T1 L18 Long term complications of diabetes Flashcards
What are microvascular complications?
Complications affecting the small blood vessels which leads to organ damage
Give examples of cells that can reduce glucose transport in response to extracellular hyperglycaemia
Retinal endothelial cells
Mesangial cells of glomerulus of the kidneys
Schwann cells and peripheral nerve cells
How long do microvascular complications take to develop?
Many years
Rare before 5 years of type 1 diabetes
Can be detected at presentation of type 2 diabetes
Describe retinal microcirculation
Low density of capillaries
- little functional reserve
- flow needs to respond to local needs
- pericytes are key to local regulation of flow
What are the pathological findings in diabetes retinopathy?
Loss of pericytes
Basement membrane thickening
Capillary closure
Ischaemia - VEGF production
What are the clinical stages of diabetic retinopathy?
Non-proliferative
Proliferative
Macular oedema
What is the treatment for diabetic retinopathy?
Laser treatment - pan retinal, focal
Intra-vitreal anti VEGF Ab if there are problems with the macula
What are the types of neuropathy?
Peripheral neuropathy
Mononeuropathy
Autonomic neuropathy
Describe some consequences of autonomic neuropathy
Gastroparesis Postural hypotension Erectile dysfunction Gustatory sweating Diarrhoea
What is charcot’s foot?
Weakening of bones in the foot when there is neuropathy
Heat, inflammation, deformity
Describe renal microcirculation
Fenestrated glomerular capillaries
Basement membrane
Highly specialised podocytes
What are the pathological findings in diabetic nephropathy?
Basement membrane thickening
Podocyte loss
Glomerular sclerosis
Mesangial expansion
What are the clinical stages of diabetic nephropathy?
Normoalbuminuria
Microalbuminuria
Albuminuria
What are microvascular complications?
Damage to large blood vessels leading to organ damage (IHD, CVD, PVD)
What are some modifiable risk factors for macrovascular complications?
Blood pressure
Lipids
Smoking
Glucose control
