Presentation and Complications of T2DM Flashcards
Why do roughly half of the people in the UK not know they have diabetes?
It has an insidious onset
How do T1DM and T2DM present differently?
T1- Acute DKA episode
T2- Complication or incidental
What are the symptoms of T2DM?
- Tiredness
- Polyuria/ polydipsia
- Hyperglycaemia
- Increased consumption of sugary drinks (+co morbidities) results in increased diuresis resulting in increased blood glucose and sodium
How do you calculate total blood osmolality?
Addition of (2 x cations) plus glucose plus urea
if we double cations like Na/K we will get the same as the cations plus anions as they must be joined to an anion
What are the microvascular complications of T2DM?
Glycosylation of basement membranes (leaky capillaries) causing:
- Retinopathy
- Nephropathy
- Neuropathy
What are the macrovascular complications of T2DM?
Dyslipidaemia, HTN and hypercholesterolaemia causing:
- IHD
- CVA
- Peripheral Gangrene
How do you differentiate between background, pre-proliferative and proliferative retinopathy?
Background:
- Hard Exudates
- Microaneurysms
- Blot haemorrhages
Pre-proliferative
- Cotton wool spots (ischamia)
- Pre-retinal haemorrhages
Proliferative
- Visible new vessels
How do we treat the different types of retinopathy?
BG- Glucose control
PP- Pan retinal photocoagulation
P- Pan retinal photocoagulation
Does good glucose control improve diabetes?
Yes- good glucose control delyas onset of complications, even if after some time control starts to wane.
What are the 4 studies that look at diabetes complications and what do they show?
Accord- People with complications face higher mortality rates if they have sudden intensive glucose control
Advance- If A1c <6.5% then there is lower mortality
UKPDS- Good control only benefits past 15 years but helps with mortality even if later control is worse
DCCT- T1DM good glucose control = good outcomes
What are the signs of diabetic nephropathy?
HTN
Progressive inreasing proteinuria
Progreeively deteriorating kidney function
Histological features
What are some classic histological features of diabetic nephropathy?
Classic histological features:
Glomerular- mesangial expansion, basement membrane thickening and glomerulosclerosis
Vascular
Tubulointerstitial
What is the epidemiology of T1/T2 DM?
T1- 20-40% after 30-40 yrs
T2- Probably equivalent but certain risk factors
What are the risk factors for getting nephropathy with T2DM?
Age at development of disease
Age at presentation of disease
Racial Factors
Loss due to cardiovascular morbidity
What are the clinical features of diabetic nephropathy?
Progressive proteinuria (normal <30mg/ 24 hrs) Increased BP Deranged renal function
