Microvascular Diabetes Flashcards
Prevalence of Dysglycemia in Canada
- Additionally, what percentage of those that have diabetes are unaware they do
50%: Normoglycemia
40%: Pre-Diabetes
10%: Diabetes
- 3% of population is unaware of that they have diabetes
Dysglycemia and affects on Microvascular/Macrovascular complications
Having Prediabetes or Diabetes increases risk of Microvascular/Macrovascular complications
- Need to start as soon as possible
Is important to start early, aggressive management of diabetes and related complications if necessary
Why is early, aggressive management of diabetes and related complications important
Diabetes has a head start even before diagnosis
Longer you have diabetes the more likely you will develop microvascular complications
Diabetes Related Complications
- Microvascular
Nephropathy
Retinopathy
Neuropathy
Foot Ulcerations / Infections / Amputations
Diabetes is the leading cause of _______
Nephropathy
- 1/2 of people with diabetes develop renal damage
Adult Blindness
Lower limb amputations
CKD and CV events
People with CKD should be considered at high risk of CV events
Nephropathy
- Treatment
Intense glycemic control
Optimized blood pressure control
Medications that disrupt renin angiotensin aldosterone system
Make sure to prevent hyperkalemia monitor potassium when using:
- ACEi
- ARBS
- Renin Inhibitors
Nephropathy
- Practical Implications
As renal function decreases may have to adjust some medication’s doses for diabetes patients
Nephropathy
- Monitor what?
Screen random urine albumin-to-creatinine ratio and estimated glomerular filtration rate
- ACR (Should be low = meaning no albumin)
- eGFR (Should be high = proper filtration)
Nephropathy
- Monitor timeframe
Type 1: Annually, start 5 years after diagnosis
Type 2: Annually, start at diagnosis
Nephropathy
- Stages of Renal Functions
Normal
Microalbuminuria
Overt Nephropathy
Renal Failure (ESRD)
Nephropathy
- Stages of Renal Functions (Normal)
< 30 mg albumin / 24 hours
ACR < 2.0 mg/mmol
Nephropathy
- Stages of Renal Functions (Microalbuminuria)
30-300 mg albumin / 24 hours
ACR 2.0-20.0 mg/mmol
Nephropathy
- Stages of Renal Functions (Overt Nephropathy)
> 300 mg albumin / 24 hours
ACR > 20.0 mg/mmol
Dangers of Retinopathy
Can lead to increased fall risks, hip fractures, mortality
Macular Edema
Diffuse or focal vascular leakage at the macula
Nonproliferative Diabetic Retinopathy
Microaneurysms, intraretinal hemorrhage, vascular malformation and tortuosity
Capillary Nonperfussion
Vascular closure
- Blood is not received in some parts of the eye
Retinopathy
- Implications
Ensure numbers on devices are large and can be seen even for patients with vision difficulties
Retinopathy
- Screening
Performed by vision care professional
- Optometrist
- Ophthalmologist
Type 1: annually, start 5 years after diagnosis
Type 2: Every 1-2 years, start at diagnosis
- Frequency depends on age and severity
Neuropathy Classes
- Sensorimotor Nevers
- Autonomic Neuropathy
Sensorimotor nevers
- Neuropathic pain
- Changes to lower limb mobility
- Loss of sensation
Autonomic Neuropathy
- Cardiovascular
Resting tachycardia
Decreased heart rate variability
Exercise intolerance
Abnormal blood pressure regulation
Clinical Implications:
- Increased sensitivity to CV adverse effects of medications
Autonomic Neuropathy
- Gastrointestinal
Gastroparesis
Constipation, Diarrhea (Especially at night)
Incontinence
Clinical Implications:
- Alters absorption of medications
- Drugs that increase GI motility have limited effectiveness
Autonomic Neuropathy
- Gastrointestinal affects what drugs
Metoclopramide
Domperidone
Erythromycin
Autonomic Neuropathy
- Urogenitcal
Bladder dysfunction
- Overflow incontinence
- Erectile dysfunction
Neuropathies
- Screening
Type 1: Annually, start 5 years at diagnosis
Type 2: Annually, start at diagnosis
Neuropathies
- Treatment
Intense and tight glycemic control can reduce risk of onset and slow progression
May need pharmacological therapy to manage pain
Neuropathies
- Neuroreceptor Reuptake Inhibitors
TCAs
SNRIs
Inhibition of serotonin and norepinephrine reuptake leading to enhanced inhibition
Neuropathies
- Anticonvulsants
Gabapentin
Pregabalin
Mechanism: Blocks Ca2+ influx preventing release of excitatory neurotransmitters
Physical Assessment for Sensory Neuropathy
- Check vascular return
- Cotton swab (Allodynia)
- Tuning fork (Sense vibrations)
- Check feet pulse
- Thermal Challenges / Little pressure (Hyperalgesia)
- Monofilament
Allodynia
Abnormal response to a non-noxious stimulus
Hyperalgesia
Intense pain to a little noxious stimulus
Neuropathies
- Goals
Reduce pain intensity
- 30-50% reduction
Improve health-related quality of life
Foot Ulcers
- Progression
- Breakdown of skin
- Ulceration
- Infection
- Gangrene and Osteomyelitis
- Amputation
Foot Ulcers
- Screening
- Daily inspection of feet
- Annual inspection of feet by healthcare professional
Foot Ulcers
- Treatment
Corns, Calluses, Ingrown, Toenails, Warts, Splinters, Wounds
- Refer to foot care specialist
- Aggressive management of infecitons
Other Considerations
- Vaccinations
- Annual influenza vaccine
- Pneumococcal vaccine
Other Considerations
- Mental Health (Diabetes Specific Conditions)
- Fear of hypoglycemia
- Psychologically induced insulin resistance
- Diabetes distress
Other Considerations
- Mental Health (Those with diabetes are at higher risk of the following psychiatric disorders)
- Depression
- Schizophrenia
- Anxiety
- Sleep Disorders
Other Considerations
- Mental Health (Screening)
Regular screening for diabetes distress or symptoms of common psychiatric disorders
