Flashcards in Vascular Complications of DM 2 Deck (25):
What are the microvascular complications of diabetes?
nephropathy, retinopathy, neuropathy
What are the macrovascular complications of diabetes?
HTN, MI, TIAs/strokes, platelet hypersensitivity, PVD
Describe the pathophysiology of diabetic nephropathy
Lesions occur in the glomeruli. Basment Membrane Thickens. the glomerulus becomes leaky due to the glomerular sclerosis. Kidneys and nephrons hypertrophy, hyperfiltration occurs increasing work on the kidneys. Can't reabsorb excess glucose.
What is microalbuminuria?
small but abnormal amounts of albumin in the urine (30-300mg/24hrs). leading indicator of developing nephropathy. strongest independent risk factor of cardiovascular disease
Describe the progression of microalbuminuria to end stage renal disease
Progresses to macroalbuminuria (>300mg/hr). Steady drop in GFR leading to dialysis. Decline can be slowed by tight glucose control, BP control, protein restricted diet, smoking cessation
What medications are used to treat diabetic nephropathy?
ACE inhibitors (Lisinopril)- need to check creatinine 7-10 days after initiating therapy, Angiotension II receptor blockers (ARB's)- Cozar, antiproteinuric effect, cardioprotective.
What characterizes nonproliferative diabetic retinopathy?
Increased capillary permeability and dilation of venules. Presence of microaneurysms, Hard exudates, Superficial retinal microinfarcts (cotton wool spots)
What characterizes proliferative diabetic retinopathy?
neovascularization, sudden vision loss, neovascular glaucoma, blind/painful eye, retinal detachment, senile cataracts
What are screening guidelines to prevent diabetic retinopathy?
Annual dilated fundoscopic exams by an opthalmologist. For women, dilated fundoscopic exam before conception and every 4-8 weeks of pregnancy
How is diabetic retinopathy managed and treated?
tight glucose control, treatment of HTN, statins to decrease lipid deposition. Lasar photocoagulation or vitrectomy as surgical corrections of advance disease.
What pathophysiologic changes are associated with diabetic neuropathy?
thickening of the walls of the nutrient vessels that supply the nerve (ischemia) and segmental demyelination of the Schwann cells
What is the clinical presentation of somatic peripheral polyneuropathy?
glove and stocking distribution- pain, numbness, hyperthesias, paresthesias, sensory loss (proprioception and vibration)
What are the diagnostic tests of neuropathy?
foot exam of each visit- color, sores, pressure areas, feel for pulses, capillary refill. neuro exam to include monofiliment test, reflexes, vibratory sensation, proprioception
What medications can be used to treat diabetic neuropathy?
Elavil (Amitryptilene), ASA, Tylenol, NSAIDS, Tegretol (Carbamazapine), Neurontin, (Gabapentin)- works thru GABA, Lyrica (Pregabalin), Cymbalta (Duloxitine)
What is the clinical presentation of autonomic neuropathy?
Gastric dysmotility - Gastroparesis, orthostatic HTN, cardiac disrhythmias, bladder incontinence, ED
What medications are used to treat orthostatic HTN?
Florinef (Fludrocortisones) and Midodrine (ProAmatine)
What medications are used to treat gastraparesis?
Erythromycin, Imodium (Loperamide), Metocloperamide (Carbamazepine)
What is diabetic amyotrophy?
Muscle atrophy and weakness of the anterior thigh or pelvic girdle
Chronic inflammatory disorder of intima of large blood vessels characterised by formation of fibrofatty plaques called atheroma
Why should beta blockers be used cautiously in diabetics?
may mask warning signs of hypoglycemia (adrenergic blunting)
How can macrovascular complications be delayed in diabetics?
optimal BP, HDL> 40 (men), >50 (women). Triglycerides <150. 30 minutes of moderate-intensity activity everyday. BMI of 18.5-24.9. Antiplatlet agents
What are the primary sites of PVD?
Femoral & Popliteal arteries: 80-90%. Tibial & Peroneal arteries: 40-50%. Aorta & Iliac arteries: 30%
What is the ankle-brachial index (ABI)?
SBP in ankle (dorsalis pedis and posterior tibial arteries) divided by SBP in upper arm (brachial artery)
How are ankle-brachial index values clinically classified?
Normal > 0.90, Claudication: 0.50-0.90. Rest pain: 0.21-0.49, Tissue loss < 0.20