Complications of Diabetes Flashcards
what are the 4 types of neuropathy?
- peripheral
- autonomic
- proximal
- focal
peripheral neuropathy examples
pain/loss of feeling in feet or hands
autonomic neuropathy examples
changes in bowel/bladder function, sexual response, sweating, HR, BP, hypoglycaemic unawareness
proximal neuropathy examples
pain in the thighs, hips or buttocks leading to weakness in the legs
focal neuropathy examples
sudden weakness in one nerve or a group of nerves causing muscle weakness or pain
give some examples of nerves affected/syndromes caused by focal neuropathy
carpal tunnel ulnar mono neuropathy foot drop bells palsy cranial nerve palsy
what complications of peripheral nerve damage can occur?
infections/ulcers
deformities
amputations
what is rocker bottom foot?
bony destruction in secondary to neuropathy, prominent area at bottom of foot, very susceptible to ulceration
what is the treatment algorithm of painful neuropathy?
simple analgesia TCAs Gabapentin Duloxetine stronger opiods
what are the 3 possible outcomes of autonomic neuropathy in the digestive systme?
- gastric slowing/frequency change
- gastroparesis
- oesophagus nerve damage
what symptoms would you see in gastric slowing/frequency change?
constipation/diarrhoea
what symptoms would you see in gastroparesis?
persistent nausea & vomiting
bloating
loss of appetite
what is gastroparesis?
slow stomach emptying
what can gastroparesis do to blood glucose levels & how?
fluctuate widely due to abnormal food digestion
what can oesophagus nerve damage cause?
may make swallowing difficult & can lead to weight loss
what is the treatment of gastroparesis?
Consider a trial of metoclopramide, domperidone, or erythromycin
gastric pacemaker
what are the possible outcomes of autonomic neuropathy affecting the sweat glands?
prevents sweat glands from working properly:
- profuse sweating at night
- profuse sweating while eating
gustatory sweating
profuse sweating while/after you eat
what can happen in hypoglycaemia in autonomic neuropathy?
hypoglycaemic unawareness
what happens to the body if the CVS nerves are damaged?
interferes with the body’s ability to adjust blood pressure & heart rate
what happens to blood pressure if the CVS nerves are damaged?
may drop sharply after sitting or standing
what does a person feel if their blood pressure drops sharply?
feels light-headed/faint
what happens to heart rate if the CVS nerves are damaged?
may stay high instead of going high or low in response to activity
how can autonomic neuropathy affect the eyes?
can affect the pupils making them less responsive to changes in light
name 4 diagnostic tools for neuropathy
- nerve conduction studies or electromyography
- heart rate variability
- ultrasound
- gastric emptying studies
amyotrophy
asymmetrical proximal motor neuropathy
wha is diabetic nephropathy also known as?
kimmelsteil-Wilson Syndrome
nodular glomerulosclerosis
what are the consequences of diabetic nephropathy?
- development of hypertension
- relentless decline in renal function
- accelerated vascular disease
who should be screened for nephropathy?
diabetics aged 12+
at diagnosis & annually
how can you screen for diabetic kidney disease?
use urinary albumin creatinine ratio
what is the normal range for the albumin:creatinine ratio in males?
what is the normal range for the albumin:creatinine ratio in females?
what is the range that signifies microalbuminuria?
30-300 mg/ml
what is the range that signifies macroalbuminuria?
> 300 mg/ml
what are the risk factors for nephropathy progression?
hypertension cholesterol smoking glycaemic control abluminuria
diabetic patients with microalbuminuria/proteinuria should be offered which class of drugs?
ACE inhibitor
what should a diabetics blood pressure be maintained at?
what happens in diabetic eye disease?
- diabetic retinopathy
- cataract
- glaucoma
- acute hyperglycaemia
cataract
clouding of the lens
glaucoma
increase in fluid pressure in the eye leading to optic nerve damage
what happens in diabetic eye disease in acute hyperglycaemia?
reversible visual blurring
what are the 4 stages of retinopathy?
Mild non-proliferative (Background)
Moderate non-proliferative
Severe non-proliferative
Proliferative
haemorrages
dot/blot/flame
cotton wool spots
ischaemic areas
hard exudates
lipid break down products
IRMA
intra-retinal microvascular abnormalities
how would bleeding in diabetic eye disease present?
sudden change in vision
floaters
what are the retinopathy treatment options?
laser
vitrectomy
anti-VEGF injections
who is screened for retinopathy?
annula screening for all (low risk) diabetes patients
what are the causes of erectile dysfunction in diabetes?
vascular
neuropathy
which medications can cause erectile dysfunction?
anti-hypertensive drugs
CNS drugs
what vascular complications does diabetes increase the risk of?
stroke
peripheral vascular disease
coronary artery disease
what lifestyle changes can a diabetic undertake to reduce CVS problems?
weight loss exercise smoking cessation improve diet reduce salt
what are the psychiatric complications that can occur in diabetes?
- depression
- eating disorders
- bi-polar
- schizophrenia
