Posters- complications of diabetes Flashcards
Define microvascular disease
Atherosclerotic plaques build up in the small vessels. This leads to nerves not getting enough oxygen so they become damaged and die off.
Give examples of microvascular disease
Retinopathy
Neuropathy
Nephropathy
Give examples of macrovascular disease
Ischaemic heart disease (IHD)
Stroke
Erectile dysfunction
Psychiatric
Peripheral neuropathy is an example of
Microvascular disease
Symptoms of peripheral neuropathy
Pain/loss of sensation in the hands and feet Could present with: Tingling/burning sensation Extreme coldness Numbness/loss of sensitivity Sensitive to touch (allodynia) Sharp pains/ cramps Loss of balance and co-ordination
What complications can arise from peripheral neuropathy
Infections/ulcers
Deformities- Charcot foot, Hammer toes, collapse of mid foot
What is Charcot foot?
Bone protrudes downwards due to many micro fractures in a foot with neuropathy
Treatment of peripheral neuropathy
Simple analgesia such as paracetamol Stronger opioids such as tramadol and oxycodone TCA's- amitriptilline Gabapentin Topical capsaicin cream
What does autonomic neuropathy present as?
Change in bowel habit (gastroparesis) change in bladder function HR and blood pressure changes (postural hypotension) eye changes sweating sexual response Hypoglycaemic unawareness
Describe gastroparesis in further detail and outline why it may be dangerous in diabetics
Gastroparesis is basically slow gastric emptying. Diabetics who have taken their insulin may experience hypos due to the mismatch in the time they take their insulin and emptying of the food into their small intestine.
Why does autonomic neuropathy affect sweating
The autonomic system controls sweat glands and it prevents them from working properly meaning body temperature cannot be regulated. People may experience excessive sweating during eating and at night.
How are the eyes affected in autonomic neuropathy
Less responsive to changes in light. Difficulty driving in the dark.
Treatment of gastroparesis
Start with metoclopramide, domperidone or erythromycin.
Last resort is a gastric pacemaker.
What is proximal neuropathy?
Pain in the thigh, buttocks and hips leading to weakness in the legs (amyotrophy).
Can lead to muscle wasting in the legs.
What is focal neuropathy?
Sudden weakness in one group of nerves causing muscle weakness or pain e.g. carpal tunnel syndrome, bells palsy ect.
What is diabetic nephropathy also known as?
Nodular glomerulosclerosis or Kimmelsteil Wilson syndrome.
How is prognosis effected by stage of nephropathy
Prognosis worsens as nephropathy worsens.
How do you screen for nephropathy
Use urinary albumin ratio (ACR)
Use eGFR
What are the normal values for ACR
Men <2.5mg
Women<3.5mg
What are the values for microalbuminuria, macroalbuminuria and proteinuria
Microalbuminuria- 30-300g/ml
Macroalbuminuria >300g/ml
Proteinuria> 500mg/ml
Treatment of diabetic nephropathy
Treat underlying exacerbating factors- blood glucose, blood pressure, smoking, albuminuria
ACEI at highest tolerated rate.
Why would you use an ACEI in diabetic nephropathy
They dilate the renal arterioles. They decrease filtration rate. They decrease filtration pressure and decrease proteinuria.
What are the diabetic eye diseases and describe them?
Diabetic retinopathy
Cataract- clouding of the lens
Glaucoma- increased fluid pressure pushes on the optic nerve
Acute hyperglycaemia- visual blurring that is irreversible as glucose clears.
Describe the retinopathy stages
Mild non proliferative
Moderate non proliferative
Severe non proliferative
Proliferative
What does proliferative mean?
New blood vessels form in the eye to try and meet oxygen demands however they are prone to haemorrhage.
What is VGEF
Growth factor for blood vessels.
Can give anti-VGEF to stop new blood vessels forming.
What other issues can the eye come into contact with and how do they look?
Haemorrhages- dot/blot/flame
Ischaemic areas- cotton wool spots
Hard exudates- liquid breakdown products
IRMA- intra-retinal microvascular abnormalities.
Grading of diabetic eye disease
Retinopathy and maculopathy are graded separately.
R0- no visible retinopathy- R4 proliferative retinopathy
M1- observable - M2- referable.
Why does diabetes cause vascular disease
Increase in atherosclerosis Dyslipidaemia- increase triglycerides and increased LDL Endothelial dysfunction Platelet aggregation Thrombogenesis Inflammation
Target blood pressures for diabetics
Normal diabetic- less than 140/80
Diabetic at risk of complications and microalbuminuria- less than 130/80
What is capillary microangiopathy?
Series of complex reactions leading to thickened, permeable and dilated small blood vessels. These lead to micro aneurysms and increase in passive diffusion of proteins.
