Complications of Diabetes

Question 1

what are the 4 types of neuropathy?

Answer 1

• peripheral
• autonomic
• proximal
• focal

Question 2

peripheral neuropathy examples

Answer 2

pain/loss of feeling in feet or hands

Question 3

autonomic neuropathy examples

Answer 3

changes in bowel/bladder function, sexual response, sweating, HR, BP, hypoglycaemic unawareness

Question 4

proximal neuropathy examples

Answer 4

pain in the thighs, hips or buttocks leading to weakness in the legs

Question 5

focal neuropathy examples

Answer 5

sudden weakness in one nerve or a group of nerves causing muscle weakness or pain

Question 6

give some examples of nerves affected/syndromes caused by focal neuropathy

Answer 6

carpal tunnel 
ulnar mono neuropathy 
foot drop 
bells palsy 
cranial nerve palsy

Question 7

what complications of peripheral nerve damage can occur?

Answer 7

infections/ulcers
deformities
amputations

Question 8

what is rocker bottom foot?

Answer 8

bony destruction in secondary to neuropathy, prominent area at bottom of foot, very susceptible to ulceration

Question 9

what is the treatment algorithm of painful neuropathy?

Answer 9

simple analgesia 
TCAs
Gabapentin 
Duloxetine 
stronger opiods

Question 10

what are the 3 possible outcomes of autonomic neuropathy in the digestive systme?

Answer 10

• gastric slowing/frequency change
• gastroparesis
• oesophagus nerve damage

Question 11

what symptoms would you see in gastric slowing/frequency change?

Answer 11

constipation/diarrhoea

Question 12

what symptoms would you see in gastroparesis?

Answer 12

persistent nausea & vomiting
bloating
loss of appetite

Question 13

what is gastroparesis?

Answer 13

slow stomach emptying

Question 14

what can gastroparesis do to blood glucose levels & how?

Answer 14

fluctuate widely due to abnormal food digestion

Question 15

what can oesophagus nerve damage cause?

Answer 15

may make swallowing difficult & can lead to weight loss

Question 16

what is the treatment of gastroparesis?

Answer 16

Consider a trial of metoclopramide, domperidone, or erythromycin
gastric pacemaker

Question 17

what are the possible outcomes of autonomic neuropathy affecting the sweat glands?

Answer 17

prevents sweat glands from working properly:

• profuse sweating at night
• profuse sweating while eating

Question 18

gustatory sweating

Answer 18

profuse sweating while/after you eat

Question 19

what can happen in hypoglycaemia in autonomic neuropathy?

Answer 19

hypoglycaemic unawareness

Question 20

what happens to the body if the CVS nerves are damaged?

Answer 20

interferes with the body’s ability to adjust blood pressure & heart rate

Question 21

what happens to blood pressure if the CVS nerves are damaged?

Answer 21

may drop sharply after sitting or standing

Question 22

what does a person feel if their blood pressure drops sharply?

Answer 22

feels light-headed/faint

Question 23

what happens to heart rate if the CVS nerves are damaged?

Answer 23

may stay high instead of going high or low in response to activity

Question 24

how can autonomic neuropathy affect the eyes?

Answer 24

can affect the pupils making them less responsive to changes in light

Question 25

name 4 diagnostic tools for neuropathy

Answer 25

- nerve conduction studies or electromyography - heart rate variability - ultrasound - gastric emptying studies

Question 26

amyotrophy

Answer 26

asymmetrical proximal motor neuropathy

Question 27

wha is diabetic nephropathy also known as?

Answer 27

kimmelsteil-Wilson Syndrome | nodular glomerulosclerosis

Question 28

what are the consequences of diabetic nephropathy?

Answer 28

- development of hypertension - relentless decline in renal function - accelerated vascular disease

Question 29

who should be screened for nephropathy?

Answer 29

diabetics aged 12+ | at diagnosis & annually

Question 30

how can you screen for diabetic kidney disease?

Answer 30

use urinary albumin creatinine ratio

Question 31

what is the normal range for the albumin:creatinine ratio in males?

Question 32

what is the normal range for the albumin:creatinine ratio in females?

Question 33

what is the range that signifies microalbuminuria?

Answer 33

30-300 mg/ml

Question 34

what is the range that signifies macroalbuminuria?

Answer 34

>300 mg/ml

Question 35

what are the risk factors for nephropathy progression?

Answer 35

``` hypertension cholesterol smoking glycaemic control abluminuria ```

Question 36

diabetic patients with microalbuminuria/proteinuria should be offered which class of drugs?

Answer 36

ACE inhibitor

Question 37

what should a diabetics blood pressure be maintained at?

Question 38

what happens in diabetic eye disease?

Answer 38

- diabetic retinopathy - cataract - glaucoma - acute hyperglycaemia

Question 39

cataract

Answer 39

clouding of the lens

Question 40

glaucoma

Answer 40

increase in fluid pressure in the eye leading to optic nerve damage

Question 41

what happens in diabetic eye disease in acute hyperglycaemia?

Answer 41

reversible visual blurring

Question 42

what are the 4 stages of retinopathy?

Answer 42

Mild non-proliferative (Background) Moderate non-proliferative Severe non-proliferative Proliferative

Question 43

haemorrages

Answer 43

dot/blot/flame

Question 44

cotton wool spots

Answer 44

ischaemic areas

Question 45

hard exudates

Answer 45

lipid break down products

Question 46

IRMA

Answer 46

intra-retinal microvascular abnormalities

Question 47

how would bleeding in diabetic eye disease present?

Answer 47

sudden change in vision | floaters

Question 48

what are the retinopathy treatment options?

Answer 48

laser vitrectomy anti-VEGF injections

Question 49

who is screened for retinopathy?

Answer 49

annula screening for all (low risk) diabetes patients

Question 50

what are the causes of erectile dysfunction in diabetes?

Answer 50

vascular | neuropathy

Question 51

which medications can cause erectile dysfunction?

Answer 51

anti-hypertensive drugs | CNS drugs

Question 52

what vascular complications does diabetes increase the risk of?

Answer 52

stroke peripheral vascular disease coronary artery disease

Question 53

what lifestyle changes can a diabetic undertake to reduce CVS problems?

Answer 53

``` weight loss exercise smoking cessation improve diet reduce salt ```

Question 54

what are the psychiatric complications that can occur in diabetes?

Answer 54

- depression - eating disorders - bi-polar - schizophrenia