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Endo yr 2 > micro and macrovascular compl of t2d > Flashcards

micro and macrovascular compl of t2d Flashcards

1
Q

3 types of microvascular complications

A

retinopathy, nephropathy, neuropathy

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2
Q

3 types of macrovascular disease

A

ischaemic heart disease, cerebrovascular disease, peripheral vascular disease

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3
Q

when does risk of microvascular disease increase exponentially? (what factor)

A

blood glucose/ hyperglycemia- target hba1c- below 53

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4
Q

what factor other than blood glucose do you need to check to avoid microvascular complications? (proportional relationship- linear)

A

blood pressure- HYPERTENSION

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5
Q

what are 2 blood-content related factors that are associated with microvascular complications

A

hyperlipidaemia (high cholesterol)- clogs arteries

hyperglycaemic memory- when for a period of time you had high-uncontrolled gluc levels and this can cause problmes later on (due to endothelial damage)

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6
Q

what are other factors that can increase risk of microvascular complications

A

duration of diabetes - when had for longer- since younger - think t1d usually- you need to monitor more

smoking - endothelial dysfunction

genetic factors - some people control glu less well and dont get compl and vise versa

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7
Q

when we say microvascular damage what part pf the vessel is actually being damaged?

A

endothelium

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8
Q

mechanism of microvascular damage (endothelium)

A

1) hyperlipidaemia and hyperglycaemia lead to
2) OXIDATIVE STRESS leads to
3) increased formation of mitochondrial superoxide free radicals (leads back to 2)
+
4) glycation of plasma porteins leaidng to advanced glycation poducts (AGEs)

5) activation of inflammatory pathways

6) damaged endothelium : a)leaky capillaries
b) ischaemia

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9
Q

what is the main cause of
visual loss in people with diabetes and blindness in people of working age?

A

diabetic retinopathy

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10
Q

how often do diabetics get screened for diabetic retinopathy and why?

A

annually because it initially is asymptomatic and we want to catch before it causes visual loss/ disturbance (irreversible)

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11
Q

what is another cause of visual disturbance in diabetes? what type fo disturbance?

A

blurry vision at start of diabetes due to thickening of lens in eye- part of osmotic sympotms- reversible and NOT THE SAME AS RETINOPATHY

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12
Q

What are the 2 normal features seen in a normal retina, where is each located and which is bright/ dark (in examination)

A

optic disc - side- bright
macula/ fovea - centre - dark (high resolution central colour vision)

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13
Q

what are the 4 pathologies in the eye?

A

background retinopathy
pre-proliferative retinopathy
proliferative retinopathy
maculopathy

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14
Q

which type of retinopathy is the least and which is most dangerous

A

least: background
most: proliferative

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15
Q

features in background retinopathy

A

1) dot (aneurisms) and blot haemorages

2) hard exudate - cheese colour from lipids

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16
Q

features in pre-proliferative retinopathy

A

“cotton wool” spots/ soft exudate - they are bright- represent retinal ischaemia (here we dont have the dots and blots- only these bright spots)

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17
Q

features of proliferative retinopathy

A

you see more branches on the retinal vessels/ more vessels (on disc or elsewhere in retina)

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18
Q

features of maculopathy

A

hard exudate but only around macula (Looks like background retinopathy but ONLY around macula as opposed to around the whole retina)

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19
Q

what does the management of all the eye pathologies involve before we move onto any kind of treatment?

A

Improve HbA1c, stop smoking, lipid lowering, good blood pressure control <130/80 mmHg

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20
Q

what is the management of background retinpathy?

A

continued annual surveillance

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21
Q

management of pre-proliferative retinopathy?

A

if left untreated will rpogress to proliferative so - early PANRETINAL photocoagulation

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22
Q

management for proliferative retinopathy

A

pnretinal photocoagulation

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23
Q

management for diabetic maculopathy

A

its oedema so: injection of anti-VEGF (vascular endothelial growth factor) straight into the eye

and grid photocoagulation

24
Q

what is seen in the retina after pan retinal photocoagulation? what does this mean clinically?

A

black spots on the periphery of the retina- loss of some peripheral vision - its worth it bc if you leave it to proliferate it will lead to uncontrolled loss of vision

25
Q

What stage of diabetic retinopathy can be observed rather than treated?

A

background retinopathy

26
Q

3 reasons why diabetic nephropathy is important/ serious

A

associated with cardiovascular complications,

associated with END STAGE renal failure which requires haemoDIALYSIS

healthcare burden

27
Q

what is an appropriate measurement for diabetic nephropathy surveillance?

A

Urine Albumin: creatinine ratio (UACR)

28
Q

what is normal ACR and what are the 3 progression stages?

A

normal ZERO
microalbuminurea: >3 mg/mmol
proteinurea: >30mg/ mmol
nephrotic range: >3000mg/ 24hr

29
Q

what do you do if a UACR comes back positive and why?

