Microvascular Complications of Diabetes Flashcards
what are the macrovascular complications of diabetes
IHD, stroke
what are all the chronic complications of diabetes
IHD, stroke
neuropathy, nephropathy, retinopathy
cognitive dysfunction/ dementia
erectile dysfunction
psychiatric
what is the pathophysiology of microvascular complications
hyperglycaemia and hyperlipidaemia = -AGE-RAGE pathway -hypoxia -oxidative stress -inflammation -mitochondrial dysfunction
what are the four types of neuropathy
peripheral, autonomic, proximal, focal neuropathy
what is peripheral neuropathy
pain/loss of feeling in feet/ hands
what is autonomic neuropathy
changes in bowel, bladder function, sexual response, sweating, heart rate, blood pressure
what is proximal neuropathy
pain in the thighs, hips, buttocks leading to weakness in the legs (amyotrophy)
what is focal neuropathy
sudden weakness in one nerve or a group of nerves causing muscle weakness or pain (carpal tunnel, ulnar mono neuropathy, foot drop, bells palsy, cranial nerve palsy)
what are the risk factors for neuropathy
increased length of diabetes poor glycaemic control T1DM>T2DM high cholesterol/ lipids smoking alcohol genetics mechanical injuty
what are the symptoms of peripheral neuropathy
distal symmetric or sensorimotor neuropathy:
- numbness/ insensitivity
- tingling/ burning
- sharp pains or cramps
- sensitivity to touch
- loss of balance and coordination
what are the complications of peripheral neuropathy
painless trauma
foot ulcer
charcots foot
what is charcots foot
when the bones weaken due to significant nerve damage
what are the treatment options for painful neuropathy
amitriptyline (off label), duloxetine, gabapentin, pregabalin (combinations of these not recommended)
if localised then can used topical capsaicin cream
what are the symptoms of focal neuropathy
appears suddenly, affects specific nerves (often head, torso, leg)
- inability to focus eye
- double vision
- aching behind eye
- bells palsy
- pain in thigh/ chest/ lower back/ pelvis
- pain on outside of foot
what is entrapment neuropathy
type of focal neuropathy- weakness in one nerve or a group of nerves causing muscle weakness or pain (carpal tunnel)
what types of neuropathy can cause peripheral neuropathy
lumbosacral plexus neuropathy
femoral neuropathy
diabetic amyotrophy (limb weakness)
what are the symptoms of proximal neuropathy
starts with pain in the thighs, hips, buttocks or legs, usually more on one side of the body
proximal muscle weakness
often associated with marked weight loss
who is proximal neuropathy most common in
elderly with type 2
how can the digestive system be affected by autonomic neuropathy
gastric slowing/ frequency
constipation/ diarrhoea
gastroparesis (slow stomach emptying), persistent nausea and vomiting, bloating, loss of appetite
oesophagus nerve damage- swallowing difficulties
how can autonomic neuropathy affect blood sugar levels
can cause them to fluctuate widely due to abnormal food digestion
what is the treatment for diabetic gastroparesis
improved glycaemic control
dietary- smaller more frequent food portions, low fat, low in fibre (prevent bezoars)
liquid meals (if severe)
promotility drugs- metoclopramide, domperidone, erythromycin
anti nausea medications- prochlorperazine and serotonin antagonists (ondansetron)
abdominal pain - NSAIDs, low dose tricyclic anitdepressants, gabapentin, tramadol, fentanyl
botox
gastric pacemaker
what are the symptoms of autonomic neuropathy affecting the heart and blood vessels
blood pressure may drop sharply after sitting or standing causing a person to feel light headed/ faint
heart rate may stay high instead of rising and falling in response to normal body functions and physical activity
(body unable to adjust blood pressure and heart rate)
how can autonomic neuropathy affect the eyes
makes them less responsive to changes in light
difficulty to see in dark
what are the diagnostic tools for neuropathy
nerve conduction studies/ electromyography heart rate variability ultrasound (bladder function) gastic emptying studies foot screening
what is diabetic neuropathy
progressive kidney disease caused by damage to the capillaries in the kidney’s glomeruli
characterised by nephrotic syndrome and diffuse scarring of the glomeruli
what are the microvascular changes in diabetic nephropathy
angiopathy of capillaries- nodular glomeruloscerlosis
what are the consequences of diabetic nephropathy
hypertension, decline in renal function, accelerated vascular disease
what is nephrotic syndrome
collection of symptoms due to kidney damage- proteinuria, hypoalbuminaemia, peripheral oedema
how do you screen for nephropathy
urinary albumin creatinine ratio (ACR)
what are the risk factors for nephropathy progression
hypertension cholesterol smoking glycaemic control albuminuria
what is the treatment for diabetic nephropathy
blood pressure maintained
glycaemic control
what eye patholoies do people with diabetes get
diabetic retinopathy
cataract
glaucoma
acute hyperglycaemia
what is cataract
clouding of the lens
what is glaucoma
increase in fluid pressure in the eye leading to optic nerve damage
what is acute hyperglycaemia
visual blurring (reversible)
what is retinopathy treatment
laser, vitrectomy, anti VEGF injections
what is the cause of diabetic erectile dysfunction
vascular and neuropathy
what should be inculded in annular diabetes screening
eyes, feet and kidneys
what are the symptoms of autonomic neuropathy when it affects nerves supplying sweat glands
body cannot regulate temp, profuse sweating at night/ while eating
what is the treatment for sweat gland autonomic neuropathy
topical glycopyrrolate, clonidine, botox
in the eye what is a dot/blot/flame
haemorrage
in the eye what is a cotton wool spot
ischaemic areas
in the eye what are hard exudates
lipid break down products
in the eye what is is IRMA
intra-retinal microvascular abnormalities (abnormalities of blood vessels/ precursor to neovascularisation) (blood vessels not leaking)
how is renital function graded
retiopathy and maculopathy graded separatley
what are the grades of retinopathy
mild background (haemorrages and microaneurysms only)
pre proliferative retinopathy (microaneurysms, hard exudates, haemorrages)
severe non proliferative retinopathy (IRMA, venous bleeding, haemorrhages)
severe proliferative retinopathy (new vessel formation)
pre retinal fibrosis +/- traction retinal detachment
what are the symptoms of retinal bleeding
floaters, sudden change in vision
what causes diabetic erectile dysfunction
vascular and neuropathic
what medications can case erectile dysfucntion
anti hypertensives, CNS drugs (anti depressants, tricyclics, SSRIs, tranquilizers, sedatives, analgesics)
what else can cause erectile dysfucntion
chronic renal failure, hepatic failure, MS, depression, vascular disease, low LDL, high cholesterol, hormonal deficiency, spinal cord injury, surgery, radiation, substance abuse, alcohol, smoking, bicycle riding
