Micro and Macrovascular complications of Diabetes Flashcards
What are microvascular complications of diabetes?
Specific to diabetes
Increased thickening of the basement membrane and increased permeability of capillaries results in symptoms
Often due to poor glycaemic control
Retinopathy, Nephropathy and Neuropathy
What is diabetic retinopathy?
Most common cause of blindness in those <65
Risk factors
- poor glycaemic control
- smoking
- HTN
- pregnancy
Can be proliferative or non proliferative
What is non proliferative diabetic retinopathy?
Occurs after having diabetes for 8-10 years
Often asymptomatic
Mild
-<1 microaneurysm
Moderate
- Hard exudates (due to increased permeability)
- cotton wool spots
- microaneurysm
- dot and blot haemorrhages
Severe
- haemorrhages or microaneurysm in all 4 quadrants
- venous beading in at least 2 quadrants
What is proliferative diabetic retinopathy?
Neovascularisation to supply oxygen to ischaemic areas
These new blood vessels are fragile and prone to bleeding
Can cause vitreous haemorrhage
Managed with pan retinal photocoagulation
What is diabetic neuropathy?
Group of different disorders characterised by damage to the nerves due to poor glycaemic control
Loss of sensation with normal motor
What is symmetrical polyneuropathy?
Glove and stocking distribution
Patient describes it as walking on cotton wool
Vibration, temperature and deep pain lost first
Intraosseous wasting of small muscles leads to abnormal foot shape and weight bearing resulting in ulcers
What is acute painful neuropathy?
Painful burning pain in feet/shins and anterior thighs
Due to poor glycaemic control
Worse at night
Resolves in 3-12months with good glycaemic control
What are other forms of diabetic neuropathy?
Mononeuropathy
-cranial nerve lesions
Diabetic amyotrophy
-painful wasting of muscles esp quadriceps
Autonomic neuropathy
-postural hypotension, erectile dysfunction, ejaculatory failure, horners syndrome
What is diabetic nephropathy?
Damage to capillaries in glomeruli leads to increased permeability and therefore secretion of albumin in the urine
Called microalbuminuria
Ultimately leads to CKD
Should monitor urine levels every 6 months
HTN is a contributing factor to this so ACEi if hypertension
If albumin in urine then ACEi should be commenced regardless of BP
What are macrovascular complications?
Diabetes can increase the risk of atherosclerosis
Increased risk of MI/stroke/amputation
Peripheral ischaemia can cause ulcers and diabetic foot
Must control CV risk factors and optimise glycaemic control
