Microvascular Complications of Diabetes Flashcards
name chronic MACROvascular complications of diabetes?
IHD
stroke
name chronic MICROvascular complications?
neuropathy
nephropathy
retinopathy
is there a link between dementia and diabetes?
yes
what causes the oxidative stress in hyperglycaemia and hyperlipidaemia?
advanced glycaemic end products (AGEs) binding to receptors
what happens when an AGE binds to a RAGE?
get hypoxia which causes oxidative stress
then get inflammation causing mitochondrial dysfunction = microvascular complications
what type of neuropathy would cause changes in bowel/bladder function?
autonomic
what is amyotrophy and what type of neuropathy is it found in?
pain in the thighs, hips and buttocks = proximal
what neuropathy would a sudden presentation of carpal tunnel indicate?
focal
which of these is not a risk factor for neuropathy: alcohol smoking type 2 > type 1 increased length of diabetes
type 2>type 1
clinical presentation of peripheral neuropathy?
numbness
tingling/burning
sensitive to touch
loss of balance and coordination
treatment options for painful neuropathy?
amitryptiline and other complex analgesics
if localised, topical capsaicin cream
what nerves are most commonly affected by focal neuropathy?
head
torso
leg
where is pain commonly felt in focal neuropathy?
thigh chest lower back pelvis outside of foot
how does the eye present in focal neuropathy?
unable to focus
double vision
aching behind eye
what 4 symptomatic groups comprise proximal neuropathy
neuropathy of the lumbosacral plexus, the femur and diabetic amyotrophy, weight loss
what type of diabetes is proximal neuropathy more common in?
2
what are the roles of the nerves involved in autonomic neuropathy?
controlling: heart rate blood pressure gastric motility respiratory dunction sexual function vision urination
clinical presentation of autonomic neuropathy on GI system?
constipation and diarrhoea due to gastric infrequency
dysphagia from oesophageal nerve damage
gastroparesis = vomiting, bloating
what can gastroparesis do to blood glucose levels?
fluctuates them due to abnormal food digestion
how can you minimise symptoms of autonomic neuropathy on the GI system pharmacologically?
smaller, more frequent meals promotility drugs eg metoclopramide anti nausea drugs amitryptiline etc and NSAIDs for abdo pain botox
what is it called when you sweat heavily at night or while eating?
gustatory sweating
what condition can present with gustatory sweating and why?
autonomic neuropathy of nerves affecting sweat glands so body can’t control temperature
treatment for gustatory sweating?
glycopyrrolate
clonidine
botox
when would you suspect heart and blood vessel involvement in autonomic neuropathy?
postural hypotension
tachycardia constantly
how can you screen for neuropathy?
nerve conduction study
electromyography
USS/gastric emptying study for GI complications
what does a nerve conduction study do?
checks the type and extent of nerve damage
what does an electromyography do?
checks how well muscles respond to electrical signals by nearby nerves
diabetic nephropathy is made up of which 3 pathologies?
nephrotic sundrome
diffuse scarring of glomeruli
angiopathy of capillaries
consequences of diabetic nephropathy on the patient?
hypertension
decline in renal function
accelerated vascular disease
what test would indicate nephropathy?
urinary albumin creatinine ratio
what urine ACR would indicate microalbuminuria in females and males?
- 5-25 in women
3. 5-35 in men
what urine ACR would indicate macroalbuminuria in females and males?
male >25
female >35
what screenings should be done for a patient with microalbuminuria?
hypertension
IHD
retinopathy
PVD
risk factors for nephropathy progression?
hypertension cholesterol smoking glycaemic control albuminuria
what blood pressure should be maintained in all diabetics?
130/80mmHg
what drug should patients with microalbuminuria or proteinuria be started on?
ACEi or ARB
what HBA1c would indicate good glycaemic control that would prevent nephropathy?
<53mmol/mol
most common cause of kidney failure?
diabetes
what eye pathologies other than diabetic retinopathy do diabetics get?
cataract
glaucoma
acute hyperglycaemia
where is the retina located?
back of the eye
what do cotton wool spots on the eye indicate?
ischaemia
what are hard exudates on the eye made of?
lipid breakdown products
what does IRMA stand for in terms of the eye?
intra retinal microvascular abnormalities
when would you refer a retinopathy compared to just monitoring it?
if there is IRMA AND haemorrhages in both hemi fields of the eye
what is maculopathy?
lesions near the centre of the fovea of the eye
when would you refer a maculopathy?
if the lesions are smaller than 1 disc diameter of the centre of the fovea
what presentation would suggest mild background retinopathy?
haemorrhages and microaneurysms only
what symptom is seen in pre proliferative but not in mild retinopathy?
hard exudates
what type of retinopathy is IRMA and venous beading seen in?
severe non-proliferative
how can bleeding in the eye present?
floaters
sudden change in vision
how is retinopathy treated?
laser
vitrectomy
cause of erectile dysfunction in diabetic men?
vascular problems
autonomic neuropathy
drug causes of erecile dysfunction?
thiazides
beta blockers
CNS drugs
analgesics
