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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
What are the constituents of diabetic eye disease?
Retinopathy and maculopathy Cataracts Rubeosis iris CN palsies
26
What is rubeosis iris?
New vessels on the iris
27
What can rubeosis iris lead to?
Glaucoma
28
What is the importance of diabetic retinopathy and maculopathy?
It is the most common cause of blindness up to 60 years
29
When should a patient be referred with diabetic retinopathy and maculopathy?
If they have pre-prolierative retinopathy/maculopathy
30
How is diabetic retinopathy/maculopathy investigated?
Fluorescein angiography
31
How is diabetic retinopathy/maculopathy managed?
Laser photocoagulation
32
What will be found on fundoscopy in diabetic background retinopathy?
Microaneurysms Blot haemorrhages Hard exudates
33
What are hard exudates?
Yellow lipid patches
34
What will be found on fundoscopy in pre-proliferative retinopathy?
Cotton-wool spots (retinal infarcts) Venous beading Haemorrhages
35
What will be found on fundoscopy in proliferative retinopathy?
New vessels | Pre-retinal or vitreous haemorrhage
36
What will be found on fundoscopy in maculopathy?
Hard exudates within one disc width of macula
37
What might be the only sign of maculopathy?
Reduced acuity
38
What are the components to the pathophysiology of diabetic neuropathy?
Metabolic | Ischaemic
39
What are the metabolic factors in diabetic neuropathy?
Glycosylation ROS Sorbital accumulation
40
What are the ischaemic factors in diabetic neuropathy?
Loss of vasa nervorum
41
What are the types of neuropathy in diabetes?
Symmetric sensory polyneuropathy Mononeuropathy/mononeuritis multiplex Femoral neuropathy/amyotrophy Autonomic neuropathy
42
What are the clinical features of symmetric sensory polyneuropathy?
Glove and stocking neuropathy Absent ankle jerks Numbness, tingling, and pain which is worse at night
43
What is lost in glove and stocking neuropathy?
All modalities
44
How may symmetric sensory polyneuropathy be managed?
Paracetamol Amitriptryline, gabapentin, or SSRI Capsaicin cream Baclofen
45
Give an example of a mononeuropathy in diabetes
CN3/6 palsies
46
What happens in femoral neuropathy?
Painful asymmetric weakness and wasting of quads, leading to loss of knee jerks
47
How is a diagnosis of femoral neuropathy made?
Nerve conduction and electromyography
48
What are the symptoms of autonomic neuropathy in diabetes?
``` Postural hypotension Gastroparesis Diarrhoea Urinary retention Erectile dysfunction ```
49
How is postural hypotension caused by diabetic autonomic neuropathy managed?
Fludrocortisone
50
What are the symptoms of gastroparesis?
Early satiety GORD Bloating
51
How is diarrhoea caused by diabetic autonomic neuropathy managed?
Codeine phosphate

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

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