Complications of Diabetes Flashcards
What are the 4 groups of complications that can occur
Macrovascular
Microvascular
Erectile Dysfunction
Psychiatric
What are the two main problems within macrovascular problems
IHD
Stroke
What are the three main problems within the microvascular complications
Neuropathy
Nephropathy
Retinopathy
Diabetes is traditionally the leading cause of what 3 things
Blindness
Dialysis
Amputation
What percentage of patients with diabetes will develop some degree of neuropathy
60-70%
What are the 4 types of neuropathy
Peripheral
Autonomic
Proximal
Focal neuropathy
Give examples of peripheral neuropathy
Pain/ loss of feeling in hands or feet
Give examples of autonomic neuropathy
Changes in bowel, bladder function, sexual response, sweating, heart rate, blood pressure, hypoglycaemic unawareness
Give examples of proximal neuropathy
Pain in the thighs, hips or buttocks leading to weakness in the legs (amyotrophy)
Give examples of focal neuropathy
sudden weakness in one nerve or a group of nerves causing muscle weakness or pain e.g. carpal tunnel, ulnar mono neuropathy, foot drop, bells palsy, cranial nerve palsy
What are some of the risk factors for developing neuropathy
Increased length of diabetes poor glycemic control Type 1 diabetes > type 2 diabetes High cholesterol / lipids Smoking Alcohol Inherited Traits (genes) Mechanical injury
What are some symptoms of peripheral nerve damage
Numbness/ insensitivity Tingling/ burning Sharp pains or cramps Sensitivity to touch Loss of balance and coordination
What are some complications of nerve damage
infections/ulcers
Charcot
Deformities
Amputations
Buzzword for charcot
rocker bottom foot
how is charcot treated
surgery to prevent chronic ulceration and then put in a cast for as long as a year
Describe the treatment for painful neuropathy
simple analgesia TCAs (amitryptiline) Gabapentin Duloxetine / pre-gabalin stronger opiods
Topical capsaicin cream
allodynia
What is the difficulty in treating patients with gastroparesis
They have slow stomach emptying and so they may need to take their insulin after they have eaten to prevent hypoglycaemia
What is gustatory sweating
Sweating after eating
Describe the effect of autonomic neuropathy on the cardiovascular system
Nerve damage interferes with the body’s ability to adjust blood pressure and heart rate
Describe the blood pressure of a patient with autonomic neuropathy
May drop sharply after sitting or standing, causing a person to feel light-headed or faint
Describe the heart rate of a patient with autonomic neuropathy
It may stay high, instead of rising and falling in response to normal body functions and physical activity
How does autonomic neuropathy affect the eyes
Make the pupils less responsive to changes in light as they don’t dilate and contract as normal
How can we diagnose neuropathy
Nerve conduction studies or electromyography
Heart rate variability
Ultrasound
Gastric emptying studies
What is focal neuropathy
sudden weakness in one nerve or a group of nerves causing muscle weakness or pain e.g. carpal tunnel, ulnar mono neuropathy, foot drop, bells palsy, cranial nerve palsy
How do we screen for neuropathy
Aim to prevent foot ulcers or unnecessary amputations
Foot examination at least once a year
Advice for patients self care
Charcot Foot is cause by infection. True or False
False - it is inflammatory only
What is diabetic nephropathy
Kimmelsteil Wilson Syndrome or Nodular Glomeruloscelrosis Microvascular changes (antipathy of capillaries )
Describe the appearance histologically of diabetic nephropathy
Sclerotic and filled with angiosclerotic matrix
What is the most common cause of kidney failure/ dialysis
Diabetes
What are some consequences of diabetic nephropathy
Development of hypertension
Relentless decline in renal function
Accelerated vascular disease
What is used to screen for diabetic kidney disease
Urinary albumin creatinine ratio (ACR)
What patients are screened for nephropathy
All patients over the age of 12
What are the normal measurements for microalbuminuria and macroalbuminuria
Micro = 30-300mg/ml Macro = >300mg/ml
What can give some else positives of microalbuminuria
Menstruation Vaginal discharge UTI pregnancy Non-diabetic renal disease
What does UAER varies what
Day:night Day: day Exercise Protein load Fluid load
Why do we have to repeat microalbuminuria
It varies so much and can have many false positives
How often does microalbuminuria have to be repeated and positive
2/3
What are some risk factors for nephropathy progression
Hypertension Cholesterol Smoking Glycaemic control Albuminuria
Why are ACE inhibitors good for diabetic patients with microalbuminuria or proteinuria
They lower the blood pressure and improve mortality
How do ACE inhibitors work
Dilation of renal arterioles
Decrease filtration pressure
Decrease proteinuria
DECREASE GFR
What blood pressure should diabetics be maintained at
What stage of Chronic kidney disease (CKD) indicates dialysis
Stage 5
What eye pathologies do diabetics get
Diabetic retinopathy
Cataract
Glaucoma
Acute hyperglycaemia
What are cotton wool spots referring to
Ischaemic areas
What are hard exudates referring to l
lipid real down products
What are haemorrhages referring to
Dot/ blot or flame
What is IRMA
Intra-retinal microvascular abnormalities
What is classed as severe non-proliferative Retinopathy
IRMA, venous beading and haemorrhages
What can be seen in pre proliferative retinopathy
Micro aneurysms, hard exudates, haemorrhages
What is seen that indicates severe proliferation
New vessel formation
Why do new blood vessels grow
The eye has become ischaemic and tries to compensate - they are very fine and are at a high risk of haemorrhage
What is a typical patient presentation of bleeding in the eye
Sudden change in vision or floaters
What are some other eye complications
Secondary glaucoma
Retinal detachment
What percentage of male diabetics are affected by erectile dysfunction
At least 50%
Why does erectile dysfunction in diabetes occur
Vascular and neuropathic
What are some general measures to manage erectile dysfunction
Improve glycemic control / lose weight/ improve lipids
reduce alcohol intake
withdraw causative drugs where possible
correct associated endocrine disease where present
involve partner as appropriate
What medication can be given to improve erectile dysfunction
Sildenafil (viagra)
Vardenafil (levitra)
Tadalafil (cialis)
What are some contraindications for erectile dysfunction medication
Nitrates/ nicorandil medication Recent stroke / MI within 3 months Hypotension Severe hepatic dysfunction Hereditary degenerative retinal disorders
