Vascular complications of DM Flashcards
what are the microvascular complications of diabetes mellitus?
retinopathy
nephropathy
neuropathy
what are the macrovascular complications of diabetes mellitus?
cerebrovascular disease
ischaemic heart disease
peripheral vascular disease
what is the target HbA1c to reduce risk of microvascular complications?
53mmol/mol (<7%)
what are the other risk factors (besides HbA1c) for complications of diabetes?
duration of diabetes smoking genetic factors hyperlipidaemia hyperglycaemic memory hypertension
how do we aim to detect retinopathy?
theough screening as early stages are asymptomatic
describe the appearance of a normal retina
optic disk bright spot visible
thin veins semi visible
macula dense/pink spot visible
describe background retinopathy?
hard exudates (white cheesy spots)
microaneuyrsms (dots)
blot haemorrhages
enhanced blood vessels
describe pre proliferative retinopathy
more extensive haemorrhage soft exudates (cotton wool spots)
describe proliferative retinopathy
new vessels visible
describe maculopathy retinopathy
hard exudates/oedema near macula
(same as background just near macula)
can threaten vision
how do you treat background retinopathy?
you can’t.
annual surveillance
lifestyle changes
how do you treat pre proliferative retinopathy
early panretinal photocoagulation
how do you treat proliferative retinopathy?
panretinal photocoagulation
how do you treat diabetic maculopathy?
grid photocoagulation
anti-VEGF injections directly into eye
what are the risks of panretinal photocoagulation?
loss of some peripheral vision
how do you diagnose diabetic nephropathy?
urinalysis (microalbuminuria >25.mg/mmol proteinuria (ACR>30mg/mmol), nephrotic range (>3000mg/24hr))
increased blood pressure
eGFR (deranged)
what is the mechanism of diabetic nephropathy?
hypertension & hyperglycaemia lead to glomerular hypertension
this leads to proteinuria, glomerular &interstitial fibrosis
glomerular filtration rate decline
renal failure
what is the renin-angiotensin system?
angiotensinogen in liver, kidney produces renin which converts this to angiotensin I
angiotensin converting enzyme converts this to angiotensin II which causes vasoconstriction and release of aldosterone from the zona glomerulosa of the adrenal cortex
what is given to prevent further decline of nephropathy?
ACE inhibitors (ACEi) or angiotensin-2 receptor blockers (ARB)
when are nephropathy treatments prescribed?
even when normotensive with microalbuminuria or proteinuria
how is nephropathy managed?
smoking cessation
tighter glycaemic control
reduce blood pressure via ACEi or A2RB
start SGLT-2 inhibitor if T2DM
when does diabetic neuropathy occur?
when vasa nervorum get blocked (blood vessels supplying nerves)
what are the risk factors of diabetic neuropathy?
age duration of diabetes poor glycaemic control height smoking prescence of diabetic retinopathy
where is most common for diabetic neuropathy to show?
glove&stocking distribution
longest nerves supply feet
what is included in annual foot checks?
inspection for foot deformity, ulceration assess sensation (monofilament, ankle jerks) assess foot pulses (dorsalis pedis, posterior tibial)
when is the risk of ulceration highest?
patients with reduced foot sensation
poor vascular supply to feet
what is the management of peripheral neuropathy with ulceration?
multidisciplinary diabetes foot clinic offloading revascularisation if concomitant PVD antibiotics if infected orthotic footwear amputation
presentation of mononeuropathy
usually sudden motor loss (foot drop, wrist drop)
cranial nerve palsy - double vision due to 3rd nerve palsy
what is autonomic neuropathy?
damage to sympathetic & parasympathetic nerves innervating GI tract, bladder, CV system
what are the GI effects of autonomic neuropathy?
delayed gastric emptying (makes post prandial insulin hard)
constipation/nocturnal diarrhoea
how is the CV system affected by autonomic neuropathy?
postural hypertension (collapsing on standing) cardiac autonomic supply causing sudden cardiac death
what are the non-modifiable risk factors for macrovascular complications of DM?
age
sex
birth weight
FH/genetics
what are the modifiable risk factors for macrovascular complications of DM?
dyslipidaemia
hypertension
smoking
central obesity
how is CV risk in DM managed?
support smoking cessation blood pressure control lipid profiles weight interventions annual microalbuminuria screens
