Saturday, May 5, 2012

DM complications

The reversible complications are the microvascular complications.

Retinopathy
Neuropathy
Nephropathy

Tight control of glucose can reverse them, so look for them.

Type 1 DM : microvascular complications don't develop until about 5 yrs after onset
onset is usually close to diagnosis 'cos they can't live for long time without insulin

Type 2 DM: check for microvascular complications at diagnosis. They probably have had the disease undiagnosed for a long time.

Retinopathy:
Do yrly Ophthalmology visit
Non proliferative. (dilated veins,microaneurysms,edema, hard exudates, haemorrhage) Ensure tight sugar control
Proliferative- (neovascularisation,cotton wool spots, haemorrhage.) Do laser rx to prevent blindness

Neuropathy:
mononeuropathy esp occulomotor
peripheral neuropathy
autonomic neuropathy e.g gastroparesis (give metochlopromide), hypotension, erectile dysfxn

Nephropathy:
Earliest fxnal abnormality is hyperfilteration
Nephrotic range proteinuria (if proteinuria present,give ACEi)



Target :Hb A1c <7, fasting sugar<125mg/dl

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