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Met3b > Complications of diabetes > Flashcards

Complications of diabetes Flashcards

1
Q

List the complications of T2DM found at diagnosis from most to less common.

A
  • retinopathy
  • erectile dysfunction
  • abnormal ECG
  • ischaemic changes to feet
  • intermittent claudication
  • plasma creatinine >120µmol/L
  • stroke or TIA
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2
Q

Describe the different types of diabetic retinopathy.

A
  1. Non-proliferative/Background: retinopathy not involving the macula, characterised by the presence of microaneurysms, dot haemorrhages and hard exudates
  2. Proliferative: ischaemic retina leads to the porduction of growth factors and to neovascularisation
  3. Maculopathy: presence of retinopathy within 1 disc diameter around the macula
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3
Q

What are the different types of maculopathy?

A
  1. Focal or exudative: hard exudates around the macula which leads to macula oedema and visual loss
  2. Diffuse
  3. Ischaemic: due to retinal vessel closure
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4
Q

List the different types of diabetic neuropathy.

A
  1. Peripheral sensory
  2. Autonomic
  3. Proximal motor (amyotrophy)
  4. Mononeuropathy (cranial nerve palsies, median nerve damage = Carpal Tunnel)
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5
Q

Describe the clinical features of diabetic peripheral neuropathy.

A
  • Glove and stocking distribution
  • Symptoms: numbness, pins + needles, burning, shooting pain
  • High risk of ulceration and amputation
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6
Q

Describe the clinical features of diabetic autonomic neuropathy.

A
  • leads to multi-system problems*
    1. Genito-urinary:
  • erectile dysfunction
  • atonic bladder (difficulty voiding/urinayr continence)
    2. GI:
  • gastroparesis → recurrent vomiting and early satiety due to gastric outflow problems
  • chronic constipation or diarrhoea
  • gustatory sweating (severe sweating on eating)
    3. CV:
  • postural hypotension
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7
Q

What are the risk factors for diabetic nephropathy?

A
  • duration of disease
  • HTN
  • poor glycaemic control
  • smoking
  • male preponderance
  • South Asian + Afro-Caribbean
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8
Q

What are the clinical features of diabetic nephropathy?

A
  1. Triad of:
    - hypertension
    - albuminuria (preceded by microalbuminuria)
    - declining renal function
  2. Renal biopsy: “Kimmelstein-Wilson” lesion
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9
Q

What is a normal level of albumin (urinary) in males and females?

A

Males: <2.5mg/mool
Females: <3.5mg/mmol

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10
Q

What is the management of diabetic nephropathy?

A
  1. Most important is to maintain BP <130/80 mmHg
    - ACE-I (1st line) or ARB
    - Often more than one anti-hypertensive is needed
  2. Optimise blood glucose control (HbA1c <53 mmol/mol)
  3. Manage CV risk factors aggressively
  4. Stop metformin when eGFR <30ml/min
  5. Refer to specialist when eGFR <45ml/min
  6. RRT may be needed
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11
Q

List the overall risk factors for diabetic complications from most potent to least potent.

A
  1. Smoking (most potent)
  2. Hypertension
  3. Dyslipidaemia
  4. Hyperglycaemia (least potent)
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12
Q

Why are mortality rates from MI higher in people with diabetes?

A

People with diabetes tend ot have silent MIs (due to autonomic diabetic neuropathy) and therefore may present atypically and in the later stages when damage is less reversible

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13
Q

What is the treatment for diabetics having an MI?

A
  1. Apirin
  2. Primary angioplasty or thrombolysis
  3. Glucose-insulin infusion
  4. Secondary prevention:
    - ACE-I
    - B-Blockers
    - Statins
    - Aspirin
    - Improve glycaemic control
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14
Q

What are the symptoms of peripheral vascular disease in diabetes?

A
  • intermittent claudication
  • rest pain
  • buttock pain
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15
Q

What are the management options for diabetes patients with peripheral vascualr disease?

A
  • aspirin
  • vasodilation agents
  • reconstructive surgery
  • angioplasty
  • amputation, rehabilitation and foot care
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16
Q

How can the complications of diabetes manifest in regards to skin?

A
  • oral/genital candidiasis
  • skin abscess (esp perianal/axillary)
  • diabetic dermopathy
  • bullosis diabeticorum
  • granuloma annulare
  • acanthosis nigricans (either insulin resistance or gastric cancer!!)
  • fungal nail infections
17
Q

How can the complications of diabetes manifest in regards to bone/joints?

A
  • Charcot neuroarthropathy - a neuropathic joints leads to severe deformity and high risk of uclers
  • Diabetic cheiroarthropathy - due to limited joint mobility
  • Adhesive capsulitis - frozen shoulder
  • Diffuse idiopathic skeletal hyperostosis
  • Flexor tendinopathy
  • Diabetic osteoarthropathy
18
Q

How can diabetes damage the liver?

A
  • NAFLD is very common in people with diabetes
  • can progress to non-alcoholic steatohepatitis/fibrosis/cirrhosis
  • raised ALT and AST >2x upper limit of normal needs investigation:
    (i) hepatitis serology
    (ii) USS
    (iii) ferritin (to exclude haemochromatosis which can cause diabetes)

Met3b (21 decks)

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