Saturday, May 5, 2012

DM complications

The reversible complications are the microvascular complications.


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.

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

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

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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