what are the main complications of type 1 diabetes
- leading cause of heart disease
- blindness
- renal failure
- ulceration and amputation
what increases the risk of complications
poor glycaemic control
what are the 2 categories of complications in type 1 diabetes
microvascular and macrovascular complications
what are the types of microvascular complications
- retinopathy
- nephropathy
- neuropathy
what are the types of macrovascular complications
- cardiovascular
- foot complications
- sexual dysfunction
what eye complications can a patient with type 1 diabetes experience
- retinopathy- 1 in 3 patients will develop sight threatening disease
- cataract- diabetes increases rate of age related formation
- refractory defects- hyperglycaemia alters osmotic pressure within lens
- glaucoma- prevalence increases in diabetes
- infection
what may be seen in a eye examination showing retinopathy
- venous irregularities
- blot haemorrhages
- cottonwool spots and exudates
why is screening necessary for retinopathy
- to prevent blindness
- retinopathy is asymptomatic
- annual eye test
- particularly high risk patients (pregnancy accelerates progression of retinopathy)
describe the management of retinopathy
- close liaison between ophthalmology and diabetes services
- development/progression delayed by optimal diabetic control
- optimal blood pressure control is equally important
- pre proliferative/proliferative retinopathy requires laser photocoagulation
Outline the stages of diabetic nephropathy
normal, microalbuminuria, persistent proteinuria, renal impairment, stage 4 cKD
- annual screening for kidney disease
name the different classifications of neuropathy
- peripheral neuropathy
- acute painful neuropathy
- pressure palsies
- mononeuropathies
- autonomic
what is peripheral neuropathy
damage to long nerve axons leading to sensory loss
what are the risk factors for peripheral neuropathy
poor control, obesity, diabetes duration, high blood pressure
what are the symptoms of acute painful neuropathy
- pain
- poor sleep
- reduced quality of life
- depression
what is pressure palsies
increased susceptibility to nerve compression/entrapment (carpal tunnel syndrome)
what is mononeuropathies
3rd/6th cranial nerve damage
- rapid onset
- muscle weakness
what are the signs and symptoms of autonomic neuropathy
- gastrointestinal- oesophageal dysmotility, diabetic diarrhoea
- cardiovascular- postural hypotension
- genitourinary- neuropathic bladder, erectile dysfunction
- musculoskeletal- charcot anthropathy
- eyes- abnormal pupillary reflexes
what are the causes of diabetic foot ulcers
- peripheral neuropathy- loss of pain sensation/injury unawareness
- motor neuropathy- characteristic posture, raised arch, callus formation
- autonomic neuropathy- reduced sweating, dry cracked skin
- Charcot anthropathy
- peripheral vascular disease- reduced blood supply to feet, poor oxygen supply
- infection
what are the principles of good foot care
- wash feet daily
- check feet daily
- seek urgent treatment of problems
- don’t use hot water bottles
- don’t walk barefoot
- don’t wear ill-fitting shoes
how does erectile dysfunction occur
- prevalence increases with age
- affects 60% of men with diabetes
- results from autonomic neuropathy
- other factors include drugs, endocrine disorders
how is erectile dysfunction managed
- improve glycaemic control
- reduce alcohol intake
- substitute drugs that may impair erection
- first line drug treatment is phosphodiesterase type 5 inhibitors
- but can cause severe acute hypotension - prostaglandin E injections
- vacuum devices
describe the prevalence of cardiovascular disease in diabetic patients
- diabetes confers a 2-4 fold increased risk of MI and stroke in men and a 10 fold increased risk in post menopausal women
- accounts for 60-75% of all deaths in people with diabetes
- greater emphasis on managing arterial risk factors
- atheroma develops earlier, faster and is more extensive in people with diabetes
what are the psychological complications of diabetes
- depression is increased in people with diabetes
- patients with depression are less likely to monitor blood glucose or take their insulin as prescribed
how can psychological complications be managed
- emotional and psychological support should be available long term and particularly at diagnosis
- all members of the diabetes team should be trained to recognise and address basic psychological issues
