Complications of diabetes Flashcards
1
Q
What are the most common causes of premature death in treated diabetic patients? [3]
A
- cardiovascular problems
- chronic kidney disease
- infections
2
Q
What are the macrovascular complications of DM? [3]
A
- stroke - x2 common in DM
- ischaemic heart disease - MI x4 common in DM
- peripheral vascular disease
3
Q
What can reduce the risk of macrovascular complications? [3]
A
- control of hypertension - ACE inhibitors e.g. ramipril
- smoking cessation
- control of cholesterol - statins e.g. simvastatin
4
Q
What are the microvascular complications of DM? [3]
A
- diabetic retinopathy - retina
- diabetic nephropathy - glomerulus
- diabetic neuropathy - nerve sheath
5
Q
What is the epidemiology of diabetic retinopathy? [2]
A
- worldwide, most common cause of blindness in working population
- annual retinal screening is mandatory as early detection and treatment can reduce risk of blindness
6
Q
What is background retinopathy? [4]
A
- at diagnosis ~30% of people with diabetes have early retinal damage
- microaneurysms appear as tiny red dots, caused by intramural pericyte death, which results in fluid leakage and microaneurysms
- haemorrhages appear as blots, and are caused by breach of microaneurysms
- hard exudates (lipid deposits) appear bright yellowish-white
7
Q
What is pre-proliferative retinopathy? [2]
A
- cotton-wool spots (micro-infarcts) due to occluded vessels; sign of retinal ischaemia
- haemorrhage and venous bleeding is also seen
8
Q
What is proliferative retinopathy? [5]
A
- damage to retinal blood vessels and resultant retinal ischaemia stimulates the release of vascular endothelial growth factor (VEGF) which causes the growth of new blood vessels in the retina
- shearing stresses of eye cause poorly supported vessels to bleed
- small haemorrhages –> pre-retinal haemorrhages –> vitreous haemorrhages
- vitreous haemorrhage leads to sudden loss of vision
- collagen tissue gives rise to fibrotic bands which may contract and pull retina, causing further haemorrhage and detachment of the retina
9
Q
What is maculopathy? [2]
A
- reduced fluid clearance from the macular area, so may result in macular oedema
- this distorts and thicken the retina at the macula and can cause loss of central vision
10
Q
What is the treatment of diabetic retinopathy? [2]
A
- laser photocoagulation aims to stop production of angiogenic factors from the ischaemic retina
- stops deterioration and prevents progression
11
Q
What is diabetic nephropathy? [2]
A
- commonest cause of end-stage renal failure
- thickening of basement membrane and glomerular damage leads to microalbuminuria, early warning sign of an impeding renal problem
12
Q
How is diabetic nephropathy diagnosed? [2]
A
- microalbuminuria is undetectable on standard urine dipstick (-ve result)
- urine albumin: creatinine ratio (UA:CR) >3mg/mmol indicates microalbuminuria
13
Q
What is the treatment of diabetic nephropathy? [2]
A
- treatment of blood pressure >130/80 - with ACE inhibitors (e.g. ramipril) or angiotensin receptor blockers / most important factor
- intensive DM control prevents microalbuminuria
14
Q
What is diabetic neuropathy? [2]
A
- symmetric sensory polyneuropathy - results in ‘glove and stocking’ numbness, tingling and pain which is worse at night
- distinguish between ischaemia (critical toes +/- absent foot pulses) and peripheral neuropathy (injury or infection over a pressure point)
15
Q
What are the clinical features of diabetic neuropathy? [6]
A
- allodynia - triggering of pain stimuli which do not normally cause pain
- paraesthesia - tingling or pricking sensation of the skin
- burning pain as if walking on broken glass, worse at night
- diabetic amyotrophy - painful wasting of quadriceps and other pelvifemoral muscles
- autonomic features - postural hypotension, gastroparesis, erectile dysfunction, diarrhoea, incontinence
- insensitivity - ‘glove and stocking’ sensory loss, reduction in sensation can result in foot ulceration, infection and amputation
