Microvascular Complications Flashcards
What are diabetic complications in vasculature
CVD, strokes, diabetic retinopathy, diabetic nephropathy, peripheral vascular disease, Diabetic Peripheral Neuropathy (DPN)
Diabetic neuropathy affects 30-__% of patients with diabetes
50
What does neuropathy cause?
Pain (burning, tingling, paraesthesia)
Autonomic dysfunction (diarrhoea, constipation, incontinence, erectile dysfunction, gastroparesis, hypotension)
Foot Ulceration (numbness, infection, amputation)
Cannot reverse nerve damage
DPN has typical g___ and s___ distributions of sensory loss
glove and stocking
Microvascular complications are preventable by rigorous g___ control
glycaemic
Treatment of Diabetic Painful neuropathy
Good glycaemic control
Antidepressants
Anticonvulsants
Opioids (less prescribed)
Psychological interventions
Diabetic Foot Ulceration (DFU)
Occurs in 15% of people with DM
Hospital bed occupancy
Expensive
2 times mortality in those with DFU
Pathway to Diabetic amputation
Neuropathy or vascular disease
Trauma
Ulcer
Failure to heal
Infection
Amputation
For annual diabetic check, always check….
the feet by taking off the shoes
How can lack of autonomic function contribute to foot amputation?
No sweating, dry skin, cracked skin, Increased risk of infection
Therefore encourage moisturise feet.
Diabetic peripheral neuropathy screening tests
Test sensation using 10 gm monofilament neurotips
Vibration perception using tuning fork and biothesiometer
Ankle reflexes
Symptoms of peripheral vascular disease
Intermittent claudication (cramps in lower limbs when walking)
Rest pain (at night, decreased perfusion, wake up with pain)
Signs of vascular disease
Diminished pedal pulses
Coolness of the feet and toes
Poor skin and nails
Absence of hair on feet and legs
Advice/treatment given to those with peripheral vascular disease
Quit smoking
Walk through pain
Surgical intervention
Eye screening
Annual scan for diabetics
2 field retinal photography
Reports sent to GP and patients
How does retinopathy occurs in diabetic patients?
High blood sugar causes basement membrane thickening
Pericyte loss
Reduces junctional contact with endothelial cells
Leakage of protein and fat into retina
occlusion of retinal arteries causing ischaemia
Growth factors released to make new blood vessels
new vessels are abnormal/weak and be damaged and break causing haemorrhage - bleeding in retina.
Treatment for diabetic retinopathy
Laser Therapy
Burn off the new abnormal blood vessels
Can be focal to macula or peripheral scatter
Risks of laser therapy
Over 50% notice difficulty with night vision
1/5 lose peripheral vision
Temporary drop in visual acuity
Over __% of severe sight loss is prevented by laser
90%
Diabetes is the main cause of e___ s____ r____ d___ (ESRD)
End Stage Renal Disease
Diabetic nephropathy is characterised by progressive kidney f___ resulting in loss of function
fibrosis
DN is hallmarked by p______ followed by decline in renal function.
proteinuria
DN is major risk factor for…
CVD
Definition of Chronic kidney disease
Decreased eGFR (<60ml/min/m2)
and
Albuminuria A2-A3 (>30 mg/g)
Treatment for diabetic CKD
RAS blockers
SGLT2 inhibitors
Finerenone
FLP-1RAs
Cholesterol control
Proteinuria control
