Diabetes Flashcards
(43 cards)
Microvascular complications of Diabetes
Retinopathy
Neuropathy
Nephropathy
Macrovascular complications of Diabetes
Ischaemic heart disease
Coronary heart disease
Peripheral vascular disease
Presentation of microvascular disease
5yrs after T1DM
May be presentation for T2DM
Diabetic eye disease
Diabetic retinopathy
Macular oedema
Cataract
Glaucoma
Diabetic retinopathy
Damage to retinal capillaries in retina due to high glucose levels in the blood
2nd commonest cause of blindness
When looking at the retina, hard exudate, blot haemorrhages and microaneurysms may develop
Pathological findings for diabetic retinopathy
Loss of pericytes therefore reduced regulation of blood flow to retina
Thickening of basement membrane
Ischaemia - VEGF production and increased capillary permeability to promote angiogenesis
Capillary closure
Clinical stages of retinopathy
Non-proliferative (mild, moderate, severe) - ischaemia
Proliferative - angiogenesis
Macular oedema
Treatment of retinopathy
Diabetic control and blood pressure control
Panretinal photocoagulation
Focal laser treatment
Intravitreal anti-VEGF antibodies
Panretinal photocoagulation
Laser treatment used to prevent new blood vessels from forming in ischaemic areas and causes old blood vessels to scar up –> reduces oxygen demand to reduce angiogenic factors
Prevents vitreous haemorrhage and neovascular glaucoma
Used to treat diabetic retinopathy
Side effect: peripheral visual field constraints
Focal laser treat
A laser is used to burn areas of retinal leakage to slow leakage and reduce the amount of fluid in the retina
Used to treat diabetic retinopathy
Intravitreal anti-VEGF antibodies
Antibodies target VEGF to reduce angiogenesis and improve diabetic retinopathy
Diabetic neuropathy
High blood glucose causes damage to the small blood vessels which supply the nerves therefore the nerve fibres are damaged or disappear
Only symptom relief available, and improve blood glucose control
Types of neuropathy
Mononeuropathy - affects a single nerve or group of nerves e.g. carpal tunnel syndrome
Peripheral neuropathy - damage to nerves of the extremities e.g. charcot foot, neuropathic ulcer and callus
Entrapment neuropathy/nerve compression syndrome
Peripheral neuropathy
Divided into:
Autonomic neuropathy - nerves to organs affected so can cause gastroparesis, postural hypotension, erectile dysfunction, etc.
Motor neuropathy
Sensory neuropathy
Charcot foot
Bones in foot are weakened and repeated use causes fractures but neuropathy causes loss of sensation (including touch and pain) and results in further damage causing distortion of the shape of the foot
Nephropathy
Common cause of end-stage renal failure requiring dialysis
High blood glucose causes damage to the glomerular basement membrane and results in leakage of proteins and glucose into the urine (albuminuria and glycosuria)
Pathological findings of the diabetic nephropathy
Basement membrane thickening - due to ROS and proteins accumulating
Loss of glomerular podocytes - loss of filtration barrier
Glomerular sclerosis - scarring of the glomerular capillaries
Mesangial expansion to clear the ROS and proteins accumulating on the basement membrane of the glomerulus
Management of diabetic nephropathy
Blood pressure control Blood glucose control RAS system blocker Reduce CVD risk Possible renal transplant
Preventing macrovascular complications
Address modifiable risk factors e.g. blood pressure, lipids/cholesterol, smoking, glucose control
Metabolic syndrome
Central/visceral obesity Insulin resistance (pathophysiological mechanism) BMI>30kg/m2 Dyslipidaemia Hyperglycaemia Hypertension
Complications associated with obesity
Increased blood volume, viscosity and vascular resistance
Hypertension, Left ventricular hypertrophy, Coronary artery disease, Stroke
Obstructive sleep apnoea, hypercapnia/hypoxia, pulmonary hypertension
Non-alcoholic fatty liver disease (steatohepatitis/NASH), cirrhosis, portal hypertension, hepatocellular cancer, gallstones, reflux
Breast, endometrial, oesophageal, colon, gallbladder, renal and thyroid cancer
PCOS, male hypogonadism, subfertility
Osteoarthritis, gout
Depression and eating disorders
Genes associated with T1DM
HLA DR3-DQ2 and HLA DR4-DQ8
Foetal programming
Epigenetic modification of gene expression in response to stimuli or insult during critical periods resulting in persistent biological effects
Slow-acting hormones regulating body weight
Insulin and Leptin
