Microvascular Complications of Diabetes Flashcards
What are the 3 main microvascular complications of diabetes?
- Retinopathy
- Nephropathy
- Neuropathy
Why do microvascular complications occur in diabetes?
Hyperglycaemia and hyperlipiaemia contribute to hypoxia, oxidative stress, inflammation, mitochondrial dysfunction and damaged nerves
What are the 4 types of neuropathy experienced in diabetes?
- Peripheral
- Autonomic
- Proximal
- Focal neuropathy
Neuropathy is more associated with which type of diabetes?
Type 1
Which things increase an individuals risk of developing neuropathy?
- Poor glycaemic control
- Increased length of time with diabetes
- Alcohol
- High cholesterol
- Smoking
- Inherited
- Mechanical injury
What is the most common neuropathy?
Peripheral
What is peripheral neuropathy and how does it present?
Distal or sensorimotor neuropathy
- Numbness/insensitivity
- Tingling/burning
- Sharp pains/cramps
- Sensitivite touch is maintained
- Loss of balance and coordination
What are some complications of peripheral neuropathy?
- Charcot foot
- Painless trauma
- Foot ulcer
What is a Charcot foot?
Progressive degeneration of a weight bearing joint, marked by bony destruction, bone resorption, and eventual deformity
Why is it so key that intensive treatment is started from the outset of diabetes?
Good glycaemic control from the start decreases long term risks
Why are injuries obtained from peripheral neuropathy particularly dangerous?
- They can worsen more than normal due to lack of pain
- Infection may occur and healing is poor
Which treatment may slow progression of Charcot foot?
Bisphosphonates
How may peripheral neuropathy be treated if it is painful?
- Amitriptyline
- Duloxetine
- Gabapentin
- Pregabalin
- Capsaicin cream
What is focal neuropathy?
Acute neuropathy affecting specific nerves, or groups of nerves most often in the head, torson or leg
How may focal neuropathy present?
- Inability to focus eye
- Double vision
- Aching behind eye
- Bell’s palsy
- Pain in thigh/chest/lower back/pelvis
- Pain on outside of foot
What is entrapment neuropathy and give an example?
Weakness in one nerve or group of nerves causing muscle weakness or pain
Carpal tunnel
What is proximal neuropathy and how does it present?
- Lumbosacral plexus neuropathy
- Femoral neuropathy
- Diabetic amyotrophy
Presents with:
- Pain in thighs, hips, buttocks or legs
- Usually occurs on one side
- More common in elderly T2DM
What is proximal neuropathy associated with?
Weight loss
What is autonomic neuropathy?
Neuropathy affecting the nerves of the autonomic nervous system
How may autonomic neuropathy present?
- Changes in HR/BP
- GI motility changes e.g. gastroparesis
- Sexual function change
- Urination
- Vision
How may gastroparesis present?
- Becoming full easily
- GORD
- Vomiting
- Diarrhoea
How is gastroparesis best treated?
- Improve glycaemic control
- Lower fat intake
- Smaller meals
- Promotility drugs
- Botox into sphincter
- Gastric pacemaker
Why may someone with diabetes experience “gustatory sweating”?
Autonomic neuropathy affecting sweat glands
How can autonomic neuropathy of sweat glands be treated?
- Topical glycopyrrolate
- Clonidine
- Botuliunum toxin (botox)
When autonomic neuropathy affects the heart how is blood pressure generally affected?
Postural hypotension
How does autonomic neuropathy affect the eyes?
Makes pupils less responsive to light
In terms of neuropathy, what may USS be used for in terms of diagnosis?
Bladder or urinary tract to show normal emptying and function
What is the use of nerve conduction studies or electomyography?
Determines type and extent of nerve damage in neuropathy
(how well muscles respond)
What does the FRAME project stand for?
Foot Risk Awareness and Management Education
What is diabetic nephropathy?
Progressive disease
Damage to capillaries surrounding glomeruli
Leads to scarring and renal failure
What are the key consequences of diabetic nephropathy?
- Hypertension
- Renal function decline
- Increased protein in urine
- Accelerated disease
When is nephropathy screened for?
At diagnosis and annually
How is nephropathy screened for?
Dipstick
What are the key risk factors for nephropathy progression?
- Hypertension
- Cholesterol
- Smoking
- Poor glycaemic control
- Albuminuria
What is the hypertension aim for all diabetic patients?
Should be below 130/80mmHg
(SIGN says 130/70mmHg is the goal)
What is the hypertension medication of choice?
ACEI
(ARB 2nd line)
What is the HbA1c of someone with good glycaemic control in diabetes?
<53mmol/mol
What are the main eye pathologies of diabetics?
- Retinopathy
- Cataracts
- Glaucoma
- Acute hyperglycaemia can cause visual blurring
What are the two key areas of the retina which become damaged in retinopathy?
Macula and fovea
Damage at the macula and fovea cause what type of visual disturbance?
Central vision
What is proliferative retinopathy?
The most severe type of retinopathy
Involves development of many new small and esily friable vessels which may bleed
How often are the retina of diabeteics screened?
Annually
How may a patient describe the experience of a severe proliferative retinopathy?
Curtain coming down over eye
(due to new vessel rupture)
What are some secondary complications of diabetic retinopathy?
- Glaucoma
- Retinal detachment
What are the treatments for retinopathy?
- Laser
- Virectomy
- Anti-VEGF injections
Which complication may occur in up to 50% of diabetic men?
Erectile dysfunction
Which medications may induced erectile dysfunction?
- Beta blockers
- Thiazide diuretics
- Antidepressants
- Sedatives
- Analgesics
