Flashcards in T1 DM chronic consequences Deck (15)
Cellular mechanism of microvascular complications
High blood glucose= too much glucose into cells
- Some cell types are unable to control glucose entry when there is excess efflux
Leads to cell damage
- Peripheral nerve cells, Schwann cells
- Retinal cells [endothelial]
- Mesangial cells of glomerulus
Complications take many years to develop
Microvascular complications for T1 DM
Rarely occur if DM has occurred in less than 5-10 years
- Due to steep decline of insulin
- Death of BV causes new, small ones to be created
- Small new vessels are more fragile and susceptible to rupture.
- Loss of pericytes
- Thickening of basement membrane
- Closure of capillary causes ischaemia
Leaky capillaries: proteins released [causes 'white spots' in retina]
Diabetic cause is the 2nd most common cause of blindness.
Treatment of diabetic retinopathy
Controlling blood sugar and BP.
- Pan retinal [burn the peripheral retina]
Anti VEGF ab
- injected into retina
Glove and stocking syndrome
- Loss of sensation in the feet that rises to hands.
Neuropathic foot ulcers that can present as callous
- Deformed foot from inflammation, broken bones
Loss of function of a single nerve
Includes carpel tunnel [entrapment neuropathy]
Dysfunction of the ANS nerves
- CVD problems [postural hypotension]
- Erectile dysfunction
- Gustatory sweating
Nephropathy in diabetes
Most common cause of end stage kidney disease in western world
- 21% of death in T1, 11% in T2.
Tends to present with other microvascular complications
Thickening of BM
Loss of podocytes
Scaring- glomerular sclerosis
Increases CVD risk
Diabetic nephropathy treatment
- ACEi and ARBs
Glucose control important but overt proteinuria
Macrovascular disease treatment
Glucose control not as important compared to microvascular
- Assessed the outcome of controlling glucose in diabetic patients
Risk reduction took 15 years for significant reduction in risk.
Whereas controlling BP saw greater reduced risk of microvascular event.
- Significance seen at 5 years
Diabetes control and complications trail
Glycosated haemoglobin does not show linear correlation with increased risk of microvascular events
- Therefore reducing glycated haemoglobin at one level does not have the same effect as at another level.