Microvascular Complications of Diabetes Flashcards
What are the 3 main sites of microvascular complications in diabetes?
Retinal arteries
Renal glomerular arterioles
Vasa nervorum
What are the vasa nervorum?
Tiny blood vessels that supply nerves
What is the main factor in increasing risk for developing microvascular complications?
High BP
What are the main 2 targets when reducing risk of complications?
Reduce HbA1c
Control BP
What is hyperglycaemic memory and how does it affect complications of diabetes?
Inadequate glucose control early on which increases risks of complications developing later on
How is HbA1c risked to MI?
Higher HbA1c increases risk of MI
What are the main mechanisms of damage in microvascular complications?
Oxidative stress
Formation of AGEs
Hypoxia
What are AGEs?
Advanced gylcolated end products- other proteins that become glycated eg on the walls of blood vessels
What are the 3 main microvascular complications called?
Retinopathy
Nephropathy
Neuropathy
How is retinopathy detected in diabetics?
Via screening- diabetics undergo once a year screening
What is mainly damaged in retinopathy?
The endothelium
What are the 3 stages of retinopathy?
Background
Pre-proliferative
Proliferative
What can occur alongside all stages of retinopathy?
Maculopathy
What can be seen during background retinopathy?
Hard exudates (cheese colour, made of lipid)
Micro aneurysms
Blot haemorrhages
What can be seen during pre-proliferative retinopathy? What does it indicate
Cotton wool spots= soft exudates
Represent retinal ischaemia
What can be seen during proliferative retinopathy?
Visible new vessels
On disk or elsewhere in retina
What is maculopathy?
Hard exudates near the macula
Same as background retinopathy but happens near the macula
Can threaten direct vision
What stage of retinopathy interferes with direct vision?
Maculopathy
How is background retinopathy treated?
Continued annual surveillance
Feedback to person
How is pre-proliferative retinopathy treated?
Early panretinal photocoagulation
How is proliferative retinopathy treated?
Panretinal photocoagulation
How is diabetic maculopathy treated?
Oedema: anti-VGF injections
Grid photocoagulation
What is measured when screening for diabetic nephropathy?
Urine albumin:creatinine
How does diabetic nephropathy present?
Hypertension
Increasing proteinuria
Deteriorating kidney function
Histological features
What is required if theres renal failure?
Haemodialysis
What glomerular changes are seen in diabetic nephropathy?
Mesangial expansion
Basement membrane thickening
Glomerulosclerosis
What constitutes a diagnosis of microalbuminuria?
above 2.5 mg.mmol for men
above 3.5 mg/mmol for women
What happens to BP and eGFR in diabetic nephropathy?
BP increases
eGFR is deranged
What type of oedema occurs if diabetic nephropathy is advanced?
Peripheral oedema
What are the 4 steps of diabetic nephropathy treatment?
- Aim for tighter glycaemic control
- Reduce BP via ACE inhibitors
- Stop smoking
- Start a SGLT-2 inhibitor if T2DM
What happens to the vasa nervorum in diabetic nephropathy?
They get blocked
What is the main concern in diabetic neuropathy?
Damage to the feet- the longest nerves supply the feet so if there is a foot injury they may not notice and complications can arise
How often do people living with diabetes have a foot check?
Once a year
What are clinical features of peripheral neuropathy?
Loss of sensation Loss of vibration Loss of temperature sensation Loss of proprioception Loss of ankle jerks Glove and stocking distribution
If there is foot ulceration what must be done?
Its a medical emergency so admit them to hospital
What is mononeuropathy?
One nerve is affected so usually there is sudden motor loss, wrist and foot drop, cranial nerve palsy
What is mononeuritis multiplex?
A random combo of peripheral nerve lesions
What is radiculopathy?
Pain over spinal nerves affecting dermatome on abdomen or chest wall
What is autonomic neuropathy?
Loss of sympathetic and parasympathetic nerves to GI tract, bladder, cardiovascular system
When does autonomic neuropathy develop?
If diabetes has been very poorly managed
What are presentations of autonomic neuropathy?
Difficulty swallowing Nausea and vomitting Constipation Nocturnal diarrhoea Bladder dysfunction Postural hypotension Cardiac autonomic supply
