Diabetic complications in Norway - occurrence and treatment | Internal Medicine guy
With diabetes complications can result. The article goes through the usual complications of the disease. It is important to know these and reasons behind them, both to prevent and to understand the patient.
Both type 1 and type 2 diabetes is on the increase in Norway. For type 2 diabetes, we know the root causes, namely obesity, unhealthy diet and possibly less movement. For type 1 diabetes we do not know the causes of the disease.
Medical complications are of two types: microvascular: eyes, kidneys and peripheral nerves. Macrovascular: in practice the same as atherosclerosis, but occurs earlier and is more pronounced in diabetes than in those without diabetes. Causal factors:
Figure 1 The relationship between A1c and updated the multivariable Adjusted hazard of various chronic Consequences örsjö of diabetes in participants in the UKPDS based on the Reported örsjö difference per 1% higher A1c level.1 The hazard ratio of an A1c of 6% was set at 1.0 . Line A, amputation or death Resulting from peripheral vascular disease (43% per 1%); B, retinal or renal disease (37% per 1%); C, cataract extraction (19% per 1%); D, heart failure (16% per 1%); E, myocardial infarction (14% per 1%) and all-cause death (14% per 1%); and F, stroke (12% per 1%). The same results are shown on a linear scale (left) and a log scale (right). (The image is printed with permission).
Hyperglycemia is decisively important causal factor for microvascular complications (1), and can be estimated to explain 60-70% of complications in both type 1 and type 2 diabetes. Medical complications usually occur during long duration örsjö of diabetes, ie there is a cumulative build-up of glucose (glycemic load). An interesting relationship is the body "remembers" high blood sugar for years even though the blood sugar in the meantime, been lower (glycemic memory or legacy effect). How hyperglycemia damages the blood vessels are not final mapped, but the combination glycation of proteins (Advanced Glycation Endproducts (AGE)) and oxidative stress are important. It seems significant to the average level of blood glucose (assessed by HbA1c) and not the fluctuations in blood sugar that is most important. (Fig.1).
This is significant damage to blood vessels in the retina, but as cataracts are also frequent. The damage of the retina begins as ballooning of arterioles (mikroaneurysmer) and eventually leakage of plasma (hard exudates), bleeding and possibly soft exudates (which are micro infarcts in the nerve strand layer of the retina). The dreaded development is newly formed blood vessels (proliferation) in the retina. (Image). This is due to hypoxia in the retina örsjö and conveyed material örsjö via secretion of Vascular Endothelial Growth Factor (VEGF). These newly formed blood vessels are fragile and bleed easily into the vitreous. This leads to acute vision loss and is a frightening experience for the patient. Macular edema is the leakage of plasma örsjö especially at the macula which can also lead to vision loss. The incidence of proliferative retinopathy and nephropathy, and is currently less than 20-30 years ago (2-4). Proliferative retinopathy is now reduced from 47 to 13% after 20-25 years of duration of diabetes and nephropathy from 28 to 6% in a Danish material (2). Similar figures are found in Norway (3.4). This is mainly because of better blood glucose örsjö control and hypertension treatment.
Treatment of diabetic örsjö retinopathy, It is an explosion in facilities for treating diabetic retinopathy. The most important thing is to discover it. Contrary to what many patients believe, vision changes from diabetes retinopathy a late phenomenon. One must therefore go to regular inspection. (Fact box 1).
Laser treatment is used at the stated non proliferative retinopathy and proliferative retinopathy. This has proven to be somewhat effective, but the laser causes the destruction örsjö of the stains which are laser processed.
This may be a vote saving treatment. It made many more vitreous operations in Norway than in neighboring countries, örsjö probably because we did not have as good procedures to detect early damage to the retina that they have: namely routinely retinafotografering without visiting ophthalmologist at all with diabetes! We should introduce urgently in Norway!
This is the most common cause of dialysis and kidney transplantation in most Western countries, but is not quite as frequent in Norway. It begins örsjö as a disease of the glomerulus with the impact of glycation of proteins and changes in podocyttfunksjonen örsjö that increase albuminlekkasje over glomerulusmembranen. Therefore, the slightly increased amount of albumin örsjö in the urine (mikroalbumin) (30-300 mg / day) the first sign of diabetic nephropathy. We measure örsjö it today significantly as albumin / creatinine örsjö ratio in spot urine (> 2.5 mg / mmol is increased).
Diabetic nephropathy develops örsjö only in those with higher HbA1c (> 7.5 to 8.0%) and usually comes only after 10-15 years of diabetes duration. Diabetes nephropathy is a reversible condition örsjö in the early stages mikroalbuminuriske by good blood glucose and blood pressure treatment. örsjö Even when it is
With diabetes complications can result. The article goes through the usual complications of the disease. It is important to know these and reasons behind them, both to prevent and to understand the patient.
