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brs2 > micro and macrovascular complications of diabetes > Flashcards

micro and macrovascular complications of diabetes Flashcards

1
Q

what are the 3 microvascular complications

A

retinopathy
nephropathy
neuropathy

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2
Q

what are the 3 macrovasc complication

A

cerebrovascular disease
ischaemic heart disease
peripheral vascular disease - usualy affects feet

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3
Q

what is the target hba1c to reduce risk of microvascular complications

A

53 mmol/mol

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4
Q

what is also a major factor that increases complication risk

A

hypertension

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5
Q

what are some other factors related to development of microvascular complications

A 
duration of diabetes
smoking - endothelial dysfunction
genetic factors
hyperlipidaemia
hyperglycaemic memory
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6
Q

what is the mechanism of damage following hyperglycaemia and hyperlipidaemia

A
  1. hypoxia, increased formation of mitochondrial superoxide free radicals in endothelium = oxidative stress and generation of glycated plasma proteins to form advanced glycation end products (AGEs)
  2. causes activation of inflammatory signalling cascades and pro inflammatory end products
  3. damaged endothelium results in leaky capillaries and ischaemia
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7
Q

what is diabetic retinopathy the main cause of

A

visual loss in people with diabetes

blindness in people of working age

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8
Q

why is screening for diabtetic retinopathy required

A

early stages are asymptomatic

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9
Q

how often should patients with diabetes get retinal screening

A

anually

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10
Q

what is retinal screening

A

taking a picture of the back of the eye

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11
Q

what is the first stage of diabetIc retinopathy

A

BACKGROUND RETINOPATHY

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12
Q

what can you expect to see in background retinopathy on screening

A

hard exudates - cheese colour,lipids

dots - microaneurysms and blot haemorrhages

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13
Q

what is the second stage of retinopathy

A

pre proliferative retinopathy

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14
Q

what can you expect to see in pre proliferative retinopathy on screening

A

more significant haemorrhages

cotton wool spots called soft exudates - retinal ischaemia

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15
Q

what is large stage of retinopathy

A

proliferative retinopathy

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16
Q

what can you expect to see in proliferative retinopathy on screening

A

visible new vessels - arise due to hypoxia

on disc or elsewhere in retina

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17
Q

what is the problem with the new vessels formed

A

very fragile and can be easily damaged

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18
Q

what is maculopathy

A

disease of macula

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19
Q

what can you expect to see in maculopathy

A

hard exudates/ oedema near macula
same as background retinopathy but near macula
can threaten vision

20
Q

what is the first line of treatment for any retinopathy

A

improve hba1c
stop smoking
lower lipids
good blood pressure control

21
Q

what is the treatment for pre proliferative or proliferative retinopathy

A

panretinal photocoagulation

22
Q

treatment for maculopathy

A

oedema - anti VEGF injections directly into eye
vegf = vascular endothelial growth factor

or use grid photocoagulation

23
Q

what is diabetic nephropathy

A

kidney disease

24
Q

why is diabetic nephropathy important

A

associated with progression to end stage renal failure requiring haemodialysis
associated with increased risk of cvd
healthcare burden

25
Q

how can we diagnose diabetic nephropathy

A

1.progressive proteinuria - urine albumin: creatinine ratio, ACR > 30mg/mmol
2. microalbuminuria >2.5 mg/mmol
3. increased bp
4. deranged renal function egfr
5. advanced - peripheral oedema
nephrotic range >3000mg/24hr

26
Q

what is the mechanism of diabetic nephropathy

A 
hyperglycaemia and hypertension causes glomerular hypertension
this causes proteinuria
glomerular and interstitial fibrosis
glomerular filtration rate decline
renal failure
27
Q

what are ACEinhibitors

A

antihypertensives which block ace

28
Q

what are ARBs

A

angiotensin receptor blockers are also antihypertensives which block angiotensin receptors

29
Q

effect of angiotensin 2

A

aldosterone release and vasoconstriction

30
Q

what med should you give to those with diabetic nephropathy

A

acei (- prils) or arbs ( -sartans)

31
Q

how can we manage diabetic nephropathy

A 
aim for tighter glycaemic control
acei/arbs even if normotensive but has microalbuminuria
reduce bp
stop smoking
start sglt2 inhibitor if type 2?
32
Q

what is the earliest feature in diabetic nephropathy

A

microalbuminuria

33
Q

what is diabetic neuropathy

A

small vessels supplying vasa nervorum ( nerves) become blcoked

34
Q

what is neuropathy serious

A

no sensation and can lead to lower limb amputation as you dont feel injury

35
Q

what are some risk factors for neuropathy

A 
age
duration of diabetes
poor glycaemia control
height
smoking
presence of diabetic retinopathy
36
Q

where is neuropathy more common

A

feet - as longest nerve supply

can be painful

37
Q

what takes place during annual foot check for patients

A

look for foot deformity/ulceration
assess sensation - monofilament, ankle jerks
assess foot pulses - dorsalis pedis and posterior tibial

38
Q

what is the risk of reduced sensation and vascular supply to feet

A

foot ulceration

as no blood flow to tissues too

39
Q

how can we manage diabetic foot disease without ulceration

A

regular inspection of feet
good footwear
avoid walking barefoot
podiatry/chirpody if needed

40
Q

how can we manage diabetic foot disease with ulceration

A 
multidisciplinary diabetes foot clinic
offloading
revacularisation 
antibiotics 
orthotic footwear
amputation if all else fails
41
Q

what are some neuropathies

A

mononeuropathy
usually sudden motor loss e.g wrist drop, foot drop
cranial nerve palsy
double vision due to 3rd nerve palsy

42
Q

what is autonomic neuropathy

A

damage to sympathetic and parasympathetic nerves innervating gi tract, bladder and cv system

43
Q

what are some gi tract features we can observe in autonomic neuropathy

A 
delayed gastric emptying
nausea
vomitting
constipation
noctural diarrhoea
44
Q

what are some cardiovascular features we can observe in autonomic neuropathy

A

postural hypotension
cardiac autonomic supply
sudden cardiac death

45
Q

what are some non modifiable risk factors for macrovascular disease

A

age
sex
birth weight
fh/genes

46
Q

what are some modifiable risk factors for macrovascular disease

A 
dyslipidaemia
hypertension
smoking
diabetes mellitus
central obesity
47
Q

how can we manage cardiovascular risk in dm

A 
support to quit smoking
lower bp
lipid profile
weight - lifestyle intervention
annual urine microalbuminuria screen

brs2 (65 decks)

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