Flashcards in Diabetes Deck (41)
what is the macula involved in?
in colour vision and acuity
what are the characteristics of background diabetic retinopathy?
- hard exudates
- microaneurysms (small blood vessels bulge)
- blot haemorrhages
what are the characteristics of pre-proliferative diabetic retinopathy?
- cotton wool spots (soft exudates) = retinal ischaemia
what are the characteristics of proliferative retinopathy?
same as background but near macula
- hard exudates near macula
- threaten direct vision
what is the management of background retinopathy?
improve blood glucose control
warm the pt
what is the management of pre-proliferative retinopathy?
suggests general ischaemia so to stop it progressing to proliferative you need pan-retinal photocoagulation
what is the management of proliferative retinopathy?
pan-retinal photocoagulation (laser to retina)
what is the management of maculopathy?
grid-retinal photocoagulation (just at macula)
what are the features of diabetic nephropathy?
- progressive increasing proteinuria
- deteriorating kidney function
- classic histological features
what are the glomerular histological features pf diabetic nephropathy?
- mesangial expansion
- BM thickening
- glomerulosclerosis (hardening of capillaries)
if there is no retinopathy, any CKD cannot be due to diabetes (come together)
what are the clinical features of diabetic nephropathy?
- progressive proteinuria (normal = <30mg/24hrs, nephrotic range > 300mg/24hrs)
- inc BP
- deranged renal function (GFR dec)
what is the treatment of diabetic nephropathy?
- control diabetes
- BP control
- stop smoking
- inhibit RAS: ACEi, ARBs
when does neuropathy happen?
when small vessels supplying vasa nervorum get blocked
what are the different types of diabetic neuropathy?
- peripheral neuropathy
- mononeuritis multiplex
- autonomic neuropathy
- diabetic amyotrophy
what is peripheral neuropathy?
- affects peripheral nerves
- affects longest nerves that supply feet
- result loss of sensation
- more common in tall people and people with poor glucose control
what is the danger of peripheral neuropathy?
people will not sense damage to foot
how can peripheral neuropathy be investigated?
tracks loss of sensation
what are the characteristics of peripheral neuropathy?
- loss of ankle jerks
- loss of vibration sense
- multiple fractures of x-rays (Charcot's joint)
what is mononeuropathy?
- only one nerve blocked
- usually sudden motor loss resulting in wrist and foot drop
- cranial nerve palsy (3rd nerve palsy)
how does 3rd nerve palsy present?
- double vision due to 3rd nerve palsy (down and out)
- lateral rectus = abducent nerve = OUT
- superior oblique = trochlear nerve = DOWN
- pupil does respond to light
why does the pupil respond to light?
- pupil sparing as PNS fibres are on the outside so they don;t easily lose blood supply
- aneurysm can also cause 3rd nerve palsy BUT aneurysm will press on PNS fibres and cause fixed dilated pupil
what is mononeuritis multiplex?
- many nerves affected
- random combination of peripheral nerve lesions
what is radiculopathy?
- dermatomes affected
- pain over spinal nerves, usually dermatomes on the abdomen or chest wall
what is autonomic neuropathy?
- loss of SNS and PNS nerves to GIT, bladder and CVS
- GIT: dysphagia, delayed gastric emptying, constipation, bladder dysfunction
- postural hypotension
- cardiac autonomic supply (can have sudden cardiac death)
what is diabetic amyotrophy?
inflammation and loss of pain
what is a macrovascular disease?
- systemic disease
- commonly present in multiple arterial beds
what are examples of macrovascular disease?
- CVD (earlier than without diabetes)
- peripheral vascular disease (contributed to diabetic foot porblems)
- renal artery stenosis (may contribute to HT)
what is hyperglycaemia associated with?
significantly reduced life expectancy
what drugs should you use in the management of T1DM?
- Short acting insulin before meals (e.g. Lispro)
- Long acting insulin as background insulin