MICROVASCULAR TRIOPATHY OF DM

Epi, Risks

PathoPhys.

Control

NEPHROPATHY

- D. accounts for 40% of CRF in US.

- 30% of ESRD patients are D. pts.

- genetics – parental HTN, Fam Hx. of cardiovascular disease.

- affects half of DMI, fewer DMII.

- onset – microalbuminuria detectable at 7-19 years of age.

- microalbuminuria is the harbinger serving as a sensitive screening tool, and strong predictor of future CVD problems: defined as 30-299 ug/mg Cr. on spot collection (also may use 24 hr. or timed collection). Must repeat and start tx. after two abnormal lab findings.

- severe HTN accelerates the development of kidney problems.

- BM thickening to mesangial expansion to glom. Fibr. & scarring (protienuria, GFR) to renal pathology.

- a positive dipstick proteinuria indicates predictable and relentless renal failure.

- Pathophys. Based on high glucose, high Ang II, and HTN

- control gylcemia, manage HTN (120/75), ACEI to lower GFR, protein restriction

- refer if substantial renal problems (creatinine > 4 or frank albuminuria).

RETINOPATHY

- the single major cause of blindness in the US.

- 20% of DMII at presentation and 2/3 DMII in 20 years will develop retinopathy.

- Best preventive tool is regular eye exams, which are recommended for every diabetic on an annual basis after the age of 30 years. Pregnant women need evaluation early.

- Hypoxia causes both non-proliferative and proliferative changes in the retina.

- Nonproliferative – retinal aneurysms in the endothelium bleed and cause vascular closure.

- Proliferative – new blood vessel growth within the retina, post. vitr.

- 90% of blindness may be prevented by glycemic control, HTN, laser tx., ACEI, regular eye exams for pts. w/ diabetes.

NEUROPATHY

- major risk factor in the development of skin infections, ulcers, and amputation.

- somatic neuropathy – tingling/pain in long/short nerves.

- autonomic neuropathy – tachy., GI issues, and gustatory sweating.

- mononeuropathy – i.e. CN III

- entrapment neuropathy – carpal, tarsal tunnel syndromes.

- annual foot exam with a Semmes-Weinstein monofilament.

- be Nice to your feet with creams, professional quality nail cutting, proper foot care, and daily exams.