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SM Endocrine > Complications of Diabetes > Flashcards

Complications of Diabetes Flashcards

1
Q

What are the 4 groups of complications that can occur

A

Macrovascular
Microvascular
Erectile Dysfunction
Psychiatric

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2
Q

What are the two main problems within macrovascular problems

A

IHD

Stroke

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3
Q

What are the three main problems within the microvascular complications

A

Neuropathy
Nephropathy
Retinopathy

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4
Q

Diabetes is traditionally the leading cause of what 3 things

A

Blindness
Dialysis
Amputation

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5
Q

What percentage of patients with diabetes will develop some degree of neuropathy

A

60-70%

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6
Q

What are the 4 types of neuropathy

A

Peripheral
Autonomic
Proximal
Focal neuropathy

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7
Q

Give examples of peripheral neuropathy

A

Pain/ loss of feeling in hands or feet

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8
Q

Give examples of autonomic neuropathy

A

Changes in bowel, bladder function, sexual response, sweating, heart rate, blood pressure, hypoglycaemic unawareness

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9
Q

Give examples of proximal neuropathy

A

Pain in the thighs, hips or buttocks leading to weakness in the legs (amyotrophy)

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10
Q

Give examples of focal neuropathy

A

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

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11
Q

What are some of the risk factors for developing neuropathy

A 
Increased length of diabetes 
poor glycemic control 
Type 1 diabetes > type 2 diabetes 
High cholesterol / lipids 
Smoking 
Alcohol
Inherited Traits (genes)
Mechanical injury
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12
Q

What are some symptoms of peripheral nerve damage

A 
Numbness/ insensitivity 
Tingling/ burning 
Sharp pains or cramps 
Sensitivity to touch 
Loss of balance and coordination
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13
Q

What are some complications of nerve damage

A

infections/ulcers
Charcot
Deformities
Amputations

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14
Q

Buzzword for charcot

A

rocker bottom foot

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15
Q

how is charcot treated

A

surgery to prevent chronic ulceration and then put in a cast for as long as a year

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16
Q

Describe the treatment for painful neuropathy

A 
simple analgesia 
TCAs (amitryptiline) 
Gabapentin
Duloxetine / pre-gabalin
stronger opiods

Topical capsaicin cream
allodynia

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17
Q

What is the difficulty in treating patients with gastroparesis

A

They have slow stomach emptying and so they may need to take their insulin after they have eaten to prevent hypoglycaemia

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18
Q

What is gustatory sweating

A

Sweating after eating

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19
Q

Describe the effect of autonomic neuropathy on the cardiovascular system

A

Nerve damage interferes with the body’s ability to adjust blood pressure and heart rate

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20
Q

Describe the blood pressure of a patient with autonomic neuropathy

A

May drop sharply after sitting or standing, causing a person to feel light-headed or faint

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21
Q

Describe the heart rate of a patient with autonomic neuropathy

A

It may stay high, instead of rising and falling in response to normal body functions and physical activity

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22
Q

How does autonomic neuropathy affect the eyes

A

Make the pupils less responsive to changes in light as they don’t dilate and contract as normal

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23
Q

How can we diagnose neuropathy

A

Nerve conduction studies or electromyography
Heart rate variability
Ultrasound
Gastric emptying studies

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24
Q

What is focal neuropathy

A

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

25
Q

How do we screen for neuropathy

A

Aim to prevent foot ulcers or unnecessary amputations
Foot examination at least once a year
Advice for patients self care

26
Q

Charcot Foot is cause by infection. True or False

A

False - it is inflammatory only

27
Q

What is diabetic nephropathy

A 
Kimmelsteil Wilson Syndrome or Nodular Glomeruloscelrosis 
Microvascular changes (antipathy of capillaries )
28
Q

Describe the appearance histologically of diabetic nephropathy

A

Sclerotic and filled with angiosclerotic matrix

29
Q

What is the most common cause of kidney failure/ dialysis

A

Diabetes

30
Q

What are some consequences of diabetic nephropathy

A

Development of hypertension
Relentless decline in renal function
Accelerated vascular disease

31
Q

What is used to screen for diabetic kidney disease

A

Urinary albumin creatinine ratio (ACR)

32
Q

What patients are screened for nephropathy

A

All patients over the age of 12

33
Q

What are the normal measurements for microalbuminuria and macroalbuminuria

A 
Micro = 30-300mg/ml
Macro = >300mg/ml
34
Q

What can give some else positives of microalbuminuria

A 
Menstruation 
Vaginal discharge 
UTI 
pregnancy 
Non-diabetic renal disease
35
Q

What does UAER varies what

A 
Day:night 
Day: day 
Exercise 
Protein load 
Fluid load
36
Q

Why do we have to repeat microalbuminuria

A

It varies so much and can have many false positives

37
Q

How often does microalbuminuria have to be repeated and positive

A

2/3

38
Q

What are some risk factors for nephropathy progression

A 
Hypertension
Cholesterol
Smoking
Glycaemic control
Albuminuria
39
Q

Why are ACE inhibitors good for diabetic patients with microalbuminuria or proteinuria

A

They lower the blood pressure and improve mortality

40
Q

How do ACE inhibitors work

A

Dilation of renal arterioles
Decrease filtration pressure
Decrease proteinuria
DECREASE GFR

41
Q

What blood pressure should diabetics be maintained at

A
42
Q

What stage of Chronic kidney disease (CKD) indicates dialysis

A

Stage 5

43
Q

What eye pathologies do diabetics get

A

Diabetic retinopathy
Cataract
Glaucoma
Acute hyperglycaemia

44
Q

What are cotton wool spots referring to

A

Ischaemic areas

45
Q

What are hard exudates referring to l

A

lipid real down products

46
Q

What are haemorrhages referring to

A

Dot/ blot or flame

47
Q

What is IRMA

A

Intra-retinal microvascular abnormalities

48
Q

What is classed as severe non-proliferative Retinopathy

A

IRMA, venous beading and haemorrhages

49
Q

What can be seen in pre proliferative retinopathy

A

Micro aneurysms, hard exudates, haemorrhages

50
Q

What is seen that indicates severe proliferation

A

New vessel formation

51
Q

Why do new blood vessels grow

A

The eye has become ischaemic and tries to compensate - they are very fine and are at a high risk of haemorrhage

52
Q

What is a typical patient presentation of bleeding in the eye

A

Sudden change in vision or floaters

53
Q

What are some other eye complications

A

Secondary glaucoma

Retinal detachment

54
Q

What percentage of male diabetics are affected by erectile dysfunction

A

At least 50%

55
Q

Why does erectile dysfunction in diabetes occur

A

Vascular and neuropathic

56
Q

What are some general measures to manage erectile dysfunction

A

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

57
Q

What medication can be given to improve erectile dysfunction

A

Sildenafil (viagra)
Vardenafil (levitra)
Tadalafil (cialis)

58
Q

What are some contraindications for erectile dysfunction medication

A 
Nitrates/ nicorandil medication 
Recent stroke / MI within 3 months 
Hypotension 
Severe hepatic dysfunction 
Hereditary degenerative retinal disorders

SM Endocrine (27 decks)

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