A

you need to repeat it to confirm because its ommon to have false positives due to UTI, fever

30
Q

what are some innapropriate measurements for screening for diabetic nephropathy?

A

GFR and creatinine because these would change only in PROGRESSED kidney disease- its too late to prevent then

31
Q

mechanism of diabetic nephropathy

A

1) Hypertension and hyperglycaemia

2) hypertension in glomerulus

3) PROTEINUREA

4) fibrosis of GLOMERULUS and INTERSTITIAL space

5) GLOMERUAL FILTRATION DECLINE

6) renal failure

32
Q

what treatment should people with microalbuminurea/ porteinurea get?

A

ARB or ACEi even if normotensive

these drugs imptove progression of diabetic nephropathy AND reduce bp

NEVER FORGET HOLLISTIC APPROACH- popping them on a drug is not enough bc still theres risk for cardiovascular disease so need to control other facotors, smoking ect.

33
Q

specific OTHER things to consider in diabetic nephropathy other than drugs

A

Aim for good glycaemic control (HbA1c <53 mmol/mol)Reduce

BP (aim <130/80 mmHg) usually through ACEi or A2RB

Stop smoking

Start an SGLT-2 inhibitor if T2DM?

34
Q

how is angiotensin 2 made?

A

1) angiotensinogen from liver
2) stimulated by renin from the kidney to turn into angiotensin I
2) STIMULATED BY ACE to turn into angiotensin II

35
Q

where does angiotensin II act on and what are the effects?

A

on angiotensin receptors in
1) blood vessels for vasoconstriciton

2) zona glomerulosa of adrenal cortex for aldosterone secretion

36
Q

what are 2 types of antihypertensives?

A

ACEi : ace inhibitors and ARBs - angiotensin receptor blockers

37
Q

what do the ACEi drugs and ARBs drugs names end with?

A

-pril

-sartan

38
Q

what is the name of small vessels supplying nerves?

A

vasa nervosum

39
Q

when do you get neuropathy (pathophysio)

A

when vasa nervosum get blocked

40
Q

most common cause of neuropathy and therefore lower limb amputation

A

diabetes mellitus

41
Q

unique risk factors for diabetic neuropathy

A

age
height (longer nerves in lower limbs of tall people)

presence of diabetic retinopathy

42
Q

why is neuropathy more common in feet?

A

bc longest nerves

43
Q

why is diabetic neuropathy in feet clinically relevant

A

1) can be painful
2) patients may not sense injury-> infection

44
Q

what are the 2 main factors u need to check for in diabetic foot

A

factors you want to check for:
1) sensation
2) blood flow

45
Q

how do you check for these factors in diabetic foot

A

1) inspect- look for deofrmity - ulceration
2) sense test with monofilament - ankle jerks
3) asses foot pulses: dorsalis pedis and posterior tibial

46
Q

what are patients with reduced sensation to feet and reduce vascular supply to feet at risk for and what are the med names of the two thongs mentioned above?

A

peripheral neuropathy
peripheral vascular disease
risk of ulceration

47
Q

peripheral neuropathy management

A

. Regular inspection of feet by affected individual
2. Good footwear
3. Avoid barefoot walking
Podiatry and chiropody if needed

48
Q

periptheral neuropathy with ulceration management

A

Multidisciplinary diabetes foot clinic
Offloading
Revascularisation if concomitant PVD
Antibiotics if infected
Orthotic footwear
Amputation if all else fails

49
Q

2 other types of neuropathy

A

mononeuropathy
autonomic neuropahty

50
Q

what are 2 common forms of mononeuropathy

A

1) drop of one wrist. leg
2) 3rd CN/ occulomotor PALSY: eye looks down and out (think eye drops like the rest)

51
Q

what is autonomic neuropathy

A

damage to sympathetic and parasympathetic nerves along multiple systems: cardiovascular, GI, bladder

52
Q

GI sympotms of autonomic neuropathy and problems it causes with diabetes

A

diarrhoea
constipation
vomiting + nausea (late GASTRIC emptying )- CHALLENGING with short acting glucose doses

53
Q

CARDIO sympotms of autonomic neuropathy

A

postural hypotension - colapse when standing
sudden cardiac death - cardiac autonomic supply

54
Q

effect of hyperglycaemic management on cardiovascular disease (MACRO vascular complic)

A

MINOR EFFECT

55
Q

modifiable RISK factors for macrovascular disease

A

dyslipidaemia
central obesity

diabetes mellitus
smoking
hypertension

56
Q

non modif risk factors for macrovascular disease

A

age
sex
birth weight
genes

57
Q

Managing cardiovascular risk in diabetes mellitus

A

Smoking status – support to quit

Blood pressure < 130/80 mmHg if microvascular complication or increased metabolic risk (NB often needs multiple agents)

Lipid profile – total chol <4, LDL <2

Weight – discuss lifestyle intervention +/- pharmacological treatments

Annual urine microalbuminuria screen – risk factor for cardiovascular disease

Endo yr 2 (11 decks)

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