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Endocrine Week 2 2017/18 > 3: Microvascular complications of diabetes > Flashcards

3: Microvascular complications of diabetes Flashcards

1
Q

What are the three main microvascular complications of diabetes?

A

Neuropathy

Nephropathy

Retinopathy

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2
Q

What are the end-stage outcomes of

retinopathy

nephropathy

neuropathy?

A

Retinopathy - blindness

Nephropathy - dialysis

Neuropathy - amputation

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3
Q

The (better / poorer) your glycaemic control, i.e the higher your level of ___, the greater your risk of microvascular complications.

A

poor glycaemic control

higher HbA1c levels

more complications

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4
Q

Good glycaemic control should be achieved ___ to avoid microvascular complications.

A

early

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5
Q

What causes microvascular complications in hyperglycaemia?

A

Hypoxia

Oxidative stress

Build-up of end products

leading to inflammation

something about mitochondrial dysfunction

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6
Q

What is peripheral neuropathy?

A

Loss of feeling

Pain

in the hands and feet.

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7
Q

What is autonomic neuropathy?

A

Damage to autonomic nerves producing:

changes in bowel habit, bladder function, sexual function, sweating, HR, BP…

basically everything controlled by autonomic nerves.

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8
Q

Peripheral neuropathy tends to have a “_____” distribution.

A

glove and stocking

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9
Q

What kind of pain do patients with peripheral neuropathy have?

A

Burning / tingly pain

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10
Q

Patients with peripheral neuropathy often develop numbness.

What can this lead to?

A

Accumulation of injuries (burns, ill-fitting shoes)

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11
Q

What eponymous name is given to the “bag of bones” appearance of a foot in peripheral neuropathy?

A

Charcot foot

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12
Q

Can drugs treat the loss of sensation in peripheral neuropathy?

A

No

Pain only

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13
Q

What are the treatment options for painful peripheral neuropathy?

A

Amitriptyline

Duloxetine

Gabapentin

Pregabalin

i.e atypical analgesics

Topical capsaicin cream

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14
Q

How can Charcot foot be avoided?

A

Appropriate footwear

Regular checking of feet

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15
Q

What are some presentations of autonomic neuropathy?

A

Tachycardia

Postural hypotension

Gastroparesis

Dysphagia

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16
Q

Why does gastroparesis pose a concern in diabetics?

A

Affects blood glucose levels due to abnormal digestion, vomiting, diarrhoea etc.

17
Q

What drug is commonly used to treat gastroparesis in diabetics with autonomic neuropathy?

A

Metoclopramide

18
Q

Improving ___ control often improves the symptoms of diabetes complications.

A

glycaemic

19
Q

How is gastroparesis treated?

A

Dietary - smaller, more frequent meals, low fat and fibre

Promotility drugs (revise these)

Botox

Gastric pacemaker

20
Q

What are two cardiovascular presentations of autonomic neuropathy?

A

Hypertension / postural hypotension

Tachycardia

21
Q

How is peripheral neuropathy screened for?

A

Hand / foot exam once a year

22
Q

What other investigations can be done for neuropathy?

A

Nerve conduction studies, EMG

Heart rate

Ultrasound of bladder for prolonged emptying

Gastric emptying study

23
Q

What is a kidney complication of diabetes?

A

Nephropathy

24
Q

Many patients on ___ also have diabetes.

A

dialysis

25
Q

What are the consequences of diabetic nephropathy?

A

Hypertension > accelerated CVD

Renal dysfunction

26
Q

How is diabetic nephropathy screened for?

A

Albumin / creatinine ratio (ACR)

27
Q

What is the name for an increase in albumin found in the urine, and is an indicator of renal damage?

A

Microalbuminuria

28
Q

Renal disease secondary to diabetes accelerates ___ disease.

A

cardiovascular

29
Q

What is the blood pressure target for diabetic patients?

A

< 130 / 80 mmHg

30
Q

What is the HbA1c target for patients with diabetes?

A

< 53 mmol/mol

ideally < 48

31
Q

What is an eye symptom of acute hyperglycaemia?

A

Visual blurring

32
Q

Chronically, diabetes can lead to which eye complications?

A

Retinopathy

Cataracts

Glaucoma

33
Q

Which structures of the retina are damaged in diabetic neuropathy?

A

Macula

Fovea (dip within macula)

both responsible for central vision

34
Q

What are the two stages of diabetic retinopathy?

A

Non-proliferative

Proliferative (leading to bleeding and vision disturbance)

35
Q

If no or minor retinopathy is found on retinal screening, what is done?

A

Rescreening later

36
Q

If significant retinopathy is found on retinal screening, what is done?

A

Referral to an opthalmologist

37
Q

Apart from retinal photographs, what other imaging can be used to view the eye?

A

Optical coherence tomography

38
Q

How is retinopathy treated?

A

Laser treatment

Anti-VEGF injections

39
Q

What is a complication of diabetes in men?

A

Erectile dysfunction

Endocrine Week 2 2017/18 (10 decks)

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