Complications of Diabetes Flashcards
(42 cards)
What are the microvascular complications?
Brain and cerebral circulation
Diabetic retinopathy
Diabetic neuropathy
Diabetic nephropathy
What are the macrovascular complications?
Stroke
Heart disease
Peripheral vascular disease
What is the pathophysiology of the complications?
Shunting of glucose down the polyol pathyway leads to inflammation
Advanced glyceration end-products and protein kinase C activation leads to increased vascular permeability
Shunting of glucose fown the hexosamine pathway leads to abnormal microvascular blood flow
All of these things cause the complications associated with diabetes
What are the risk factors for macrovascular disease?
Obesity Poor glycaemic control Hypertension Hyperlipidaemia Smoking Microalbuminuria
What is the cause of most deaths in T2DM?
75% deaths caused by CV disease
How should a diabetic patient with CV problems be managed?
Maintain blood glucose <11mmol/l in 24 hours following an acute MI
CABG superior to PCI if they have multivessle coronary artery disease
What risk factors increase risk of stroke?
Microalbuminuria
Features of metabolic syndrome
What kind of stroke is most common in diabetes patients?
Ischaemic rather than haemorrhagic
What are the Fontaine classification stages of PVD?
Stage 1 - asymptomatic
Stage 2 - intermittent claudication
Stage 3 - rest pain/night pain
Stage 4 - necrosis and gangrene
Which vessels are most commonly affected by PVD in diabetes?
Femoral-popliteal and tibial vessels
- less amenable to surgery than the normal place of aorto-iliac
What are the risk factors for developing PVD?
Age
Diabetes duration
Neuropathy (PVD often presents with ulcer/gangrene in diabetic patients)
What kind of therapy reduces CV risk?
Intensive multifactorial intervention
- blood glucose (SGLT2 inhibitors and GLP-1 agonists)
- RAAS blockade
- antiplatelet
- lipid lowering (statins)
What are the signs and symptoms of an ischaemic foot?
Cold Atrophic/hairless Absent foot pulses If ulcer is present, it is painful History of claudication and/or rest pain
What are the signs and symptoms of a neuropathic foot?
Warm Dry skin Present foot pulses Painless ulcer (if present) Callus over pressure points
What are the risk factors for a diabetic foot disease?
PVD Neuropathy Previous amputation Previous ulceration Joint deformity Callus Male
What are the general principles in treating foot disease?
Education Multidiscipplinary foot clinic - podiatrist - diabetes physician - orthotist - nurse specialist - surgical input Sensible footwear
What is the management of active foot disease?
Debridement
Pressure relief (total foot casting)
Antibiotics when indicated (High index of suspicion for osteomyelitis)
Arterial reconstruction where indicated
Charcot foot
- total contact cast and no weight bearing
What is Charcot Foot?
Fracture and acute inflammation of the foot
Red, swollen, oedematous
Painful
Skin temperature is 2-8 degrees higher than the contralateral foot
Hard to distinguish from infection
What are the symptoms of autonomic neuropathy?
Gustatory sweating Cardiac denervation Postural hypotension Gastroparesis Diarrhoea Atonic bladder Erectile dysfunction Atriovenous swelling
What are the symptoms of somatic neuropathy?
Ocular palsies Carpal tunnel syndrome Small muscle wasting Amyotrophy Painful neuropathy Neuropathic foot
What is a peripheral sensory neuropathy?
Insidious, often symmetrical
Affects all sensory modalities
- impaired vibration sense is an early sign
Wasting of intrinsic muscles/clawing of toes
Painful (sharp burning) neropathy in 5% of cases
What is a mononeuropathy?
Peripheral or cranial Median nerve/carpal tunnel syndrome in 10% Can affect the lateral cutaneous nerve Cranial palsies occur suddenly - CN III or IV
What is diabetic amyotrophy?
Affects males with T2DM
Uncommon
Severe pain/parasthesia in the upper legs/thighs
Wasting/weakness of the quadriceps
How is peripheral sensory neuropathy treated?
Tricyclic antidepressants (e.g. amytriptyline)
Other antidepressants
Anticonvulsants (e.g. gabapentin)
Opiate analgesia
