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Yr3 Met 3B > 4. Diabetic Complications > Flashcards

4. Diabetic Complications Flashcards

1
Q

What is the most common complication of Diabetes?

A

Retinopathy: 21%

Erectile Dysfunction: 20%

Abnormal ECG: 18%

Rare: Feet, Stroke ischaemia

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2
Q

Why do Diabetic complications occur?

A

Long term exposure to Hyperglycemia:

  1. Vessel closure: Decreasing oxygen/nutrient supply
  2. Vessel permeability: Dilation of damaged vessels
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3
Q

What Risk Factors increase risk of complications in Diabetics?

A
  1. Smoking
  2. Hypertension
  3. Dyslipidemia
  4. Hyperglycemia
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4
Q

What are the Main Groups of Diabetic Complications?

A

Microvascular

Macrovascular

Other

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5
Q

What is classed under the Microvascular group of Diabetic complications?

A

Retinopathy
Nephropathy
Neuropathy (Peripheral Sensorimotor/Autonomic)

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6
Q

What is classed under the Macrovascular group of Diabetic complications?

A

Coronary Heart Disease
Cerebrovascular Disease
Peripheral Vascular Disease

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7
Q

What is classed under the Other group of Diabetic complications?

A

Skin
Rheumatological
Liver

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8
Q

What is Diabetic Retinopathy?

A

Complication of diabetes caused by Hyperglycemia damaging the back of the eye (retina)

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9
Q

What is the most common cause of blindness in working age people?

A

Diabetic Retinopathy

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10
Q

How can Diabetic Retinopathy be prevented?

A
  1. Good BP control
  2. Good Glycaemic control
  3. Regular eye screening
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11
Q

What is Non-Proliferative Retinopathy?

A

Retinopathy NOT involving the Macula

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12
Q

What three main features are there for Non-Proliferative Retinopathy?

A
  1. Microaneurysms
  2. Dot Haemorrhages
  3. Hard Exudates (Lipid deposits)
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13
Q

What Three subgroups of Non-proliferative Retinopathy are there?

A

Mild
Moderate
Severe

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14
Q

What can be seen in Severe Non-Proliferative Retinopathy?

A

Cotton Wool Spots (Soft Exudates)

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15
Q

What do Cotton Wool Spots indicate?

A

Areas of Retinal Ischaemia

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16
Q

What is Proliferative Retinopathy?

A

Ischaemic Retina leading to Growth Factor production and Neovascularisation

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17
Q

What do NVD and NVE mean in the context of Proliferative Retinopathy?

A

NVD: New Vessels on Disk
NVE: New Vessels Elsewhere

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18
Q

What is Diabetic Maculopathy?

A

Presence of any retinopathy within 1 DISC DIAMETER around macula

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19
Q

What different types of Maculopathy are there?

A

Focal/Exudative - Hard exudates around Macula leading to Macular Oedma/Vision Loss

Diffuse

Ischaemic - Retinal Vessel Closure

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20
Q

How can we prevent Diabetic Retinopathy?

A
  1. Diabetic patients should undergo yearly Digital Retinal Screening
  2. Aim for HbA1C <53 (control glycemia)
  3. Aim for good BP/cholesterol
  4. Laser Photocoagulation
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21
Q

When would one use Laser Photocoagulation?

A

Sight preservation for Proliferative Retinopathy or Maculopathy

22
Q

What types of Diabetic Neuropathy exist?

A
  1. Peripheral Sensory Neuropathy
  2. Autonomic Neuropathy
  3. Proximal Motor Neuropathy (Amyotrophy)
  4. Mononeuropathy (Cranial Nerve palsies, Carpal Tunnel)
23
Q

How do we test for Peripheral Sensory Neuropathy?

A

Screening for high risk of ulceration

  1. Low Vibration sense
  2. Low Fine Touch sense (Semmes Weinstein Monofilament)
  3. Low Ankle reflexes
  4. Muscle Wasting
24
Q

What symptoms can we see for Peripheral Sensory Neuropathy?

A
  1. Numbness
  2. Pins and Needles
  3. Burning
  4. Shocking
25
Q

What risks are there for patients with Peripheral Sensory Neuropathy?

A

Ulceration

Amputation

26
Q

What is the most common cause of Non-traumatic amputation?

A

Diabetic Neuropathy

27
Q

What issues can Diabetic Autonomic Neuropathy cause?

A
  1. Genitourinary
  2. GI
  3. Cardiovascular
28
Q

What Genitourinary issues can Diabetic Autonomic Neuropathy cause?

A
  1. Erectile Dysfunction

2. Atonic bladder (Issues with voiding/urinary incontinence)

29
Q

What GI issues can Diabetic Autonomic Neuropathy cause?

