Flashcards in EXAM #2: COMPLICATIONS OF DM Deck (21)
What do the majority of patients with DM die from?
What are the microvascular complications of DM?
1) DM Retinopathy
2) DM Nephropathy
3) DM Neuropathy
What are the macrovascular complications of DM?
How does DM lead to microvascular injury?
1) Advanced glycation end products
3) Oxidative stress
What do AGEs, DAG, and oxidative stress activate?
PKC B activation, which mediates microvascular damage
What is the leading cause of blindness in the developed world?
What are the stages of DM retinopathy?
What characterizes non-proliferative DM retinopathy?
2) Blot hemorrhages
3) Cotton wool spots
How is DM retinopathy prevented? How is DM retinopathy treated once it has started?
- Dilated eye exam 5 yrs s/p DM I dx or at DM II dx
- Glycemic control
- BP control
Describe the natural history of DM nephropathy.
1) Glomerular hyperperfusion, hypertrophy, and increased GFR
2) Thickening of BM/ normal GFR
5) End Stage Renal Disease
How is DM nephropathy prevented?
1) Assess albumin excretion annually
2) Serum creatinine annually
3) Glycemic control
When should Metformin be stopped in male and female patients?
Male= Greater than 1.5
Female= Greater than 1.4
How does the treatment of a DM patient with GFR between 45 and 60 need to be treated?
1) Refer to nephrology
2) Consider medication dose adjustments
3) eGFR q6months
4) Monitor electolytes
5) Check Vitamin D/ bone density
How does the treatment of a DM patient with GFR between 30 and 45 need to be treated?
1) Consider medication dose adjustments
2) eGFR q3months
3) Monitor electolytes
How does the treatment of a DM patient with GFR less than 30 need to be treated?
Refer to nephrology
How is CKD treated in DM patients?
2) Angiotensin receptor blockers
3) Modest protein restriction
*Refer to nephrology*
How is the distribution of DM neuropathy described?
How is DM neuropathy treated?
1) Better glycemic control
2) Proper foot care
How can DM nerve pain be treated?
What is DM autonomic neuropathy?
Dysfunction of the ANS due to DM