peripheral vascular disease Trauma- a repeated and minor/discrete episode Reduced resistance to infection Other diabetic complications eg retinopathy
What are the 3 types of diabetic foot?
Neuropathic foot
Ischaemic foot
Neuro-ischaemic foot
Describe the neuropathic foot
numb warm dry palpable foot pulses ulcers at points of high pressure
Describe the ischaemic foot
cold
pulseless
ulcers at foot margins
Describe the neuro-ischaemic foot
numb cold dry pulseless ulcers at points of high pressure and foot margins
How do we assess the foot of a diabetic patient?
Appearance- is there deformity or callus
Feel it- it is hot or cold? is it dry?
Check for foot pulses
Check for neuropathy- vibration sensation, temp, ankle jerk reflex, fine touch sensation
What are some preventative measures for diabetic foot?
Control hyperglycaemia, lipids and BP
Wear suitable footwear always, check the insides of it
Cut nails straight
How is ulceration managed?
Relief of pressure via bed rest Antibiotics Amputation Debridement Revascularisation
Where on the foot is affected by osteomyelitis?
Forefoot: MIPs and IPs
Hindfoot: calcaneus
Where on the foot is affected by active charcot?
Midfoot and subarticular
Out of active charcot and osteomyelitis which has ulcer?
Osteomyelitis
Out of active charcot and osteomyelitis which has hot red foot?
Both
What will show on MRI for osteomyelitis
Marrow oedema in forefoot and hindfoot near ulcer
What will show on MRI for active charcot
Marrow oedema and midfoot subchondral
Will active charcot or osteomyelitis show on xray?
Not in the first few weeks
