Microvascular Complications Flashcards
diabetes id the leading cause of what three ailments?
blindness
dialysis
amputation of the lower limbs
what are the types of neuropathy?
peripheral
autonomic
proximal
focal
describe peripheral neuropathy?
pain/loss of feeling in feet, hands
what are some complications of peripheral neuropathy?
charcot foot
painless trauma e.g stepping on nail without noticing
foot ulcers
what is another name for charcot foot?
osteoarthropathy
what is charcot foot?
disorgansied joint
loss of bone
multiple fractures
what can be done in charcot foot?
in acue painful hot joint use biphosphonate drugs
orthotic shoes
loss of blanace and coordination can occur in which neuropathy?
peripheral
describe autonomic neuropathy?
chnages in bowel, bladder function, sexual response, sweating, HR, BP
what effect does autonomic neuropathy have on the digestive system?
constipation/diarrhoea
gastroparesis (slow stomach emptying)- persistent nausea, vomiting, bloating
oesophagus nerve damage- can make swalowing difficult
does gastroparesis affect blood glucose?
yes- blood glucose levels can fluctuate widely due to abnormal food digestion
how do you treat gastroparesis?
improved glycaemic control
dietary- smaller portions
promotility drugs e.g metoclopramide
gastric pacemaker
botilnum toxin
which neuropathy causes abnormalities in the sweat glands?
autonomic
how are the sweat glands affected in autonomic neuropathy?
body cannot refulate its temperature so sweats at irregular time- profusely at night or while eating
how would you treat gustatory sweating in autonomic neuropathy?
topical glycopyrrolate
clonidine
botulinum toxin
describe proximal neuropathy?
pain in the thighs, hips, buttocks leading to weakness in the legs
what is teh name given to the weakiening of the legs in proximal neuropahthy?
amyotrophy
who is proximal neuropathy most common in?
elderly people with T2DM
proximal neuropathy is commonly associated with what?
weight loss
describe focal neuropathy?
sudden wekaness in one nerve or group of nerves casuign muscle weakness
what are some examples of focal neuropathy?
carpal tunnel
ulnar mono neuropathy
foot drop
bells palsy
cranial nerve palsy
focal neuropathy appears suddenly/gradually?
suddenly
what are the treatment options fro painful neuropathy?
amitriptyline
duloxetine
gabapentin
topical capsaican cream
what are some of the diagnostic tools used for neuropathy?
nerve conduction studies/ electromyography
heart rate variability
ultrasound
gastric emptying studies
what is diabeteic nephropathy?
progressive kidney disease caused by damage to capillaries in the kidneys glomeruli
diabetic nephropathhy is also known as?
kimmelsteil-Wilson syndrome
nodular glomerulosclerosis
what are the consequences of diabetic nephropathy?
development of hypertension
decline in renal funcion
accelerated vascular disease
which ratio is used to screen for diabetic kidney disease?
urinary albumin creatinine ratio (ACR)
what is the urine ACR in microalbuminuria for males and females?
males: 2.5-25
females: 3.5-35
what are ther risk factors for nephropathy progression?
hypetension
cholesterol smoking
glycaemic control
albuminuria
what is the target for BP in pateints with diabetes?
130/70
blood pressure should be maintained at _/_ in patients with diabetes?
<130/80mmHg
what eye pathologies do people with diabetes get?
retinopathy
cataract
glaucoma
acute hyperglycaemia (visual blurring)
what is a cataract?
clouding of the lens
what is a glaucoma?
increase in fluid pessure in the eye leading to optic nerve damage
which structure in the eye contains the most cones and allows us to see what is striaght in front of us?
macula
what are the stages of retinopathy?
mild non-proliferative (backgorund)
moderate non-proliferative
severe non-proliferative
proliferative
what are hard exudates in the eye?
lipid breakdown products
what are ischaemic areas in the eye called?
cotton wool spots
what are haemorrages in the eye called?
dot/flame/blot
what does IRMA stnad for?
Intra-retinal microvascular abnormalities
retinopathy and maculopathy are graded together/seperately?
seperately
mild background retinopathy encompasses what?
haemorrages and microaneurysms
pre proliferative retinopathy encompasses what?
haemorrages, micro aneurysms, hard exudates
severe non-proliferatve retinopathy encompasses what?
haemorrages, IRMA, venous bleeding
what is the mainstay treatment for retinopathy?
laser therapy
also vitrectomy, anti-VEGF injections
what is a vitrectomy?
surgical removal of the vitreous gel layer of the eye
how do anti- VEGF drugs work?
stopping vascular endothelial growth factor protein from working- prevents new blood vessel growth