A
  1. Gastroparesis (Vomiting/Early satiety)
  2. Chronic constipation
  3. Gustatory sweating (when eating)
30
Q

What CVS issues can Diabetic Autonomic Neuropathy cause?

A

Postural Hypotension

31
Q

What is the most common cause of End Stage Renal Failure in the UK?

A

Diabetic Nephropathy

32
Q

What percentage of Type 2 Diabetics have nephropathy?

A

25-30%

33
Q

Which ethnic groups have a higher risk of Diabetic Nephropathy?

A

South Asians

Afro-Caribbeans

34
Q

List at least 5 Risk Factors for development/progression of Nephropathy

A
  1. Duration of Diabetes
  2. Hypertension
  3. Poor glycemic control
  4. Smoking
  5. Male
  6. Ethnicity
  7. Family History
35
Q

What are the clinical features of Diabetic Nephropathy?

A
  1. Hypertension
  2. Albuminuria (Preceded by Microalbuminuria)
  3. Declining Renal Function

Triad of Symptoms

36
Q

Upon a renal biopsy, what can be found in Diabetic Nephropathy?

A

Kimmelstein-Wilson pathological lesion

37
Q

How do we screen for Microalbuminuria?

A
  1. Measure the Urine Albumin:Creatinine Ratio (ACR)
  2. Normal: <2.5 mg/mmol in men, <3.5 mg/mmol in women
  3. Repeat Twice if elevated
  4. Positive if 2/3 is positive
38
Q

How do we treat Nephropathy?

A
  1. Maintain BP of 130/80
    - Give ACEI
    - Consider ARB if ACEI sucks
  2. Optimise Blood Glucose (<53)
  3. Manage CV Risk Factors aggressively
  4. Stop Metformin when eGFR <30 ml/min
  5. Refer to specialist when eGFR <45 ml/min and falling
  6. Renal Replacement Therapy
39
Q

When should you stop Metformin on a Diabetic Nephropathy patient?

A

When their eGFR drops below 30 ml/min

40
Q

When should you refer a Diabetic Nephropathy patient to a specialist?

A

When their eGFT drops below 45 ml/min and is FALLING

41
Q

What types of Renal Replacement therapy is available for Diabetic Nephropathy patients?

A

Peritoneal Dialysis
Haemodialysis
Transplant

Simultaneous Pancreas/Kidney Transplant in T1DM

42
Q

What treatment can be provided for those with Diabetic Nephropathy?

A
  1. Smoking Cessations
  2. Maintain BP
    - ACEI
    - CCB
    - Thiazide
    - Alpha or Beta blocker
  3. Cholesterol to 4 mmol/L
    - Statin (If 40+ and diabetic, or 40- and 1 RF)
  4. HbA1c < 53
43
Q

Give 5 ways we can treat or manage AMI?

A
  1. Aspirin
  2. Primary Angioplasty/Thrombolysis
  3. Glucose-Insulin infusion
  4. Secondary Prevention
    - ACEI, BB, Statin, Aspirin, Improve Glycemia
  5. Cardiac rehab
44
Q

How do we manage Cerebrovascular Events?

A

If it’s within 3 hours, consider Thrombolysis

  • Treat all vascular risk factors aggressively using
    a) ACEI
    b) Statin
    c) Aspirin
    d) Glucose/Insulin infusion
45
Q

What skin manifestations can persist via diabetes?

A
  1. Oral/Genital Candidiasis
  2. Skin abscesses
  3. Diabetic dermopathy
  4. Necrobiosis Lipoidica Diabeticorum (T1DM)
  5. Bullosis Diabeticorum
  6. Granuloma Annulare
  7. ACANTHOSIS NIGRICANS (Insulin resistance)
  8. Fungal Nail infections
46
Q

What is Acanthosis Nigricans a sign of?

A

Insulin resistance

47
Q

**What 6 Rheumatological manifestations are there of Diabetes?

A
  1. Charcot Neuroarthropathy (Neuropathic joint leading to severe deformity/ulcer risk)
  2. Diabetic Cheiroarthropathy (Due to limited joint mobility)
  3. Adhesive Capsulitis (Frozen shoulder)
  4. DISH
  5. Flexor Tendinopathy
  6. Diabetic osteoarthropathy
48
Q

What liver issues are associated with Diabetes?

A
  1. NAFLD (Very common)
  2. Progression to NASH/Fibrosis/Cirrhosis
  3. High ALT and AST > 2 x the upper limit of normal
49
Q

What does NASH stand for in relation to liver diseases?

A

Non-alcoholic steato hepatitis

50
Q

How can we investigate ALT and AST?

A
  1. Hepatitis serology
  2. US scan
  3. Ferritin to exclude haemochromatosis
51
Q

What drug can be used to reduce progression of Diabetic patients’ liver to cirrhosis?

A

Pioglitazone

Yr3 Met 3B (13 decks)

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