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Semester 4 > case 6 - disease complications > Flashcards

case 6 - disease complications Flashcards

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1
Q

what is the epidemiology of diabetes 1

A

10% of global health expenditure is spent on diabetes - 80% spent on managing complications
1,110,100 children and adolescents have type 1 diabetes

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2
Q

what are the microvascular complications of type 1 diabetes

A

diabetic retinopathy

diabetes nephropathy

diabetes neuropathy

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3
Q

what are the macrovascular complications of type 1 diabetes

A

stroke

heart disease

peripheral vascular disease

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4
Q

what is the macula responsible for

A

responsible for out central vision, most of the colour vision and detailed vision

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5
Q

what is the diabetic retinopathy classification and what is the scale used

A

Retinopathy scale:
Goes from R0 —> R3

Maculopathy:
Goes from M0-M1

Photocoagulation:
Goes from P0 —>P1
Had previous surgery - photocoagulation scars for P1

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6
Q

what is the prevalence of exudates and haemorrhages (R1) in type 1 diabetes

A

Any retinopathy 77%
Proliferative retinopathy 32%

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7
Q

what is the prevalence of exudates and haemorrhages (R1) in type 2 diabetes

A

25% any retinopathy
3% proliferative retinopathy

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8
Q

what are the venous changes that can happen (R2)

A

beading, looping and reduplication

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9
Q

what are the proliferative changes (R3)

A

new vessels
On disc or elsewhere
fibrous proliferation
On disc or elsewhere
haemorrhages
Pre-retinal
Vitreous

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10
Q

what are the prevention methods for diabetic retinopathy

A

glycemic control (UKPDS, DCCT)
Blood pressure control
Annual screening

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11
Q

what are the treatment options for diabetic retinopathy

A

photocoagulation
anti-VEGF therapy
Surgery

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12
Q

what are the different diabetic neuropathy characteristics

A

Distal symmetrical sensorimotor polyneuropathy and small fibre neuropathy

Radiculopathies

Mononeuropathy - can affect cranial nerves

Autonomic neuropathy

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13
Q

what is the pain in peripheral neuropathy

A

Burning
Paraesthesia
Persistent hyperaesthesia
Nocturnal exacerbation

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14
Q

what is the loss of sensation in peripheral neuropathy

A

postural hypotension
Diabetic gastroparesis
Small bowel bacterial overgrowth
Cardiac autonomic neuropathy
Urogenetic

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15
Q

what are the first line agents for neuropathy pain

A

Duloxetine
Pregabalin
Gabapentin
Amitryptiline

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16
Q

what are the treatments for gastroparaesis

A

Prokinetics
Botox to pylorus,
gastric pacemakers

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17
Q

what are the treatments for postural hypotension

A

Fludrocortisone
Midodrine
Compression stockings

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18
Q

what is diabetic foot

A

neuropathy
Deformity increased pressure, ulcer
Ischemia - peripheral vascular disease
Infection

19
Q

what are the statistics of foot complications in diabetes

A

20-40% have neuropathy
5% have a foot ulcer
5-7% 10 year cumulative incidence of amputation
Increased morbidity, mortality and reduced quality of life

20
Q

what is the prevention for foot ulcers

A

education
Good glucose control
Regular foot checks to identify high risk feet
Regular podiatry review of high risk feet
Appropriate footwear

21
Q

what is the treatment for foot ulcers

A

foot MDT
Off-loading, debridement
Antibiotics
Surgery
Revascularisation

22
Q

what is the most common cause of renal failure

A

diabetes

23
Q

what percentage of people with diabetes develop diabetic nephropathy

A

30% of T1DM and 40% of T2DM

24
Q

how is diabetic nephropathy defined

A

moderately increased albuminuria:
Increased albumin creatine ratio (ACR)
ACR > 2.5mg/mmol (men)
ACR > 3.5mg/mmol (women)
OR: urinary albumin concentration >20mg/L in men and women
OR: positive microalbumintest results from 2 first morning urine specimens (sensitivity 93% specificity 80% )

nephropathy
Dipstick positive proteinuria
OR: ACR >30mg/mmol
OR: urinary albumin concentration >< 200mg/L

25
Q

what is the treatment for diabetic nephropathy

A

blood pressure control
Renin aldosterone system (RAS) blockade
e.g ACEI, ARB (ramipril and irbesartan)
glycemic control
Cardiovascular disease risk management
Management of the complications of renal failure
Dialysis
Haemodialysis
Peritoneal
renal, pancreas and islet transplantation

