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
