Complications of Diabetes Flashcards
Causes of Hypoglycaemia
HYPO <4 mmol/l
-Insulinoma - increased ratio of proinsulin to insulin
-Self-administration of insulin/Sulphonylureas
-Liver failure
-Addison’s disease
-Alcohol= causes exaggerated insulin secretion
=Mechanism is thought to be due to the effect of alcohol on the pancreatic microcirculation → redistribution of pancreatic blood flow from the exocrine into the endocrine parts → increased insulin secretion
-Nesidioblastosis - beta cell hyperplasia
Clinical presentation of hypoglycaemia
-<3.3 mmol/l (autonomic symptoms as glucagon release and adrenaline)
=Sweating
=Shaking
=Hunger
=Anxiety
=Nausea
-<2.8 mmol/l (neuroglycopenic symptoms due to inadequate glucose supply to brain)
=Weakness
=Vision changes
=Confusion
=Dizziness
-Severe
=Convulsion
=Coma
Investigations of Hypoglycaemia
-Blood glucose test
-Check for signs of lipohypertrophy
Management of hypoglycaemia
-Community
=Initially, oral glucose 10-20g should be given in liquid, gel or tablet form
=GlucoGel or Dextrogel.
=A ‘HypoKit’ may be prescribed which contains a syringe and vial of glucagon for IM or SC injection at home
-Hospital
=If the patient is alert, a quick-acting carbohydrate may be given
=If the patient is unconscious or unable to swallow, subcutaneous or intramuscular injection glucagon may be given.
=Alternatively, intravenous 20% glucose solution may be given through a large vein
Screening of diabetic retinopathy
-All adults with type 2 diabetes: offered at diagnosis and every 2 years (for low risk of sight loss- no identified retinopathy on 2 successive screening tests) and at least annually for all other people with diabetes (pregnancy, pre-existing eye problems, recently diagnosed, no prior screening)
Emergency assessment indication of diabetic retinopathy
-Sudden loss of vision
-Rubeosis iridis (formation of abnormal blood vessels on anterior iris)
-Pre-retinal or vitreous haemorrhage
-Suspected retinal detachment
-Large sudden, unexplained reduction in visual acuity
Investigations of diabetic retinopathy
-Macular oedema
-Microaneurysms
-Cotton wool spots
-Intraretinal haemorrhage
-Lipid exudates
-Floaters
-Macular thickening
Screening of diabetic foot ulcer
-Foot check in primary care at diagnosis and at least once a year thereafter, or sooner if any foot problems arise.
-Frequently (for example every 3–6 months) — for people who are at moderate risk.
-More frequently (for example every 1–2 months) — for people who are at high risk, if there is no immediate concern.
-Very frequently (for example every 1–2 weeks) — for people who are at high risk, if there is immediate concern
Investigation/ examination of diabetic foot ulcer
-10G monofilament in foot sensory examination
-ABPI in limb ischaemia
-Neuropathic ulceration (plantar surface, areas overlying bony deformity)/ neuroischaemic or ischaemic ulceration (tips of toes or lateral border)
-Callus
-Infection and inflammation
-Deformity (claw or hammer toes, limited joint mobility, large bony prominences)
-Gangrene
-Charcot arthropathy (acute localised inflammatory condition: bone destruction, subluxation, dislocation, deformity)
Management of diabetic foot ulcer
Amputation risk stratification
-Low risk:
=No risk factors present except callus alone.
-Moderate risk (referral 6-8 weeks):
=Deformity, Neuropathy, Peripheral arterial disease.
-High risk (referral 2-4 weeks):
=Previous ulceration, Previous amputation, renal replacement therapy, Neuropathy and peripheral arterial disease together, Neuropathy in combination with callus and/or deformity, Peripheral arterial disease in combination with deformity.
Screening for diabetic nephropathy
-Annual
=Urinary albumin: creatinine ratio (ACR)
-Early morning specimen
-ACR >2.5 (microalbuminuria)
-Serum creatinine to calculate eGFR
-Frothy urine (proteinuria) and peripheral oedema
CKD diagnosis in diabetic nephropathy
-A persistent reduction in kidney function, if the eGFR is less than 60 mL/min/1.73 m2 for 3 months or more
-Persistent proteinuria with urine ACR greater than 3 mg/mmol, for 3 months or more
Management of diabetic nephropathy
-Stage
-Sick day rules for medication to stop (AKI)
-All people with CKD stage 3 or more and/or confirmed urine microalbuminuria, should be offered atorvastatin 20 mg once daily, irrespective of lipid profile
-All people with CKD stage 3 or more and/or confirmed urine microalbuminuria, should be offered an angiotensin-converting enzyme (ACE) inhibitor if not contraindicated
Clinical presentation of atherosclerosis in diabetes
-Ischaemic stroke
-STEMI
-Micro and macrovascular ischaemia
-Hypertension
Risk factors for gangrene
-DM
-Atherosclerosis
-Smoking
-Hypercoagulable states
-Drug abuse
-Malignancy
-Renal disease
-Trauma
-Abdominal surgery
-Alcoholism
-Malnutrition
