3.20 Micro and Macro vascular complications Flashcards
(25 cards)
What are the 3 microvascular complications of diabetes?
retinopathy
nephropathy
neuropathy
What are the 3 macrovascular complications of diabetes?
cerebrovascular disease
ischemic heart disease
peripheral vascular disease
What increases the risk of microvascular complications?
HbA1c > 53 (direct relationship between risk of microvascular complications and glycaemic control)
hypertension
What are some risk factors for the development of microvascular complications?
duration of diabetes
smoking
hyperlipidemia
hyperglycemic memory
Why is screening needed for diabetic retinopathy?
main cause of blindness in working age people
early stages are asymptomatic
How often do screenings for diabetic retinopathy occur?
annually
What are the 3 stages of diabetic retinopathy?
background retinopathy
pre-proliferative retinopathy
proliferative retinopathy
What other eye problems can diabetes form?
diabetic maculopathy - similar to retinopathy but near macula
How is background retinopathy treated?
continued annual surveillance improve glycemic control stop smoking weight loss blood pressure control
How to treat pre proliferative and proliferative retinopathy?
panretinal photocoagulation
How to treat diabetic maculopathy?
anti-VEGF injection into the eye
grid photocoagulation
Why is diabetic nephropathy important?
associated with progression to end stage renal failure
increased risk of cardiovascular events
What is the first sign of diabetic nephropathy?
microalbuminuria >2.5
What are further signs of diabetic nephropathy?
proteinuria (ACR increase)
increased blood pressure
decreased eGFR (renal function)
peripheral oedema
How do ACE inhibitors work?
block conversion of angiotensin 1 to angiotensin 2
How do angiotensin receptor blockers (ARBs) work?
block angiotensin receptors
What does angiotensin do?
increase BP (by vasoconstriction) and acts on zona glomerulosa of adrenal cortex to produce aldosterone
How is diabetic nephropathy managed?
glycaemic control
ACEi/ARB even if no hypertension as preventative
stop smoking
SGLT-2 inhibitor (if T2D)
What is diabetic neuropathy?
vasa nervosum (small vessels supplying nerves) get blocked
What does the distribution of diabetic neuropathy look like?
glove and stocking
What is the danger of diabetic neuropathy?
will not sense injury to foot
What to look for when checking feet?
foot deformity/ulceration
sensation
foot pulses
How do we manage diabetic foot (caused by diabetic neuropathy)
regular inspection
good footwear
avoid barefeet
What other neuropathies can be caused by diabetes?
mononeuropathy - cranial nerve palsy (3 nerve - occulomotor)
eye looks down and out
