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endocrine > Chronic Complications Of Diabetes > Flashcards

Chronic Complications Of Diabetes Flashcards

1
Q

name some macrovascular complications of diabetes

A

IHD, stroke

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1
Q

name 3 microvascular complications of diabetes

A

neuropathy, nephropathy, retinopathy

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1
Q

name some other complications of diabetes

A

cognitive dysfunction, erectile dysfunction, psychiatric complications

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2
Q

what is usually done at a patient’s yearly diabetic review ? (3)

A

digital retinal screening
foot risk assessment
urine albumin/creatine ratio and serum creatine

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3
Q

how do advanced glycation end products form

A

glucose binds irreversibly to methyl glyoxal

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4
Q

result of the formation of advanced glycation end products

A

tissue injury and inflammation via stimulation of pro-inflammatory factors e.g. cytokines and complement

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5
Q

what is sorbitol formed from

A

glucose + aldose reductase

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6
Q

effect of increased flux of glucose through the sorbitol-polyol pathway

A

sorbitol and fructose accumulate causing changes in vascular permeability, cell proliferation and capillary structure via the stimulation of protein kinase C and TGF-β

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7
Q

what is another name for diabetic eye disease

A

retinopathy

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8
Q

what is retinopathy

A

damage to the retina

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9
Q

pathophysiology of non-proliferative retinopathy

A

damage to the wall of small vessels cause microaneurysms and then intraretinal haemorrhages
blood leaves hard exudates
ischaemia due to occluded vessels cause cotton wool spots

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10
Q

what are the 3 types of haemorrhage associated with diabetic retinopathy

A

dot, blot and flame

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11
Q

what occurs in proliferative retinopathy

A

blockage of blood vessels leads to areas of non-perfusion and ischaemia
abnormal blood vessels begin to grow on the surface of the retina -> very fragile

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12
Q

management of retinopathy

A

laser: panretinal photocoagulation
vitrectomy in a vitreal haemorrhage

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13
Q

how does panretinal photocoagulation work

A

reduces oxygen requirement of the retina so reduces the ischaemia that is driving the retinopathy

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14
Q

what happens in diabetic macular oedema

A

retinal thickening and oedema including the macula, hard exudates and macula ischaemia

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15
Q

how is diabetic macular oedema investigated

A

optical coherence tomography

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16
Q

management of diabetic macular oedema

A

intravitreal anti-VGEF

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17
Q

name 3 other eye complications of diabetes

A

earlier development of cataracts
glaucoma is more likely
hyperglycaemia can cause reversibly vision blurring

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18
Q

what is diabetic nephropathy

A

progressive kidney disease caused by damage to the capillaries in the glomeruli

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19
Q

what are other names for diabetic nephropathy

A

kimmelsteil-wilson syndrome or nodular glomerulosclerosis

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20
Q

what is diabetic nephropathy characterised by

A

proteinuria and diffuse scarring of the glomeruli

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21
Q

dipstick investigation of diabetic nephropathy

A

may show proteinuria

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22
Q

how do we establish microalbuminuria in diabetic nephropathy

A

ACR <30 or PCR<50

23
Q

management of diabetic nephropathy

A

microalbuminuria: ACEi/ARB to decrease filtration proteinuria
should also be started on SLGT2i with microalbuminuria
manage other vascular complications

24
Q

how do we reduce the risk of diabetic nephropathy

A

good glycaemic control

25
Q

complications of diabetic nephropathy

A

hypertension, decline in renal function, accelerated vascular disease

26
Q

what is diabetic neuropathy

A

damage to peripheral nervous tissue

27
Q

risk factors for diabetic neuropathy

A

increased length of diabetes, poor glycaemic control, smoking, drinking, mechanical injury

28
Q

what type of diabetes is neuropathy more commonly associated with

A

T1DM

29
Q

what is peripheral neuropathy

A

symmetrical pain/loss of feeling in hands and feet

30
Q

what kind of distribution is said to be seen in peripheral neuropathy

A

glove and stocking

31
Q

symptoms of peripheral neuropathy

A

numbness, tingling/burning, sharp pains, sensitivity to touch, loss of balance and coordination

32
Q

name 4 complications of peripheral neuropathy

A

foot ulcer
claw foot and callus formation
charcot foot
painless trauma

33
Q

name a clinical sign that can be seen in peripheral neuropathy

A

argyll robertson pupil

34
Q

what is argyll robertson pupil

A

small bilateral pupils that don’t constrict when exposed to bright light but do constrict when focused on a nearby object

35
Q

symptoms of charcot foot

A

acute onset of hot, swollen foot +/- pain
deformation due to destruction of bone if treatment is delayed
radiological consolidation and stabilisation after 6-12 months

36
Q

investigation of charcot foot

A

MRI to differentiate between infection

37
Q

management of charcot foot

A

minimise bony destruction by keeping pressure off the foot

38
Q

what does charcot foot predispose patients to

A

ulceration

39
Q

what is claw foot

A

interosseous wasting results in unbalanced traction by the long flexor muscles

40
Q

why does neuropathy cause callus formation

A

abnormal distribution of pressure on walking

41
Q

name 4 drugs that can be used in the management of painful neuropathy

A

amitriptyline, duloxetine, gabapentin or pregabalin

42
Q

what can be used to manage painful neuropathy in patients who don’t want systemic treatment

A

topical capsaicin cream

43
Q

what is autonomic neuropathy

A

affects the nerves regulating the heart rate and blood pressure as well as control of internal organs

44
Q

what is autonomic neuropathy usually associated with

A

a long history of very poor diabetes

45
Q

affect of autonomic neuropathy on digestion

A

gastric slowing
gastroparesis
dysphagia due to oesophagus nerve damage

46
Q

management of gastroparesis in diabetes

A

improve glycaemic control
diet: smaller, more frequent meals
metoclopramide (promotility)
anti-nausea
analgesia

47
Q

management of severe gastroparesis in diabetes

A

consider botox or a gastric pacemaker

48
Q

give 2 examples of anti-nausea meds

A

ondansetron, prochlorperazine

49
Q

how can autonomic neuropathy affect the sweat glands

A

lack of thermoregulation
profuse sweating at night or gustatory sweating

50
Q

what is gustatory sweating

A

sweating while eating

51
Q

effects of autonomic neuropathy on the heart and blood vessels

A

postural hypertension
tachycardia
ECG: loss of R-R variability

52
Q

what causes proximal neuropathy

A

damage to the nerves of the lumbosacral plexus

53
Q

who commonly presents with proximal neuropathy

A

elderly T2DM

54
Q

what is proximal neuropathy commonly associated with

A

weight loss

55
Q

clinical presentation of proximal neuropathy

A

pain in the buttocks, hips, thighs or legs followed by variable weakness in the proximal muscles of the lower limbs and then muscle wasting

56
Q

what is focal neuropathy

A

sudden weakness in one nerve or a group of nerves
can cause pain

57
Q

give examples of focal neuropathy

A

carpal tunnel syndrome, cranial nerve palsy

endocrine (15 decks)

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