Microvascular Complications of Diabetes Flashcards
What are the 3 major clinical consequences of diabetic neuropathy?
painful neuropathic symptoms, autonomic neuropathy and its manifestations and insensitivity that results in foot ulceration and amputation
What is the most common complication of diabetes?
Diabetic peripheral neuropathy
What happens in diabetic peripheral neuropathy?
- starts in the toes and gradually marches proximally in a stocking distribution
- typical ‘glove and stocking’ sensory loss
- significant motor deficit is not common
What are risk factors for diabetic neuropathy?
- hypertension
- smoking
- BMI
- TG
- cholesterol
How is painful diabetic neuropathy treated?
- Good glycaemic control
- Anticonvulsants (carbamazepine, Gabapentin)
- Opiods (Tramadol, oxycodone)
What is the most common cause for hospital bed occupancy?
Diabetic Foot Ulceration (DFU)
What are the 2 principal factors that contribute to high-risk diabetic foot?
- Peripheral neuropathy – damage to the nerves that serve the lower limbs and hands
- Peripheral vascular disease, which affects the larger vessels of the lower limbs
What is the nature of diabetic foot disease?
- Painless
- A significant amount of damage can occur; people are completely oblivious to this until they notice blood or swelling
What other things can occur in neuropathy?
- Sensory nerve damage
- Motor nerve damage
- Localized callus
- Autonomic nerve damage
What does motor nerve damage lead to?
- This causes weakness in the intrinsic muscles of the feet, leading to contraction of the muscles and clawed toes
- As the toes claw back, the fat pads are pulled forward from under the metatarsal heads, increasing the pressure under these metatarsal heads and on the tips of the toes (common places for neuropathic ulceration)
How do localised calluses form and what do they lead to?
- Build up of callus at the site of most pressure (as no sensation)
- Ultimately this hard, localized callus can cause the tissue underneath to breakdown forming ulceration
What does autonomic nerve damage lead to?
- people lose the ability to perspire; the skin dries out and becomes cracked
- These cracks are a very common portals for infection
What are screening tests for diabetic neuropathy?
- Test sensation
- Vibration perception
- Ankle reflexes
What is peripheral vascular disease?
- Decreased perfusion due to macrovascular disease
- Sites: more distal
- 15-40 times more likely to have lower limb amputation
What are symptoms of peripheral vascular disease?
- Intermittent claudication
- pain in the calf that is brought on by walking, especially upstairs or up a hill, and is relieved by rest
- Rest pain
- is experienced pain in the lower limbs, even at rest
- Surgical intervention is required to relieve the symptoms
