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3: MED2 Y3 - Endocrinology [5] > [12] Diabetic Complications > Flashcards

[12] Diabetic Complications Flashcards

1
Q

What are the macrovascular complications of diabetes?

A

MI
PVD
CVA

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2
Q

Why might MI as a complication of diabetes be ‘silent’?

A

Due to autonomic neuropathy

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3
Q

How might PVD as a complication of diabetes manifest?

A

Claudication

Foot ulcers

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4
Q

How is the risk of macrovascular complications in diabetes minimised?

A

Manage CV risk factors

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5
Q

What CV risk factors should be managed in diabetes?

A

BP
Smoking
Lipids
HbA1c

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6
Q

What BP should be aimed for in diabetes?

A

<130/80

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7
Q

What is the effect of good glycaemic control in diabetes?

A

It prevents both macro- and micro-vascular complications

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8
Q

What screening is given in diabetes to check for complications?

A

Fundoscopy
Albumin:creatinine ratio
Foot checks

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9
Q

What happens in diabetic feet?

A

Ischaemia

Neuropathy

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10
Q

What can result from ischaemia in diabetic feet?

A

Critical toes
Absent pulses
Ulcers

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11
Q

How do ischaemic ulcers on diabetic feet present?

A

Painful

‘Punched-out’

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12
Q

Where do diabetic foot ulcers due to ischaemia occur?

A

Foot margins and pressure points

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13
Q

What is the problem with neuropathy in diabetic feet?

A

Loss of protective sensation

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14
Q

What can neuropathy in diabetic feet lead to?

A

Deformity
Injury or infection over pressure points
Ulcers

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15
Q

What deformities can result from neuropathy in diabetic feet?

A

Charcot’s joints
Pes cavus
Claw toes

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16
Q

Where do diabetic foot ulcers caused by neuropathy occur?

A

Metatarsal heads and calcaneum

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17
Q

What is involved in the conservative management of diabetic feet?

A

Daily foot inspection, e.g. with mirror
Comfortable/therapeutic shoes
Regular chiropody to remove calluses

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18
Q

When is medical management of diabetic feet required?

A

When there is infection

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19
Q

What antibiotics are used when diabetic feet are infected?

A

Benpen + fluclox + met

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20
Q

When is surgical management of diabetic feet indicated?

A

Abscess or deep infection
Spreading cellulitis
Gangrene
Suppurative arthritis

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21
Q

What is the pathophysiology of diabetic nephropathy?

A

Hyperglycaemia leads to nephron loss and glomerulosclerosis

22
Q

What is considered to be microalbuminuria in diabetic nephropathy?

A

Urine albumin : creatinine ratio = >30mg/mM

23
Q

What should be done if microalbuminaemia is present in diabetes?

A

Give ACEi or angiotensin receptor blocker

24
Q

What is the pathogenesis of diabetic eye disease?

A

Microvascular disease leads to retinal ischaemia. This causes increased VEGF production, leading to new vessel formation

25
Q

What are the constituents of diabetic eye disease?

A

Retinopathy and maculopathy
Cataracts
Rubeosis iris
CN palsies

26
Q

What is rubeosis iris?

A

New vessels on the iris

27
Q

What can rubeosis iris lead to?

A

Glaucoma

28
Q

What is the importance of diabetic retinopathy and maculopathy?

A

It is the most common cause of blindness up to 60 years

29
Q

When should a patient be referred with diabetic retinopathy and maculopathy?

A

If they have pre-prolierative retinopathy/maculopathy

30
Q

How is diabetic retinopathy/maculopathy investigated?

A

Fluorescein angiography

31
Q

How is diabetic retinopathy/maculopathy managed?

A

Laser photocoagulation

32
Q

What will be found on fundoscopy in diabetic background retinopathy?

A

Microaneurysms
Blot haemorrhages
Hard exudates

33
Q

What are hard exudates?

A

Yellow lipid patches

34
Q

What will be found on fundoscopy in pre-proliferative retinopathy?

A

Cotton-wool spots (retinal infarcts)
Venous beading
Haemorrhages

35
Q

What will be found on fundoscopy in proliferative retinopathy?

A

New vessels

Pre-retinal or vitreous haemorrhage

36
Q

What will be found on fundoscopy in maculopathy?

A

Hard exudates within one disc width of macula

37
Q

What might be the only sign of maculopathy?

A

Reduced acuity

38
Q

What are the components to the pathophysiology of diabetic neuropathy?

A

Metabolic

Ischaemic

39
Q

What are the metabolic factors in diabetic neuropathy?

A

Glycosylation
ROS
Sorbital accumulation

40
Q

What are the ischaemic factors in diabetic neuropathy?

A

Loss of vasa nervorum

41
Q

What are the types of neuropathy in diabetes?

A

Symmetric sensory polyneuropathy
Mononeuropathy/mononeuritis multiplex
Femoral neuropathy/amyotrophy
Autonomic neuropathy

42
Q

What are the clinical features of symmetric sensory polyneuropathy?

A

Glove and stocking neuropathy
Absent ankle jerks
Numbness, tingling, and pain which is worse at night

43
Q

What is lost in glove and stocking neuropathy?

A

All modalities

44
Q

How may symmetric sensory polyneuropathy be managed?

A

Paracetamol
Amitriptryline, gabapentin, or SSRI
Capsaicin cream
Baclofen

45
Q

Give an example of a mononeuropathy in diabetes

A

CN3/6 palsies

46
Q

What happens in femoral neuropathy?

A

Painful asymmetric weakness and wasting of quads, leading to loss of knee jerks

47
Q

How is a diagnosis of femoral neuropathy made?

A

Nerve conduction and electromyography

48
Q

What are the symptoms of autonomic neuropathy in diabetes?

A 
Postural hypotension
Gastroparesis
Diarrhoea
Urinary retention 
Erectile dysfunction
49
Q

How is postural hypotension caused by diabetic autonomic neuropathy managed?

A

Fludrocortisone

50
Q

What are the symptoms of gastroparesis?

A

Early satiety
GORD
Bloating

51
Q

How is diarrhoea caused by diabetic autonomic neuropathy managed?

A

Codeine phosphate

3: MED2 Y3 - Endocrinology [5] (18 decks)

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