Diabetes Complications Flashcards
(41 cards)
Name two macrovascular complications
IHD and Stroke
Name three microvascular complications
Neuropathy, Nephropathy, Retinopathy
State three non vascular complications
Dementia, erectile dysfunction, psychiatric
What helps to prevent complications?
HbA1c target
What are the key issues that lead to complications?
AGE-RAGE (glucose binds to proteins to produce toxic products) Oxidative stress Hypoxia Inflammation Mitochondrial dysfunction
Name four types of neuropathy
peripheral
proximal
autonomic
focal
Describe peripheral neuropathy
glove-stocking distribution, starts on long nerves distally (usually toes)
What are the symptoms of peripheral neuropathy?
numbness, tingling, sharp pain, sensitivity, loss of balance
State three consequences of peripheral neuropathy
charcot foot
painless trauma
foot ulcers
Describe charcot arthropathy
destructive inflammatory process involving fractures/bony destruction and foot deformity. Presents as hot swollen foot and requires MRI to diagnose
What is the treatment for charcot arthropathy?
Airiest boot/non-weight bearing
In general what are the drugs available for a painful neuropathy
amitriptyline, duloxetine, gabapentin, prcegablin, capsaicin cream
How does proximal neuropathy present?
Pain in the thighs, hips, buttocks leading to weakness in the legs (amyotrophy) - associated with marked weight loss
How is proximal neuropathy treated?
symptomatic treatment as will resolve over time
What nerves does autonomic neuropathy affect?
Nerves regulating; heart rate/BP, gastric motility, respiration, urination, sexual function & vision
Describe the effect of autonomic neuropathy in the digestive system
gastric slowing, gastroparesis (slowed stomach emptying) can mess with glucose levels due to disturbed carbohydrate absorption rate, oesophageal nerve damage can impact swallowing
What is the treatment for autonomic neuropathy affecting the digestive system?
Improve glycemic control, dietary advice, promotility drugs, anti-nausea drugs, Bo-tox, gastric pacemaker
How does autonomic neuropathy impact the sweat glands?
Body cannot regulate temperature - nerve damage can also cause perfuse sweating at night/while eating
What is the treatment for sweat gland related problems?
topical glycopyrrolate, clonidine, bo-tox
Describe focal neuropathy
sudden weakness in one nerve/group of nerves causing weakness/ pain
Give some examples of focal neuropathy
carpal tunnel syndrome/foot drop/bells palsy
What are the risk factors for diabetic complications?
- poor glycemic control
- type 1>type 2
- high cholesterol
- smoking/alcohol
- genetics
- mechanical injury
What are the effects of diabetes on the kidneys?
Damage to capillaries in the glomeruli (scaring & proteinuria) means protein leaks through into the urine
What are the consequences of nephropathy?
- development of hypertension
- decline in renal function
- accelerated vascular disease
