Microvascular complications of diabetes Flashcards
what are common microvascular complications
blindness
dialysis
amputation
what is the relationship between HbA1c and risk of microvascular complications
higher HbA1c = higher risk
esp. retinopathy
what is peripheral neuropathy
peripheral - pain/loss of feeling in feet, hands
what is autonomic neuropathy
changes in bowel, bladder function, sexual response, heart rate, blood pressure
what is proximal neuropathy
pain in the thighs, hips or buttock leading to weakness in the legs
what is focal neuropathy
sudden weakness in one nerve or a group of nerves causing muscle weakness or pain eg. carpal tunnel, ulnar mono neuropathy, foot drop, bells palsy
what is the basic pathophysiology of microvascular disease
hyperglycaemia and hyperlipidaemia leads to hypoxia, oxidative stress, inflammation and mitochondrial dysfunction
what factors increase the risk of neuropathy
increased length of diabetes poor glycaemic control type 1 diabetes>type 2 diabetes high cholesterol/lipids smoking alcohol inherited traits mechanical injury
peripheral neuropathy symptoms
numbness/insensitivity tingling/burning sharp pains or cramps sensitivity to touch loss of balance and coordination
what are some complications of peripheral neuropathy
Charcot foot
painless trauma
foot ulcers
how do you treat painful neuropathy
amitriptyline, duloxetine or gabapentin (titrate up as needed)
topical capsaicin cream can be used as another option
symptoms of focal neuropathy
inability to focus eye double vision aching behind eye Bell's palsy pain in thigh/chest/lower back/pelvis pain on outside of foot
symptoms of proximal neuropathy
starts with pain in thighs, hips, buttocks or legs usually on one side of the body
more common in elderly type 2
often associated with marked weight loss
what is autonomic neuropathy
neuropathy affecting the nerves regulating heart rate, blood pressure and control of internal organs
autonomic neuropathy affect on digestive system
gastric slowing/frequency-constipation
diarrhoea
gastroparesis (slow emptying)
oesophagus nerve damage (may make swallowing difficult)
what is the treatment for gastroparesis
improved glycemic control diet - smaller more frequent food portions promotability drugs antibiotics botulinum toxin gastric pace maker
affect of autonomic neuropathy on swear glands
prevents the sweat glands from working properly
body cannot regulate its temperature as it should
profuse sweating at night or while eating ‘gustatory sweating’
how to treat autonomic neuropathy affects on swear glands
topical glycopyrrolate
clonidine
botulinum toxin
Affect of autonomic neuropathy on heart and blood vessels
cardiovascular system nerve damage interferes with bodies ability to adjust to blood pressure and heart rate
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 activity
what are some diagnostic tools for neuropathy
nerve conduction studies or electromyography
heart rate variability
ultrasound
gastric emptying studies
what is diabetic nephropathy
progressive kidney disease caused by damage to the capillaries in the kidneys and glomeruli
consequences of diabetic nephropathy
development of hypertension
relentless decline in renal function
accelerated vascular disease
how to screen for nephropathy
albumin creatinine ratio
screen all patients ages 12 or over
dipstick test at point of care
U&Es
risk factors for nephropathy progression
hypertension cholesteral smoking glycemic control albuminuria
