EXAM #2: COMPLICATIONS OF DM Flashcards
What do the majority of patients with DM die from?
CAD
What are the microvascular complications of DM?
1) DM Retinopathy
2) DM Nephropathy
3) DM Neuropathy
What are the macrovascular complications of DM?
1) CVA
2) CAD
3) PVD
How does DM lead to microvascular injury?
1) Advanced glycation end products
2) Diacylglycerol
3) Oxidative stress
What do AGEs, DAG, and oxidative stress activate?
PKC B activation, which mediates microvascular damage
What is the leading cause of blindness in the developed world?
DM reinopathy
What are the stages of DM retinopathy?
1) Non-proliferative
2) Proliferative
What characterizes non-proliferative DM retinopathy?
1) Microaneurysms
2) Blot hemorrhages
3) Cotton wool spots
How is DM retinopathy prevented? How is DM retinopathy treated once it has started?
Prevention
- Dilated eye exam 5 yrs s/p DM I dx or at DM II dx
- Glycemic control
- BP control
Treatment= Laser
Describe the natural history of DM nephropathy.
1) Glomerular hyperperfusion, hypertrophy, and increased GFR
2) Thickening of BM/ normal GFR
3) Microalbuminemia
4) Nephropathy
5) End Stage Renal Disease
How is DM nephropathy prevented?
1) Assess albumin excretion annually
2) Serum creatinine annually
3) Glycemic control
When should Metformin be stopped in male and female patients?
Male= Greater than 1.5 Female= Greater than 1.4
How does the treatment of a DM patient with GFR between 45 and 60 need to be treated?
1) Refer to nephrology
2) Consider medication dose adjustments
3) eGFR q6months
4) Monitor electolytes
5) Check Vitamin D/ bone density
How does the treatment of a DM patient with GFR between 30 and 45 need to be treated?
1) Consider medication dose adjustments
2) eGFR q3months
3) Monitor electolytes
How does the treatment of a DM patient with GFR less than 30 need to be treated?
Refer to nephrology
