Microvascular Complications of diabetes Flashcards
What types of microvascular complications are common?
Neuropathy
Nephropathy
Retinopathy
What other complications are common as a result of diabetes?
Cognitive dysfunction
Erectile dysfunction
Psychiatric
What is believed to cause the pathophysiology behind microvascular disease?
Hyperglycaemia
Hyperlipidaemia
What is the presenting complaint in peripheral neuropathy?
Burning tingling sensation
Loss of feeling
Loss of coordination
Gloves and Stockings - distribution
What are the three screening tests done at each annual review?
Digital retinal screenig
Foot risk assessment
Urine albumin:creatinine ratio
What are the risk factors for developing neuropathy?
Duration of diabetes, smoking, alcohol, high LDL,
What are the common injures associated with peripheral neuropathy?
Painless trauma
Diabetic foot ulcer
Charcot foot
What increases the likely hood of complications?
Macrovascular peripheral vascular disease
What is Charcot foot?
Destructive inflammatory process which leads to the breakdown of bones within the foot.
How does Charcot foot present?
Hot swollen foot
To differentiate from deep cellulitis - MRI
What is the treatment for Charcot foot?
Avoid all weight bearing
Total contact cast
What is a low risk on diabetic foot screening?
Normal sensation and pulses
What is a moderate risk in diabetic foot screening
Absent sensation or pulse
Unable to care for own feet
What is a high risk in diabetic foot screening?
Absent sensation and pulse
Scars from ulcer
In painful neuropathy what is the treatment?
Amitriptyline
gabapentin
Pregablin
If pain in neuropathy is localised and patient wishes to avoid the side effects of other drugs what can be used?
Topical Capsaicin cream
What is diabetic amyotrophy?
Self resolving painful muscle loss
Usually proximal limbs hips thighs gluteals
Autonomic neuropathy
Affects Heart rate Blood pressure Sexual function Sweating Digestion
What affect on the GI system does autonomic neuropathy have?
Gastric Slowing (gastroparesis)
Persistant nausea and vomiting
oesophageal nerve damage dysphagia
What is the impact on Blood glucose levels in autonomic neuropathy affecting the GI tract
Constantly fluctuating due to abnormal digestion
What drugs are used to promote GI motility in autonomic neuropathy?
Metoclopramide
Erythromycin
What drugs are used to alleviate nausea in autonomic neuropathy?
Odansetron 5-HT3 antagonist
What toxin is used in GI autonomic neuropathy?
Botulinum toxin
Injected into the pyloric sphincter to relax it
What is a highly successful treatment used to control GI autonomic neuropathy?
GI pacemaker
What can be used to control pain in GI autonomic neuropathy?
NSAIDs
Gabapentin
Tramadol
What can be other autonomic neuropathy complications?
Postural hypertension - usually ride hypertensive
Sweat - Gustatory sweating after eating
Nephropathy
Damage to capillary beds found within the glomeruli leading to poor filtration, inflammation and subsequent scarring.
What is characteristic if diabetic nephropathy?
Developmental Hypertension
Relentless decline in renal function
Accelerated vascular disease
What is the average loss of function in diabetic nephrology?
10% per year
If the urine dipstick come back +ve what should be done?
Send a sample of for quantitive results
What is the normal range for ACR?
<3.5 female
<2.5 male
Microalbuminuria is classed as what?
ACR of 3.5 - <30 females
2.5 - <50 males
In microalbuminuria will the dipstick test work?
No dipstick will come back as negative
Proteinuria
ACR of >30 women
>50 men
What will a dipstick show in proteinuria?
Positive
In screening what happens?
Abnormal test results confirmed by first pass (first urine of the day) urine sample
What causes fluctuations in microalbuminuria levels?
Time of the day
Exercise
Protein load
Gender
How many samples should be tested for microalbuminuria?
3x
What is the first line treatment for diabetic nephropathy?
ACE or ARB inhibitors
Discuss Angiotensen II antagonist therapy
Example of ARB
Losartan
Example of ACE inhibitor
Lisinopril
What do ACE inhibitors do within the kidney?
They dilate the efferent tubule reducing filtration pressure
In type II diabetes what should everyone with renal issues be prescribed?
SGLT2i
reduces risk of both CVD and renal related mortality
At what EGFR should metformin be stopped?
30 this is usually in severe Nephropathy
metformin is excreted via the kidneys so can build up triggering lactic acidosis
Can DDP-4 inhibitors be used in nephropathy?
Dose should be reduced but continue
In acute hyperglycaemia what is a common symptom?
Blurred vision
What can be the ocular conditions associated with diabetes?
Glaucoma
Cataracts
Diabetic macular oedema
What is a maculopathy?
Abnormalities focused within the macula
What is the macula?
Dense collection of rods and cones, appears a dark patch
Responsible for most of the vision
What is the centre of the macula called?
Fovea
What is a sign of a bleed within the eye?
Sudden loss vision without trauma
floaters
What is the main reason behind bleeds in regards to retinopathy?
Ischaemic drive within eye causes new vessel growth which have weaker walls
What is main treatment in retinopathy?
Pan retinal photocoagulation
What is the effect of laser therapy on the eye?
By killing cells it reduces the ischaemic drive which reduces the stimulation that results in new vessel development.
Where are the lasers focused?
Around the periphery
Vision is hardly affected might have some blurriness in periphery
What is the treatment for a bleed within the eye?
Vitrectomy - removal of blood
Diabetic macular oedema
Fluid build up resulting in out-bulging of the retina causing blind spots and possibly blindness.
What is treatment for diabetic macular oedema?
Intravitreal Anti - VEGF
What is VEGF
Vascular epidermal growth factor
What is the effect of anti VEGF on retinopathy?
Inhibits stimulus that drives new vessel growth and reduces oedema
