What are the 3 main microvascular complications of diabetes?
Why do microvascular complications occur in diabetes?
Hyperglycaemia and hyperlipiaemia contribute to hypoxia, oxidative stress, inflammation, mitochondrial dysfunction and damaged nerves
What are the 4 types of neuropathy experienced in diabetes?
- Focal neuropathy
Neuropathy is more associated with which type of diabetes?
Which things increase an individuals risk of developing neuropathy?
- Poor glycaemic control
- Increased length of time with diabetes
- High cholesterol
- Mechanical injury
What is the most common neuropathy?
What is peripheral neuropathy and how does it present?
Distal or sensorimotor neuropathy
- Sharp pains/cramps
- Sensitivite touch is maintained
- Loss of balance and coordination
What are some complications of peripheral neuropathy?
- Charcot foot
- Painless trauma
- Foot ulcer
What is a Charcot foot?
Progressive degeneration of a weight bearing joint, marked by bony destruction, bone resorption, and eventual deformity
Why is it so key that intensive treatment is started from the outset of diabetes?
Good glycaemic control from the start decreases long term risks
Why are injuries obtained from peripheral neuropathy particularly dangerous?
- They can worsen more than normal due to lack of pain
- Infection may occur and healing is poor
Which treatment may slow progression of Charcot foot?
How may peripheral neuropathy be treated if it is painful?
- Capsaicin cream
What is focal neuropathy?
Acute neuropathy affecting specific nerves, or groups of nerves most often in the head, torson or leg
How may focal neuropathy present?
- Inability to focus eye
- Double vision
- Aching behind eye
- Bell's palsy
- Pain in thigh/chest/lower back/pelvis
- Pain on outside of foot
What is entrapment neuropathy and give an example?
Weakness in one nerve or group of nerves causing muscle weakness or pain
What is proximal neuropathy and how does it present?
- Lumbosacral plexus neuropathy
- Femoral neuropathy
- Diabetic amyotrophy
- Pain in thighs, hips, buttocks or legs
- Usually occurs on one side
- More common in elderly T2DM
What is proximal neuropathy associated with?
What is autonomic neuropathy?
Neuropathy affecting the nerves of the autonomic nervous system
How may autonomic neuropathy present?
- Changes in HR/BP
- GI motility changes e.g. gastroparesis
- Sexual function change
How may gastroparesis present?
- Becoming full easily
How is gastroparesis best treated?
- Improve glycaemic control
- Lower fat intake
- Smaller meals
- Promotility drugs
- Botox into sphincter
- Gastric pacemaker
Why may someone with diabetes experience "gustatory sweating"?
Autonomic neuropathy affecting sweat glands
How can autonomic neuropathy of sweat glands be treated?
- Topical glycopyrrolate
- Botuliunum toxin (botox)
When autonomic neuropathy affects the heart how is blood pressure generally affected?
How does autonomic neuropathy affect the eyes?
Makes pupils less responsive to light
In terms of neuropathy, what may USS be used for in terms of diagnosis?
Bladder or urinary tract to show normal emptying and function
What is the use of nerve conduction studies or electomyography?
Determines type and extent of nerve damage in neuropathy
(how well muscles respond)
What does the FRAME project stand for?
Foot Risk Awareness and Management Education
What is diabetic nephropathy?
Damage to capillaries surrounding glomeruli
Leads to scarring and renal failure