Complications of Diabetes

Question 1

Diabetic nephropathy is also known as

Answer 1

diabetic kidney disease

Question 2

What is the most common cause of acute kidney failure

Answer 2

diabetic nephropathy

Question 3

poor glycaemic control causes kidney hypertrophy why

Answer 3

due to the increase in GFR

Question 4

An increase in GFR causes what to happen

Answer 4

increased arterial dilatation which causes an increased intraglomerular pressure

Question 5

Increased glomerular pressure in diabetic nephropathy causes what

Answer 5

glomerular sclerosis (thickening of the basement membrane and disruption of protein links) causing protein to leak out of the urine

Question 6

Protein in the urine is called

Answer 6

proteinuria

Question 7

Increased ________ is a sign of renal failure

Answer 7

creatinine

Question 8

What is the investigation for diabetic nephrophathy

Answer 8

microalbuminaemia (urinalysis)

Question 9

What increases the risk of getting diabetic nephropathy

Answer 9

Hypertension 
high cholesterol 
smoking 
poor glycaemic control 
albuminuria

Question 10

what is the treatment for diabetic nephropathy

Answer 10

ACEI/ARBs for patients with proteinuria

Question 11

A chronically high HbA1c can cause what

Answer 11

diabetic retinopathy and peripheral neuropathy

Question 12

What does abnormal amount of glycosylated sugars do to the retina

Answer 12

causes basement membrane thickening and increased permeability

Question 13

An increase in basement membrane thickening and increased permeability of the retina causes

Answer 13

increased passive movement of protein which reacts with the retina to cause a fibrous (scarring) response - damages the retina neural network

Question 14

what is the investigation for retinopathy

Answer 14

annual retina scan

Question 15

What does an annual retina scan look for

Answer 15

haemorrhages
cotton wool spots (areas of ischaemia)
hard exudates

Question 16

Diabetics are also predisposed to getting what other ocular conditions

Answer 16

cataracts

glaucomas

Question 17

What si the treatment for retinopathy

Answer 17

laser
vitrectomy
anti -VEGF injections (stop new blood vessel growth)

Question 18

What increases the risk of getting diabetic neuropathy

Answer 18

increased length of diabetes 
Type 1
poor glycaemic control 
increased cholesterol 
smoking/alcohol
genetics
mechanical injury

Question 19

What is an example of peripheral neuropathy

Answer 19

pain/loss of feeling of feet and hands

Question 20

What are likely symptoms of peripheral neuropathy

Answer 20

distal and symmetrical
numbness/insensitivity
tingling/burning
sharp pain/cramps
sensitivity to touch 
loss of balance and coordination

Question 21

What is the treatment for peripheral neuropathy

Answer 21

amitriptyline 
duloxetine 
gabapentin
pregabalin 
topical capsaicin cream

Question 22

What is an example of focal neuropathy

Answer 22

carpal tunnel
foot drop
Bell’s palsy

Question 23

what can focal neuropathy be described as

Answer 23

sudden weakness in one/a group of nerves that cause muscle weakness and pain

Question 24

Where is focal neuropathy common

Answer 24

head
torso
leg

Question 25

What else might be a focal neuropathy symptom

Answer 25

``` inability to focus eye double vision aching behind the eye pain in the thigh, chest lower back or pelvis pain on outside of foot ```

Question 26

What is an example of proximal neuropathy

Answer 26

pain in thigh, hip or bum leading to weakness in legs (amyotrophy)

Question 27

Is proximal neuropathy usually unilateral or bilateral

Answer 27

unilateral

Question 28

Who is more likely to get proximal neuropathy

Answer 28

elderly T2DM

Question 29

Proximal neuropathy can be described as

Answer 29

proximal muscle weakness

Question 30

What is proximal neuropathy associated with

Answer 30

weight loss

Question 31

What is an example of autonomic neuropathy

Answer 31

changes in bowel/bladder function, sexual response, sweat, HR and BP

Question 32

What symptoms may present in someone with autonomic neuropathy

Answer 32

gastric slowing/frequency (constipation/diarrhoea) gastroparesis - persistent N&V, bloating, loss of appetite Oesophageal nerve damage - difficulty swallowing can lead to weight loss If affects HR and BP -> dizziness can affect sweat glands - can't control temp

Question 33

what is the treatment for autonomic neuropathy

Answer 33

topical gylcopyrrolate clonidine botulinum toxin

Question 34

what is the investigations for neuropathy

Answer 34

nerve conduction studies/EMG HR variability USS Gastric emptying studies

Question 35

what is the treatment for gastroparesis in autonomic neuropathy

Answer 35

``` improve glycaemic control smaller, more frequent food portions metoclopramide, domperidone erythromycin to improve motility prochlorperazine/ondansetron for N&V NSAIDs for abdo pain ```

Question 36

What is a complication of peripheral neuropathy

Answer 36

foot ulcers

Question 37

What are the 2 types of foot ulcers

Answer 37

neuropathic | ischaemic

Question 38

How do foot ulcers occur in peripheral neuropathy

Answer 38

damage to nerves causes absence of sweating which causes cracking of skin due to excessive dryness which can lead to infection

Question 39

Where do neuropathic foot ulcers occur

Answer 39

in high pressure areas | e.g. metatarsal head/big toe

Question 40

where do ischaemic foot ulcers occur

Answer 40

more common in margins of feet

Question 41

Ischaemic foot ulcers are caused by

Answer 41

atriovenous shunting which causes ischaemia and decreased nutrients

Question 42

what else will be seen in ischaemic foot ulcers

Answer 42

absent pulses cold feet gangrene

Question 43

How does charcot foot occur

Answer 43

injury to the foot causes decreased bone density and joints are destroyed causing gross deformity

Question 44

what will be seen on an X-ray of charcot foot

Answer 44

bag of bones appearance