Both type 1 and type 2 diabetes is on the increase in Norway. For type 2 diabetes, we know the root causes, namely obesity, unhealthy diet and possibly less movement. For type 1 diabetes we do not know the causes of the disease.
Medical complications are of two types: microvascular: eyes, kidneys and peripheral nerves. Macrovascular: in practice the same as atherosclerosis, but occurs earlier and is more pronounced in diabetes than in those without diabetes. Causal factors:
Figure 1 The relationship between A1c and updated the multivariable Adjusted hazard of various chronic Consequences örsjö of diabetes in participants in the UKPDS based on the Reported örsjö difference per 1% higher A1c level.1 The hazard ratio of an A1c of 6% was set at 1.0 . Line A, amputation or death Resulting from peripheral vascular disease (43% per 1%); B, retinal or renal disease (37% per 1%); C, cataract extraction (19% per 1%); D, heart failure (16% per 1%); E, myocardial infarction (14% per 1%) and all-cause death (14% per 1%); and F, stroke (12% per 1%). The same results are shown on a linear scale (left) and a log scale (right). (The image is printed with permission).
Hyperglycemia is decisively important causal factor for microvascular complications (1), and can be estimated to explain 60-70% of complications in both type 1 and type 2 diabetes. Medical complications usually occur during long duration örsjö of diabetes, ie there is a cumulative build-up of glucose (glycemic load). An interesting relationship is the body "remembers" high blood sugar for years even though the blood sugar in the meantime, been lower (glycemic memory or legacy effect). How hyperglycemia damages the blood vessels are not final mapped, but the combination glycation of proteins (Advanced Glycation Endproducts (AGE)) and oxidative stress are important. It seems significant to the average level of blood glucose (assessed by HbA1c) and not the fluctuations in blood sugar that is most important. (Fig.1).
This is significant damage to blood vessels in the retina, but as cataracts are also frequent. The damage of the retina begins as ballooning of arterioles (mikroaneurysmer) and eventually leakage of plasma (hard exudates), bleeding and possibly soft exudates (which are micro infarcts in the nerve strand layer of the retina). The dreaded development is newly formed blood vessels (proliferation) in the retina. (Image). This is due to hypoxia in the retina örsjö and conveyed material örsjö via secretion of Vascular Endothelial Growth Factor (VEGF). These newly formed blood vessels are fragile and bleed easily into the vitreous. This leads to acute vision loss and is a frightening experience for the patient. Macular edema is the leakage of plasma örsjö especially at the macula which can also lead to vision loss. The incidence of proliferative retinopathy and nephropathy, and is currently less than 20-30 years ago (2-4). Proliferative retinopathy is now reduced from 47 to 13% after 20-25 years of duration of diabetes and nephropathy from 28 to 6% in a Danish material (2). Similar figures are found in Norway (3.4). This is mainly because of better blood glucose örsjö control and hypertension treatment.
Treatment of diabetic örsjö retinopathy, It is an explosion in facilities for treating diabetic retinopathy. The most important thing is to discover it. Contrary to what many patients believe, vision changes from diabetes retinopathy a late phenomenon. One must therefore go to regular inspection. (Fact box 1).
Laser treatment is used at the stated non proliferative retinopathy and proliferative retinopathy. This has proven to be somewhat effective, but the laser causes the destruction örsjö of the stains which are laser processed.
This may be a vote saving treatment. It made many more vitreous operations in Norway than in neighboring countries, örsjö probably because we did not have as good procedures to detect early damage to the retina that they have: namely routinely retinafotografering without visiting ophthalmologist at all with diabetes! We should introduce urgently in Norway!
This is the most common cause of dialysis and kidney transplantation in most Western countries, but is not quite as frequent in Norway. It begins örsjö as a disease of the glomerulus with the impact of glycation of proteins and changes in podocyttfunksjonen örsjö that increase albuminlekkasje over glomerulusmembranen. Therefore, the slightly increased amount of albumin örsjö in the urine (mikroalbumin) (30-300 mg / day) the first sign of diabetic nephropathy. We measure örsjö it today significantly as albumin / creatinine örsjö ratio in spot urine (> 2.5 mg / mmol is increased).
Diabetic nephropathy develops örsjö only in those with higher HbA1c (> 7.5 to 8.0%) and usually comes only after 10-15 years of diabetes duration. Diabetes nephropathy is a reversible condition örsjö in the early stages mikroalbuminuriske by good blood glucose and blood pressure treatment. örsjö Even when it is
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