1.3 MTB Step 3 - Complications of Diabetes

Question 1

INTRODUCTION

What are the (7) Complications of Diabetes?

Answer 1

1. Hypertension
2. Hyperlipidemia
3. Retinopathy
4. Nephropathy
5. Neuropathy
6. Erectile Dysfunction
7. Gastroparesis

Question 2

HYPERTENSION

1. What is the Goal of Management of Hypertension in Diabetes?
2. What is the First-Line therapy for Hypertension in a Diabetic?

Answer 2

1. < 140 / 90 mmHg
2. ACEIs / ARBs

• This is the Same BP Goal as for the general population.*
• BP Control is critical in DM to prevent long-term complications to the Heart, Eye, Kidney, and Brain*

Question 3

HYPERLIPIDEMIA

1. What is the LDL Goal in a patient with Diabetes?
2. What is the LDL Goal when the patient has both Diabetes and CAD?

Answer 3

1. < 100 mg/dL (at least)
2. < 70 mg/dL (at least)

Question 4

RETINOPATHY

1. What is the diagnostic test used to detect Proliferative Retinopathy in a patient with Diabetes and how often should it be performed?
2. What is the Treatment for Proliferative Retinopathy if found?
3. Which (2) Medications can be used for SEVERE Proliferative Retinopathy and what drug class are they in?

Answer 4

1. Dilated Eye Exam (annually)
2. Laser Photocoagulation
3. VEGF Inhibitors, Ranibizumab, or Bevacizumab

Question 5

DIABETIC NEPHROPATHY

1. What is the Best Diagnostic Test for Diabetic Nephropathy?
2. What is the Best INITIAL Treatment for Diabetic Nephropathy (i.e., f the Diagnostic Test from #1 is Positive)?

Answer 5

1. Urine Microalbumin
2. ACEIs / ARBs

Use ACEs / ARBs for Proteinuria even if the BP is normal, and especially if they also have HTN.

Question 6

DIABETIC NEPHROPATHY

BASIC SCIENCE CORRELATE

What is the Mechanism of Glomerular Damage in Diabetic Nephropathy?

Answer 6

• Uncontrolled Diabetes removes the Negative charge from the Filtration Slits of the Glomerular Basement Membrane (GBM).
• Normally, negative charges Repel the filtration of Albumin, which is also Negatively charged.
• Loss of Negative charges allows Albumin to pass through the Glomerulus.
• ACEIs Decrease Intraglomerular Hypertension by Dilating the Efferent Arteriole.
• This protects the Glomerulus from the damage caused by Intraglomerular Hypertension

Question 7

DIABETIC NEUROPATHY

1. What is the best method for diagnosing Diabetic Neuropathy?
2. What is the Treatment for Diabetic Neuropathy?

Answer 7

1. Foot Exam annually
2. Gabapentin or Pregabalin - go straight to treatment if diabetic neuropathy is diagnosed of foot exam.

Question 8

DIABETIC NEUROPATHY

BASIC SCIENCE CORRELATE

What is the Mechanism of Neuropathy in Diabetes?

Answer 8

• Nerves have a supply of Blood Vessels.
• Diabetes damages small Blood Vessels, starving off the nerves that they supply.

Question 9

ERECTILE DYSFUNCTION

What is the Treatment for Erectile Dysfunction associated with Diabetes?

Answer 9

Sildenafil

Sildenafil is a PDE Inhibitor

Do NOT give Sildenafil with Nitrates!

Question 10

GASTROPARESIS

1. What is the Mechanism of Diabetic Gastroparesis?
2. What are (4) Symptoms of Diabetic Gastroparesis?
3. What are (2) Medications that can be used to Treat Diabetic Gastroparesis?

Answer 10

1. Impaired ability to perceive Stretch in the GI tract (which is the stimulant for Gastric Motility) causing Impaired Motility.
2. Bloating, Constipation, Abdominal Fullness, and Diarrhea.
3. Metoclopramide or Erythromycin

• Erythromycin increases the release of Motilin, a promotility GI hormone*
• You can also diagnose Diabetic Gastroparesis with a Gastric-Emptying Scan*