DR Medhat MRCP

Complications of DM :
Complication
Clinical condition
Coronary artery disease (CAD)
Macrovascular Cerebrovascular disease (CVD)
Peripheral vascular disease (PVD)
Diabetic eye disease
1) D.retinopathy (the commonest, in all DM-1 & 20% of DM-2)
- Background retinopathy Microaneurysms (in capillaries)
Microvascular
Dot & blot hge (≤ 3)
Hard exudates (lipids & proteins)
- Pre-Proliferative Venous beading/looping
retinopathy Multiple blot hges (> 3), soft exudate.
Deep /dark cluster hemorrhage
Multiple cotton-wool spots (retinal infarcts)
More in DM1 (TTT : Laser ttt)→ destroys
ischaemic but viable retina,not applied directly on new vessels
- Proliferative neovascularisation around the disc (TTT : Laser ttt)
- Diabetic maculopathy (hard exudates in fovia)→urgent referral
- Later retinal detachment .
2) Optic neuritis.
3) Vitreous hge, Cataract (appears 10yrs earlier than non-diabetics)
4) Argyle Robertson pupil(irregular,miotic,eccentric) & Rubiosis iridis.
سؤال Neuropathy , Diabetic amyotrophy
Specific
Hyperglycemic
emergencies
Nephropathy (microalbuminuria 5-15y after D, albuminuria 17y after D,
when s.cr 100→↓GFR 2ml/min/month, ESRD 7-10y after albuminuria)
Diabetic foot (ulcer,gangrene&hair loss d.to vasculopathy & neuropathy)
Arthropathy (e.g charcot`s joint i.e progressive degeneration of a weight
bearing joint, bony destruction, bone resorption, and eventual deformity.
Skin complications
- Recurrent infections (e.g cellulitis).
- Diabetic Dermopathy (light brown, scaly patches / front of legs)
- Necrobiosis lipoidica diabetecorum (violet spots on tibial chin&foot)
- Itching (especially in female vulva)
Gastro-enteropathy
- Gastroparesis diabetecorum (delayed stomach emptying)
- Autonomic neuropathy of intestine diarrohea/constipation
- GB stones & chronic calcular cholecystitis
Genital complications (impotence in males ,infections& pruritis in female)
↑ Risk of infections.
1. Diabetic ketoacidosis (DKA).
2. Hyperosmolar hyperglycemic state .