Med Con 1-Diabetes Related Complications Microvascular and Soft Tissue

what are some key points in the natural history of type 2 diabetes?
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what are some key points in the natural history of type 2 diabetes?
-Long pre-symptomatic phase prior to diagnosis of type 2 diabetes (T2D)
-beta cell function declines early, way before diagnosis and insulin resistance has an inverse relationship
-postprandial glucose is glucose after eating and you can't hand the increase in glucose
-you have microvascular and macrovascular complications start before diabetes occurs
-before someone has diabetes, they already have a higher risk of cardiovascular diseases already
what happens in diabetes mellitus? (not physiology, but some effects)
1. increased oxidative stress
2. pro-inflammatory gene expression
3. altered protein function
4. endothelial damage
5. platelet activation
what are some sensorial neuropathic effects of diabetes mellitus?
loss of protective sensation... can lead to repetitive trauma
what are some motor/somatic neuropathic effects of diabetes mellitus?
1. foot deformities
2. limited joint mobility
... leads to increased risk shear, pressure, and injury
what are some autonomic neuropathic effects of diabetes mellitus?
1. vascular dysfunction
2. decreased sweating
... leads to dry skin, callus, foot at risk, foot ulcer,
OR
increased peripheral blood flow... leading to dilated foot veins and warm, dry feet
what are some angiopathic effects of diabetes mellitus?
-macrovascular:
1. accelerated atherosclerosis
2. peripheral arterial occlusion
... leads to poor tissue perfusion

-microvascular:
1. tissue changes
2. retinopathy
3. nephropathy
4. poor tissue healing
what are some microvascular complications individuals with diabetes mellitus may have?
1. retinopathy
2. nephropathy
3. neuropathy --> affects autonomic, sensory, and motor systems

