DIABETIC RETINOPATHY
Diabetic retinopathy is damage to the photosensitive part of the eye (retina) common in long standing diabetes mellitus for at least 10 years. It is the leading cause of blindness amongst people under the age of 65 years. High blood sugars puts small blood vessels at throes of being destroyed especially those of the eye. The damaged blood vessels are weak and leak fluid and lipids.[1]
These small blood vessel leaks may cause some of the blood vessel to be occluded leading to ischemia (lack of blood supply) and as a way of body's adaptation to these changes, new blood vessel grow to provide alternative blood supply to areas in the eye which lack blood. These new blood vessels lack connective tissue and are fragile with high likelihood to bleed into the eye segments. [2]
To take you through a crush course of anatomy, the eye has got two segments i.e anterior and posterior segment. Anterior segment is filled with aqueous fluid secreted by the cilliary gland. The posterior segment is filled with the vitreous body. [3]
Bleeding into these segments causes visual loss which may be reversible but when left untreated results into profound and irreversible loss of vision, traction of the retina leading to retinal detachment. [2]
DIABETIC NEPHROPATHY.
Diabetic nephropathy is when there is an increase in albumin excretion through the urine. According to American Diabetes Association, about 40% of people with type 1 and 2 DM are suffer from diabetic nephropathy. [4]
Diabetic nephropathy is characterized by thickening of the glomerular basement membrane and enlargement of the mesangium. Thickened glomerular basement membrane is defective in its function and allows proteins in blood to permeate. This causes proteins to appear in urine which is unusual occurrence in absence of kidney pathology. [2]
According to the level of albuminuria, Diabetic Nephropathy is categorized into two:-
- Microalbuminuria- the urine albumin excretion is >20µg/min and less than or equal to 199µg/min.
- Macroalbuminuria- urine albumin excretion of more than 200µg/min [4]
Mesangium enlargement leads to defects in glomerular filtration with resultant diminished function if the kidney filtration. This leads to accumulation of water and waste products in the body (renal failure). [2]
Care:-
- In type 1 DM, annual screening for microalbuminuria.
- In type 2 DM, screen for microalbuminuria at the point of diagnosis then done annually thereafter.
- Treating lipid problems with cholesterol lowering tablets.
- Treating and monitoring of high blood pressure.
DIABETIC NEUROPATHY.
This is damage to the nerves that occurs in people with diabetes mellitus. It is more prevalent in people with poorly controlled blood glucose level. High blood sugar is toxic to the nerves in the body and is implicated with damage to nerves and blood vessels. [5]
Peripheral neuropathy- this involves damage to the nerves of the feet and occasionally hands. Individual with peripheral neuropathy may present with:-
- Loss of sensation of feet and/or hands.
- Not able to elicit a 10-g mono-filament device.
- Reduced ankle and knee reflexes.
- Loss of balance
- Hypersensitivity of feet and legs which worsen at night with patient not able to tolerate weight of beddings on the lower limbs.
- Burning sensation. [2]
Autonomic neuropathy- different systems like the cardiovascular system, gasto-intestinal system, genito-urinary system and the skin.
- Heart- increased heart rate at rest, postural hypotension.
- Gastro-intestinal system- abdominal bloating, feeling of satiety, delayed stomach emptying, nausea, vomiting, altered bowel habits with evidence of diarrhea and stool incontinence.
- Skin- excess facial sweating with eating.
- Urinary system- urine incontinence, urine retention/incomplete emptying of bladder, increased risks to urinary tract infections.[6]
Common post: ALCOHOLIC BLACKOUTS-10 avoidable risk factors
References.
1. Wikipedia, the free encyclopedia. Diabetic Retinopathy. Viewed at http://www.en.m.wikipedia.org/wiki/diabetic_retinopathy. Viewed on 20/05/2015, last edited 2days ago by Spokbot (from the date of view)
1. Wikipedia, the free encyclopedia. Diabetic Retinopathy. Viewed at http://www.en.m.wikipedia.org/wiki/diabetic_retinopathy. Viewed on 20/05/2015, last edited 2days ago by Spokbot (from the date of view)
2. Medicine, Second Edition 2004. By John Axford and Chris O'callaghan. Diabetic Mellitus, Lipoprotein Disorders and other metabolic diseases- complicstions of diabetes mellitus. Viewed on 20/05/2015
3. Ross and Wilson textbook of Anatomy and Physiology, in health and illness, by Anne Waugh and Allison Grant. Tenth edition. The Special Senses, sight and the eye. Viewed on 20/05/2015.
4. America Diabetes Association, Diabetes care. Diabetic nephropathy: diagnosis, prevention and treatment by Jorge L. Gross, MD, Mirela J. De Azevedo, MD, Luis Henrique Canani, MD, and Themis Zelmanovitz, MD. Viewed at: http://www.care.diabetesjournals.org/content/28/1/164.abstract. viewed on 21/05/2015
5. Mayo Clinic, Diseases and Conditions. Duabetic neuropathy by Mayo clinic staff. Revised on Feb 24th, 2015.
Viewed at: http://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/basics/definition/con-20033336.
Viewed at: http://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/basics/definition/con-20033336.
6. Wikipedia, the free encyclopedia. Diabetic Neuropathy. Edited 11 days ago (from date of viewing 23/05/2015) by Paine Ellsworth.
Viewed at: http://en.m.wikipedia.org/wiki/Diabetic_neuropathy
Viewed at: http://en.m.wikipedia.org/wiki/Diabetic_neuropathy
