Vascular Complications of Diabetes Flashcards
Microvascular
Nephropathy
Retinopathy
Neuropathy
Macrovascular
HTN MI TIA Platelet hypersensitivity PVD
Nephropathy epedemiology
Leading cause of ESRD in US
33% of ppl seeking renal replacement have DM
Predominantly occurs in type 1
Nephropathy Pathophysiology
Lesions occur in kidney, injures glomeruli Basement membrane thickens Glomerular sclerosis Nodular glomerulosclerosis Impair blood flow, kidneys slowly die
Microalbuminuria
Small, but abnormal amounts of albumin in urine
Strongest independent risk of CVD
Leading indicator of developing nephropathy
30-300mg/24hr
Macroalbuminuria
Next progression from micro Steady drop in GFR ESRD ----> Dialysis Can be slowed by: -tight glucose control, BP control, protein restriction, smoking cessation.
Drugs that improve neuropathy
Ace inhibitors
ARB’s: Angiotensin II blockers
Beta blockers
Nondihydropyridine blockers
Types of renal lesions
Renal artery stenosis
Glomerulosclerosis
Retinopathy
Leading cause of acquired blindness in US
at 20 yrs after onset: 100% type 1 retinopathy. 60% type II.
Proliferative and nonproliferative
Nonproliferative retinopathy patho
Increased capillary permeability
Dilation of venules
Presence of microaneurysms
Hard exudates and cotton wool spots
Proliferative retinopathy patho
Neuvascularization Sudden vision loss Bling, painful eye Retinal detachment (floaters) Senile cataracts
Retinopathy screening
annual dilated fundoscopic exam
every 4-8 wks for pregnancy
Retinopathy Tx
Tight glucose control HTN control Statins Laser photocoagulation Vitrectomy for severe macular degeneration
Peripheral Neuropathy Patho
Thickening of walls that supply vessel and nerve, leading to vessel ischemia.
Demyelination, schwann cells slow and nerve conduction slows.
Peripheral Polyneuropathy
Most common type Glove and stocking distribution Pain, numbness, increased sensitivity Burning, itching, tingling, sensory loss Loss of vibratory sense/proprioception
Neuropathy S/S
Abnormal gait Hammer toes Abnormal pressures on feet Trauma/fx Soft tissue atrophy Foot ulcers: don't heal osteomyelitis/gangrene
Neuropathy Tx
Elavil ASA, APAP, NSAIDS Tegretol Neurontin (Gabapentin) Lyrica (Pregabalin) Cymbalta (Duloxitine)
Autonomic Neuropathy
Gastric dysmotility
Delayed emptying
Constipation
N/V/D
Types of autonomic neuropathy
Orthostatic Hypotension Cardiac rhythm disturbances Bladder involvement Erectile Dysfxn Focal limb and cranial nerve Muscle weakness
Autonomic Neuropathy Tx
Orthostatic Hypo: fludrocortisones, midodrine
Gastraparesis: Carbamazepine, erythromycin, imodium
Atherosclerosis
70-80% of diabetics will die of a macrovascular event.
MI, TIA, AAA
“Chronic inflammatory disorder of the INTIMA of large blood vessels characterized by the formation of fibrofatty plaques called atheroma”
Atherosclerosis Mechanism
Abnormal lipoproteins HTN Insulin resistance Procoagulant state Hormones, GF, cytokines
Atherosclerosis manifestation
Depends on vessel and extent Ischemia, narrowing Sudden vessel obstruction due to rupture Thrombosis and emboli Aneurysm formation, weakening of wall
Coronary Artery Disease
Leading cause of death of men and women in the US.
Hypertension
Detrimental risk factor in diabetes.
Control HTN to s, Beta blockers
Common sites for macro PVD
Femoral, popliteal: 80-90%
Tibial and peroneal: 40-50%
Aortic and Iliac: 30%
Ankle-brachial index
Ratio between brachial and ankle Blood pressures. Normal: >90 Claudication: .5 - .9 Rest Pain: .21 - .49 Tissue loss: <.20
