Microvascular Complications of Diabetes Flashcards
what complications can occur from diabetes?
diabetic retinopathy
diabetic nephorpathy
peripheral vascular disease
stroke
cardiovascular disease - leading cause of mortality
what are the clinical consequences of diabetic neuropathy?
pain- burning
including painful neuropathic symptoms, autonomic neuropathy- and its manifestations; and insensitivity that results in foot ulceration and amputation.
describe how diabetic peripheral neuropathy progresses
starts in the toes and gradually marches proximally in a stocking distribution. Once it is well established in the lower limbs the upper limbs are affected.
what does diabetic neuropathy cause
Significant motor deficit is not common.
Painful symptoms are present in about a third.
Mortality amongst our neuropathic patients is high and the cause of death is often cardiovascular disease.
what are the risk factors for diabetic neuropathy?
baseline glycaemic control,
change in glucose control over the 7 years and duration of diabetes, traditional markers of macrovascular disease and insulin resistance including hypertension,
smoking,
BMI,
TG
and cholesterol were significant independent risk factors for the development of neuropathy.
what are the different measures of treatment of diabetic painful neuropathy?
Good glycaemic control
Tricyclic antidepressants / SSRIs
Anticonvulsants (carbamazepine, Gabapentin)
Opiods (Tramadol, oxycodone)
IV lignocaine
Capsaicin
Transcutaneous nerve stimulation / acupuncture / spinal cord stimulators
Psychological interventions / hypnosis
what is the cause of diabetic amputation?
neuropathy or vascular disease—> trauma—->ulcer—–>failure to heal—> infection—-> amputation
what are the two principle factors that contribute to the high risk diabetic foot?
- Peripheral neuropathy – damage to the nerves that serve the lower limbs and hands.
- Peripheral vascular disease, which affects the larger vessels of the lower limbs
what nerves do peripheral neuropathy effect?
sensory nerves
ALSO MOTOR NERVES causing the weakness in the intrinsic muscles of the feet, leading to contraction of the muscles and clawed toes.
what are the three Diabetic peripheral neuropathy screening tests?
- Test sensation
10 gm monofilament
neurotips - Vibration perception
Tuning fork
biothesiometer - Ankle reflexes
define peripheral vascular disease
Decreased perfusion due to macrovascular disease
Sites: more distal
describe clinical presentation of peripheral vascular disease clinical presentation
Intermittent claudication
Rest pain
what are the signs of vascular disease?
Diminished or absent pedal pulses
Coolness of the feet and toes
Poor skin and nails
Absence of hair on feet and legs
what are two non invasive methods to evaluate peripheral vascular disease?
Methods
Doppler pressure studies (ABI)
duplex arterial imaging/MRA
Rationale
identify and confirm disease
predict healing or determine need for surgical intervention
what is the treatment used for peripheral vascular disease?
Quit smoking
Walk through pain
Surgical intervention