Microvascular changes include thickening of the capillaries leading to poor oxygen and nutrient exchange and injury to the basement membrane
what are some soft tissue complications with diabetes mellitis?
1. skin
2. connective tissue
3. joints
what is diabetic retinopathy?
individuals with diabetes that affect the retina so they will have spots where they see black. it results from microvascular occlusion of the retina, leading to ischemia and tissue death. it's strongly related to the duration of diabetes and glucose control
what is the most frequent cause of new cases of blindness in adults 20-74 years old?
diabetic retinopathy
how can you prevent diabetic retinopathy?primary and secondary prevention: 1. optimize glucose control 2. optimize BP control 3. yearly comprehensive eye examshow does diabetic nephropathy occur? (what happens?)angiopathy of the capillaries in the kidney glomeruli, leading to progressive albuminuria, loss of glomerular filtration, and hypertension -occurs in 20-40% of pts with diabetes -the single leading cause of end stage renal diseasewhat is the single leading cause of end stage renal disease?diabetic nephropathywhat are the type of sensation receptors? what do they do?1. meissner corpuscles-discrimatory touch; high sensitivity, rapidly adapting 2. pacinian corpuscle-pressure 3. ruffini organ-stretch 4. merkel disks-light touch 5. free nerve endingswhat happens when there is a sensory stimulus?When stimulus is strong enough, it sends an AP down axon to dorsal horn and up to sensory cortex. Sensory cortex sends down information for motorhow do diabetes affect nerves and blood vessels?Diabetes affects the vasa nervorum, which affects ability of the nerve to get blood and affect the nerve itselfwhat happens if there is a loss of sensation in a dermatomal pattern?there is a problem at the nerve rootDoes diabetes affect peripheral or dermatomal?neither; it's in the distal extremities. All afferent cell bodies are in the dorsal root ganglion which is at the spinal cord level. The longest neurons are affected first and it happens distally to proximallywhat are the diabetic polyneuropathies?1. symmetrical neuropathy: diabetic peripheral neuropathy 2. focal and multi-focal neuropathy: -mononeuropathy -amyotrophy -entrapment 3. autonomic neuropathywhat is mononeuropathy?Could be 1 nerve that is damaged and lost sensationwhat happens in neural entrapment? give an exampleSoft tissue changing; ex. People with diabetes are more susceptible to carpal tunnel bc of potential of entrapmentwhat autonomic neuropathy is suspectable to neuropathy?vagus nerve bc it's the longest autonomic nervedefine sensory polyneuropathyprogressive degeneration loss of nerve fibers if the most distal portions and progresses proximally (multiple nerves losing sensation) -Oxidative stress, excessive neuronal intracellular glucose, and glycation end product disruption of cellular metabolism, and ischemia -Additional causes of nerve damage: Alcohol, HIV, syphilis, infectionwhat are the motor neuropathies?1. diabetic amyotrophy (proximal diabetic neuropathy) 2. loss of intrinsic muscle strength 3. results in muscle imbalances 4. claw foot and hammer toe deformities 5. loss of ankle DF may cause foot drop 6. carpal tunnel syndromewhat problems do claw foot and hammer toe deformities cause?high pressure areas at metatarsal heads, PIP joints, and distal tips of toeswhat happens in diabetic amyotrophy?1. asymmetrical proximal muscle weakness 2. muscle wasting or weakness, typically anterior thigh 3. first symptoms is often pain in thigh, butt, or hips 4. most commonly affects one side and can be gradual or suddenwhat is Charcot's Joint neuroarthropathy?a chronic progressive degeneration of stress-bearing portion of the joint. subluxation of tarsal/metatarsal joints results in "rocker-bottom" foot: swollen, arm, and edematous; unilateral; may be painlesswhen should you suspect if someone has Charcot's joint neuroarthropathy?-age 40+ -obesity & peripheral neuropathy w/ acute swollen foot following minimal or no recalled trauma -reports minimal to no pain, esp. if radiography and laboratory markers of infections are normalwhat happens in autonomic neuropathy?-gradual onset and slowly progressive; common in long standing diabetes 1. impaired skin blood flow-hair loss, loss of sweat, dry skin, bone loss 2. sudomotor-anhidrosis of extremities, gustatory sweating, loss of thermoregulatory sweating in glove and stocking 3. genitourinary-retention, incontinence-UTI; sexual dysfunction 4. GI tract-gastroparesis (Erratic glucose control), diarrhea, constipation 5. cardiovascular-hypotension, HR variability, exercise intolerance, silent ischemiawhat are skin signs of diabetes-related complications?1. xanthomas-fat deposits in the skin (elbows, knees, neck, heels & eyelids) 2. acanthosis nigricans-dark pigmenting in areas in the neck; associated with hyperinsulinemia and insulin resistance and a risk factor for type 2 diabetes and other chronic diseases; imp in identifying children with high insulin levels; impaired vision and loss of sensation leads to frequent loss of skin integrity; poor blood supply affects delivery of oxygen, nutrients, and WBC to area 3. delayed wound healing-tissue hypoxia 4. infections-hyperglycemia feeds the microbes causing urinary and vaginal infections 5. dry skin-dehydration; autonomic neuropathywhat are connective tissue disorders that may be related to diabetes?1. syndrome of limited joint mobility 2. dupuytren's contracture 3. flexor tenosynovitis 4. adhesive capsulitis 5. carpal tunnel syndromewhat is syndrome of limited joint mobility?painless stiffness and limitation of finger joints (flexion contractures), hardness of subcutaneous tissue -may also develop in: elbow, shoulder, knees, spinewhat is dupuytren's contracture?flexion contracture and thickening of the palmar fascia. -3rd and 4th digits in DM -pain/decreased ROM -painless nodules in distal palmar creasewhat is flexor tenosynovitis?accumulation of fibrosus tissue in tendon sheath. -aching, nodularity along flexor tendons -tigger finger: locking of digit -can result in contracturewhat is adhesive capsulitis?loss of ROM in all planes rather than in a typical capsular patternwhat is carpal tunnel syndrome?thickness of the flexor retinaculum results in compression of the median nerve -mononeuropathy-ischemia of median nerve makes it more susceptible to injury for compressionMSK disorders of what parts are 5x more common in individuals with DM?hand and shoulderwhat are the joint disorders that may be associated with DM?diffuse idiopathic skeletal hyperostosiswhat is diffuse idiopathic skeletal hyperostosis?calcifications along the sides of the vertebrae of the spine -osteophytes develop causing bony spurs -associated with inflammation and calcification of tendons -may lead to bone spurs and feel spurs -c-pine spurs may cause dysphagia