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18 Cards in this Set
- Front
- Back
What are the main acute complications of diabetes?
- which has the highest risk of mortality? |
1. hyperglycemia
2. DKA - diabetic ketoacidosis 3. Hyperosmolarity (HIGH MORTALITY) |
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What are the 2 categories of chronic complications of diabetes?
- % diabetics affected? |
Microvascular - 80% diabetics; 50% type II diabetics at time of dx!!!!
- retinopathy - nephropathy - neuropathy (foot problems) - erectile dysfunction Macrovascular- CAD and stroke - 2-6-fold increased risk in diabetics (compared to non-diabetics) |
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Diabetes is the #1 cause of...???
(3 things) |
- end-stage renal failure
- blindness in working-aged adults - non-traumatic leg amputations |
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What are the biochemical consequences of hyperglycemia?
|
- tissue damage - via AGEs
- glucose activates cellular kinases (protein kinase C) - increased sorbitol in nervous tissue --> swelling --> dysfunction - increased basement membrane thickness in kidney - increased oxidative stress |
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AGEs
- what are? - how formed? - what do they do? |
= Advanced Glycosylation End-Products (AGEs)
- Formed from the addition of Glu to the NH2 groups on proteins (reversible) --> modified via highly reactive carbonyl derivatives (irreversible) **cause tissue damage - responsible for many of the cellular complications of diabetes due to hyperglycemia |
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HbA1c
- what is? - how formed? |
= good marker for blood Glucose
- Formed from addition of Glu to NH2 terminus of Beta-chain of HbA (in RBCs) |
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What is role of GROWTH FACTORS in chronic diabetes?
|
TGF-beta
- induced by hyperglycemia - associated with renal hypertrophy and nephropathy VEGF (vascular endothelial growth factor) - induced by hypoxia in retina due to microvascular damage from hyperglycemia - causes neovascularization - proliferation of abnormally frail blood vessels; causes hemorrhage and scarring |
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What was the DCCT?
What was the UKPDS? ... results? |
DCCT - clinical trial on Type I DM
UKPDS - clinical trial on Type II DM ... showed that TIGHT CONTROL over glucose levels led to LESS COMPLICATIONS |
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What is the main limitation to achieving tight patient control over diabetes?
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HYPOGLYCEMIA --> unpleasant sx!!!
- and can be life-threatening ... patients want to avoid this, so don't take their meds |
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What are the stages of Diabetic Retinopathy?
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1. Non-proliferative/Background Retinopathy
- dots (microaneurysms) - blots (small intraretinal hemorrhages) - cotton wool spots (retinal ischemia) - hard exudates (lipids form circles around leaking blood vessels) - Intraretinal Microvascular Abnormalities (IRMA) - maculopathy - exudates around macula (more common in type II DM) 2. Proliferative Retinopathy - new vessel formation due to VEGF secreted in response to retinal ischemia --> fragile - tendency to hemorrhage --> can lead to retinal detachment, permanent blindness |
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Other than retinopathy, what eye problems are associated with chronic diabetes?
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- increased rate of age-related cataracts and type I specific cataracts
- refractory defects due to altered osmotic pressure within lens - glaucoma rates increased! - infections |
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What are important management recommendations for diabetics at risk of eye problems?
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- tight control!!
- laser surgery to decrease O2 and thus decrease VEGF - periodic ophthalmologist exams |
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Diabetic Neurophathy
- percent diabetic patients affected? - types? |
- affects 20-50% patients with TYPE II DM
Acute Reversible - Hyperglycemic Neuropathy Persistent, Peripheral Polyneuropathy - dysesthesia (numbness) - paresthesia (pins and needles - painful) Pressure Palsies - carpel tunnel - median nerve - ulnar nerve compression at elbow Mononeuropathy - diabetic amyotrophy (femoral n - wasting of muscle tissue) - III, VI nerves - truncal nerves Autonomic Neuropathy - GI tract - diarrhea, gastric dilatation - CV - postural hypotension, abdnormal cardiac refexes, edema - Bladder Neck Dysfunction - Erectile Dysfunction - Eyes - abnormal pupillary reflex |
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Diabetic Nephropathy
- type I v type II? - stages? - assessment? - meds? |
- Risk in Type I > Type II bc II has later onset
... BUT more Type II on dialysis bc such a high prevalence Stages: - hyperfiltration and renal hypertrophy - expansion of tubular tissue - microalbuminuria - glomerulosclerosis (accelerated by HTN) - late stage: kidneys fibrotic and atrophied Assessment: - monitor microalbumin in urine (creatinine ratio is sensitive marker!!!) - normal is < 30 - later signs: creatinine, BUN, clearance GIVE ACE INHIBITORS!! |
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What is microalbuminuria a marker of?
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= independent risk factor for CV disease!!!
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What are the main causes of Diabetic Foot Ulcers?
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- Neuropathy
--- peripheral --- motor - characteristic posture of raised arch and clawed toes- puts pressure (calluses) on metatarsal hads and heels - hemorrhage and necrosis within callus --> ulcer --- autonomic (reduced sweating --> dry, cracked skin --> infection entry); charcot arthropathy - Peripheral vascular disease --- reduced blood supply to feet - low O2 and nutrition - Infections |
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What is recommended foot care for diabetics?
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- daily self-exam
- exam by physicians - MONOFILAMENT ESTHESIOMETER - properly fitted shoes |
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Macrovascular Complications
- men v. women? - mortality rate? - risk factors? |
Men: 2-4-fold increased risk of MI and stroke
Women: (postmenopausal): 10-fold increased risk ***>80% diabetics die from CV disease Risk factors leading to accelerated atherosclerosis: - hyperglycemia - traditional risks - HTN, dyslipidemia, obesity, renal dysfunction |