26
Q

what is the first manifestation of CHD in DM

A

angina - 50% - people with diabetes may not have classic angina therefore symptoms arent classic

27
Q

what are the life years lost in relation to age at onset of type one diabetes

A

development of type 1 diabetes before 10 years of age resulted in a loss of 17 life-years for women and 14 life years for men

28
Q

what does hypoglycaemia result from

A

Absolute or relative hyperinsulinemia
And/or defective glucose counter-regulation

29
Q

what are the acute implications of hypoglycaemia

A

hypos disrupt everyday activities, provokes unpleasant symptoms
Severe hypoglycaemia can cause coma, seizures, strokes, arrhythmias and even death

negative effects on mood and emotions
Impairs cognitive function; can affect performance of many activites
Interference with balance, coordination, vision and level of consciousness can precipitate falls and injury

30
Q

what are the long term effects of hypoglycaemia

A

fear of hypoglycaemia, elevated HbA1c —> complications
Reduced quality of life
Weight gain
Restrictions on employment
Driving licensing restrictions
Personal relationships disrupted
Acquired hypoglycaemia-induced syndromes
Cognitive declines

31
Q

what are the factors that contribute to high HbA1c sub optimal diabetes

A

fear and burden of hypoglycaemia
Lack of access/non-engagement with high quality structured education
Burden of carbohydrate counting, injections, time and life pressures
Depression, anxiety and lack of motivation
Not monitoring glucose
Variable insulin absorption and problems with insulin injection sites
Lack of access to technology
Clinical inertia
Lack of access to insulin

32
Q

what is DAFNE

A

dose adjustment for normal eating

structured patient education: provide vital knowledge and skills to manage T1D
Carbohydrate counting, hypoglycaemia, dynamic insulin adjustment
Dealing with exercise, inter-current illness, alcohol, partying, sex, pregnancy, periods, anxiety and depression

33
Q

what has DAFNE shown to improve

A

HbA1c and reduces hypoglycaemia

34
Q

what are the rapid acting analogues (meal insulin)

A

Novorapid
Humalog
Apidra

35
Q

what are the long acting insulins (16 to 24 hours)

A

levemir
lantus

36
Q

what is an example of ultra-rapid acting analogue (meal insulin)

A

fiasp

37
Q

what are examples of ultra long acting insulins (24hrs+)

A

Tresiba
Toujeo

38
Q

what is an analogue insulin

A

laboratory grown and genetically modified sequence

39
Q

what is the current technology used to treat type one diabetes

A

Insulin delivery:
insulin pen
Insulin pump
Conventional pump
Patch pump

Glucose sensing:
capillary blood glucose
Continuous glucose monitoring
Flash glucose monitoring
Conventional
Implantable

Data management:
health care professional centred
Data and/or web portals
patient centred
Data and/or web portals
Remote monitoring
Mobile apps

Glucose responsive insulin delivery:
threshold based suspension
Predictive low glucose suspension
Hybrid single hormone closed loop

40
Q

what are the benefits of insulin pumps

A

CSII allows more physiological replacement of basal insulin requirements
On demand modulation of basal insulin to match individual needs; e.g exercise or stress
Lower variability of absorption of basal insulin

41
Q

NICE TA151 - CS11
Continuous subcutaneous insulin infusion or insulin pump therapy is recommended as a possible treatment for adults and children 12 years and over with type 1 diabetes mellitus if:

A
  • attempts to reach target haemoglobin A1c levels with multiple daily injections result in the person having disabling hypoglycamia

or

Hb1Ac levels have remained high (8.5% or above) with multiple daily injections despite the person and/or their carer carefully trying to manage their diabetes

42
Q

what are smart glucose meters

A

majority of patients either do not correct for high glucose at all or et the calculations wrong
Meter programmed with insulin:carb ratio and correction factor. Each bolus consists of insulin for carbs and insulin for correcting high glucose
Studies have shown improved HbA1c, reduced hypos and improved quality of life

43
Q

what are sensory augmented pumps

A

continuous glucose monitoring data are displayed on the pump screen

predictive low glucose suspend technology

44
Q

what is the closed loop system compontents

A

autonomous, graduated modulation of insulin delivery to achieve target glucose
Hybrid = meal bolus still required

Semester 4 (80 decks)

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