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Flashcards in Complications of diabetes Deck (19):
1

What are the 6 general complications of diabetes?

microvascular: diabetic retinopathy, diabetic nephropathy, diabetic neuropathy
macrovascular: stroke, heart disease, peripheral vascular disease

2

How does hyperglycemia lead to complications of diabetes?

multiple pathways, mostly related to increased ROSs
1. incr. aldose reductase causes sorbitol accumulation. sorbital can cause neural problems and changes Na-K-ATPase activity
2. incr. DAG and Protein kinase C activity: alters the contractility and responsiveness of smooth muscle. changes endothelial cell permeability.
3.altered non-enzymatic glycosylation: activates endothelial and macrophage AGE (advanced glycosylation end products) receptors. changes lipid, basement membrane, and matrix proteins
4. glucose-dependent epigenetic changes

3

How can DM cause blindness?

proliferative retinopathy causing hemorrhage and retinal detachment
macular edema- retinal thickening dt accumulation of fluid
cataracts
glaucoma

4

What is the pathogenesis of diabetic retinopathy?

1. microthrombi causing capillary nonperfusion and reduced retinal blood flow. this leads to hyposia and VEGF production. may increase permeability or hemorrhage
2. pericyte death and microaneurysms: can cause tight junction loosening, leakage, hemorrhage, and exudates

5

How does VEGF contribute to diabetic retinopathy?

causes blood retinal barrier breakdown and macular edema
also causes retinal neovascularization

6

risk factors for diabetic retinopathy

duration, puberty, gycemic control, HTN, lipids, pregnancy

7

what are two fancy treatment for diabetic retinopathy?

also pan-retinal photocoagulation- kills of peripheral retina to reduce oxygen needs of the retina as a whole and spare important center part from ischemia
also anti-VEGF agents:Avastin/bevacizumab. or ranibiumab

8

management of diabetic retinopathy

1. annual eye exams after yr 5 in DM1 and every yr in DM2 and every trimester in preg with established retinopathy
2. BP control
3. glycemic control
4. laser or anti-VEGF (Anti-VEGF especially for diabetic macular edema)

9

pathology of diabetic nephropathy

glomerular basement membrane changes and mesangial expansion
classically causes diabetic nodules

10

What changes occur in the kidney as a result of hyperglycemia? What other factors are important in determining diabetic nephropathy

growth of kidney, changes to renal hemodynamics, and changes to the chemical composition of glomerular components
genetics, as well as glucose control, matter for determining the course of diabetic nephropathy

11

What is the natural history of diabetic nephropathy?
What is the course of DN in terms of protein in the urine

type 2s get there fast than type 1s- though this may be because type 2 diabetics may be diabetic for a long time before their diagnosis
course: normoalbuminuria to microalbuminuria (50%). Fot these, about half develop overt proteinuria. and some of these get end stage renal disease.
incr. BP and risk of CV disease increase as you move along this progression

12

What factors promote progression of diabetic nephropathy

genetics, BP, albuminuria, metabolic control, smoking

13

What drugs can help prevent diabetic nephropathy and how do you treat overt diabetic nephropathy

Prevention: ACE-Is, ARBs
Treatment: BP control, ACE-Is, glycemic control, protein restriction, renal or pancreatic transplant?
diabetic nephropathy may be reversible within 10 yrs after a pancreatic transplant

14

What is the pathology of diabetic neuropathy?

early axonal thickening, then a decrease in microfilaments and capillary narrowing. eventually, axon loss

15

What is the pathophysiology of diabetic neuropathy?

neuronal ishcemia with incr. VEGF and decrease in NO-dependent vasorelaxation
glycemic death: aldose reductase, edema, loss of neurotrophic factors, etc.

16

What are the classificationsof diabetic neuropathies?

may be forcal or multifocal, distal symmetrical polyneuropathies, or autonomic neuropathy

17

Clinical manifestations of distal sensorimotor polyneuropathy?

paresthesia, dysesthesia, pain, burning, impaired reflexes, abnormal vibratory sensation

18

What is Charcot foot?

malalignment of the joints of the foot that results from the combination of bone disintegration and trauma. can predispose to other injuries, like neuropathic ulcers

19

What is autonomic neuropathy?

problems with automonic regulation: gastroparesis, diarrhea, CV problems (orthostatic hypotension), GU: ED, neurogenic bladder), sweating after eating