Long-term complications - micro and macro Flashcards
What are some risk factors for complications associated with diabetes?
- Duration of diabetes
- Metabolic control
- Smoking
- Hypertension
- Hyperlipidaemia
- Genetics
What are some risk factors for cardiovascular disease?
- Glucose control
- Blood pressure
- Smoking
- Lipids
- Proteinuria
- Family history
- Gender
What is the target HbA1c level in diabetics?
Target HbA1c - 53 mmols/mol (7%)
What is the target blood pressure in diabetics?
Control BP to ≤ 130/80
How can cardiovascular complication risk be decreased?
- Smoking cessation - support, nicotine replacement or drug therapy (Zyban, Champix)
- Statin therapy e.g. simvastatin for patients over 40 and in younger patients with significant complications
- Lifestyle choices – maintaining healthy weight, exercise
What drug therapy is used for smoking cessation?
Zyban (bupropion, also used as as antidepressant)
Champix (varenicline)
What 3 pathologies are caused by diabetic microvascular disease?
- Retinopathy
- Neuropathy
- Nephropathy
What is the most common cause of blindness in the working age population?
Diabetic retinopathy
What are some retinal abnormalities seen in diabetes?
- Microaneurysms (small red dots)
- White spots from lipid aggregates
- Blot haemorrhages
- Hard exudates
- Cotton wool spots
- New vessel formation
- Vitreous haemorrhage
How can proliferative retinopathy be treated?
Laser photocoagulation
Vitrectomy
What affects vision in maculopathy?
- Exudates and blot haemorrhages at macula
- Macular ischaemia
- Macular oedema deforms the macula, affecting visual acuity
What is used to treat diabetic maculopathy?
Grid laser therapy
BP and blood glucose control
How much does risk of cataracts increase in diabetic patients?
2X increase
What are the 3 subtypes of diabetic neuropathy?
o Peripheral neuropathy (diffuse nerve disease) – most common
o Mononeuritis (single nerve palsy) – less common
o Autonomic neuropathy
What are some symptoms of peripheral neuropathy?
Gloove and stocking distribution of:
- feet insensitive to trauma: risk of feet ulcers
- paraesthesia (abnormal sensation)
- burning pain
- numbness
- small muscle wasting
- can be asymptomatic!!
How can peripheral neuropathy be managed?
• Early detection – screening for diabetic foot disease
• Self care education
• Protection of feet
• Pain relief
– Capsaisin cream (local treatment)
– Amitriptyline, gabapentin, duloxetine (systemic treatment, pain)
What local treatment can be given for pain caused by peripheral neuropathy?
Capsaisin cream
What systemic treatment can be given for pain caused by peripheral neuropathy?
Amitriptyline
Gabapentin
Duloxetine
What techniques are used for foot screening and risk scoring for ulcer prevention?
Microfilament - record sensation
Peripheral pulses
How can foot ulcers be prevented?
Foot screening Education on foot care Regular podiatry for those at high risk Avoidance of trauma Avoid fitted footwear
What is Charcot foot/Charcot neuro-arthropathy, and why is prevention important?
- Progressive degeneration of a weight bearing joint, a process marked by bone destruction, bone resorption, and eventual deformity due to loss of sensation and an initial small trauma. Onset is usually insidious (gradual)
- If this pathological process continues unchecked, it can result in joint deformity, ulceration and/or superinfection, loss of function, and in the worst-case scenario, amputation or death. Early identification of joint changes is the best way to limit morbidity.
What factors indicate high risk of complications of the feet?
- Impaired circulation
- Impaired sensation
- Impaired vision
- Foot shape changes
- Abnormal pressures
What is acute sensorial peripheral neuropathy, and what causes it?
Rapid onset of neuropathic symptoms
Precipitating factors
– Rapid tightening of control e.g. trying to get pregnant
– Acute metabolic upset
What can happen after a rapid tightening of glycemic control or an acute metabolic upset?
Acute sensorial peripheral neuropathy
