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PY366 Type 1 Diabetes > Complications > Flashcards

Complications Flashcards

1
Q

what are the main complications of type 1 diabetes

A
  • leading cause of heart disease
  • blindness
  • renal failure
  • ulceration and amputation
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2
Q

what increases the risk of complications

A

poor glycaemic control

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3
Q

what are the 2 categories of complications in type 1 diabetes

A

microvascular and macrovascular complications

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4
Q

what are the types of microvascular complications

A
  1. retinopathy
  2. nephropathy
  3. neuropathy
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5
Q

what are the types of macrovascular complications

A
  1. cardiovascular
  2. foot complications
  3. sexual dysfunction
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6
Q

what eye complications can a patient with type 1 diabetes experience

A
  1. retinopathy- 1 in 3 patients will develop sight threatening disease
  2. cataract- diabetes increases rate of age related formation
  3. refractory defects- hyperglycaemia alters osmotic pressure within lens
  4. glaucoma- prevalence increases in diabetes
  5. infection
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7
Q

what may be seen in a eye examination showing retinopathy

A
  • venous irregularities
  • blot haemorrhages
  • cottonwool spots and exudates
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8
Q

why is screening necessary for retinopathy

A
  • to prevent blindness
  • retinopathy is asymptomatic
  • annual eye test
  • particularly high risk patients (pregnancy accelerates progression of retinopathy)
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9
Q

describe the management of retinopathy

A
  1. close liaison between ophthalmology and diabetes services
  2. development/progression delayed by optimal diabetic control
  3. optimal blood pressure control is equally important
  4. pre proliferative/proliferative retinopathy requires laser photocoagulation
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10
Q

Outline the stages of diabetic nephropathy

A

normal, microalbuminuria, persistent proteinuria, renal impairment, stage 4 cKD
- annual screening for kidney disease

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11
Q

name the different classifications of neuropathy

A
  1. peripheral neuropathy
  2. acute painful neuropathy
  3. pressure palsies
  4. mononeuropathies
  5. autonomic
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12
Q

what is peripheral neuropathy

A

damage to long nerve axons leading to sensory loss

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13
Q

what are the risk factors for peripheral neuropathy

A

poor control, obesity, diabetes duration, high blood pressure

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14
Q

what are the symptoms of acute painful neuropathy

A
  • pain
  • poor sleep
  • reduced quality of life
  • depression
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15
Q

what is pressure palsies

A

increased susceptibility to nerve compression/entrapment (carpal tunnel syndrome)

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16
Q

what is mononeuropathies

A

3rd/6th cranial nerve damage
- rapid onset
- muscle weakness

17
Q

what are the signs and symptoms of autonomic neuropathy

A
  1. gastrointestinal- oesophageal dysmotility, diabetic diarrhoea
  2. cardiovascular- postural hypotension
  3. genitourinary- neuropathic bladder, erectile dysfunction
  4. musculoskeletal- charcot anthropathy
  5. eyes- abnormal pupillary reflexes
18
Q

what are the causes of diabetic foot ulcers

A
  1. peripheral neuropathy- loss of pain sensation/injury unawareness
  2. motor neuropathy- characteristic posture, raised arch, callus formation
  3. autonomic neuropathy- reduced sweating, dry cracked skin
  4. Charcot anthropathy
  5. peripheral vascular disease- reduced blood supply to feet, poor oxygen supply
  6. infection
19
Q

what are the principles of good foot care

A
  1. wash feet daily
  2. check feet daily
  3. seek urgent treatment of problems
  4. don’t use hot water bottles
  5. don’t walk barefoot
  6. don’t wear ill-fitting shoes
20
Q

how does erectile dysfunction occur

A
  • prevalence increases with age
  • affects 60% of men with diabetes
  • results from autonomic neuropathy
  • other factors include drugs, endocrine disorders
21
Q

how is erectile dysfunction managed

A
  1. improve glycaemic control
  2. reduce alcohol intake
  3. substitute drugs that may impair erection
  4. first line drug treatment is phosphodiesterase type 5 inhibitors
    - but can cause severe acute hypotension
  5. prostaglandin E injections
  6. vacuum devices
22
Q

describe the prevalence of cardiovascular disease in diabetic patients

A
  1. diabetes confers a 2-4 fold increased risk of MI and stroke in men and a 10 fold increased risk in post menopausal women
  2. accounts for 60-75% of all deaths in people with diabetes
  3. greater emphasis on managing arterial risk factors
  4. atheroma develops earlier, faster and is more extensive in people with diabetes
23
Q

what are the psychological complications of diabetes

A
  • depression is increased in people with diabetes
  • patients with depression are less likely to monitor blood glucose or take their insulin as prescribed
24
Q

how can psychological complications be managed

A
  • emotional and psychological support should be available long term and particularly at diagnosis
  • all members of the diabetes team should be trained to recognise and address basic psychological issues

PY366 Type 1 Diabetes (12 decks)

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