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Endocrine > Complications of DM > Flashcards

Complications of DM Flashcards

1
Q

The majority of people with DM die of what?

A

Heart disease

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2
Q

What are the three major microvascular complications of DM?

A

DM retinopathy
DM nephropathy
DM neuropathy

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3
Q

What is the MOA of high BG causing damage with DM?

A

AGE + DAG + Oxidative stress lead to PKC activation, which causes microvascular damage

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4
Q

True or false: DM is the most common cause of blindness in the US

A

True

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5
Q

What percent of DM vision loss is preventable?

A

90%

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6
Q

What is the earliest stage of DM retinopathy? What are the two characteristics of this stage?

A

Non-proliferative phase, characterized by:

  • hemorrhages
  • cotton wool spots
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7
Q

What is the proliferative stage of DM retinopathy?

A

Crappy neovascularization d/t small vessel occlusion and hypoxia.

This causes vitreous hemorrhage and retinal detachment

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8
Q

What are the two factors that, if controlled, can prevent DM retinopathy?

A

HTN

Hyperglycemia

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9
Q

What are the ADA recommendations to prevent retinopathy?

A

Dilated eye exam annually after 5 years at dgs

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10
Q

What is the treatment for DM retinopathy? How does this work? What happens to vision?

A

Panretinal xenon/Ar last photocoagulation, which will cauterize the crappy vessels, and the remaining will receive more nutrients

This causes loss of peripheral vision, but spares the macula

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11
Q

What causes the initial increase in GFR in patients with DM?

A

Glomerular hyperperfusion and hypertrophy, causing thickening of the BM.

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12
Q

What is the first sign of DM nephropathy?

A

Microalbuminuria

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13
Q

How do you screen for DM nephropathy?

A

Assess urine albumin and CrCl annually

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14
Q

What is the treatment to prevent DM nephropathy? (3)

A

ACE inhibitors
ARBS
Reduce protein intake

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15
Q

When should DM I and II pts be screened for nephropathy?

A 
I = annually after 5 years
II = annually after diagnosis
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16
Q

If a DM pt’s GFR reduces to 45-60, what should you do?

A
  • Monitor lytes x1 year

- Consider bone testing and referral to nephrology

17
Q

If a DM pt’s GFR reduces to less than 30, what should you do?

A

Refer to nephrology

18
Q

If a DM pt’s GFR reduces to less than 30-44, what should you do?

A

Monitor eGFR q 3 months

19
Q

What is the neuropathy distribution like with DM neuropathy?

A

Stocking glove

20
Q

How do you assess for DM neuropathy?

A

Monofilament test

21
Q

How do you treat neuropathy?

A
  • Glycemic control
  • Proper foot care
  • Analgesics PRN
22
Q

What are the 4 drug types that can be used to treat pain that is associated with neuropathy?

A
  • TCA (amitriptyline)
  • Gabapentin etc
  • Duloxetine
  • Topical capsaicin
23
Q

What is charcot arthropathy?

A

Severely neuropathic extremity exposed to trauma

24
Q

What are the ssx of charcot arthropathy? (3)

A

Edema
Erythema
Warmth

25
Q

What are the consequences of untreated autonomic neuropathy 2/2 DM?

A
  • Resting tachycardia
  • Orthostatic hypotension
  • Urinary retention
  • ED
26
Q

True or false: the more aggressive control of DM, the fewer poor outcomes

A

True

27
Q

What is the goal HbA1C (AACE vs ADA)?

A

Less than 6.5% per AACE

Less than 7% per ADA

28
Q

What are the three specific annual exams for DM pts to prevent complications?

A

Annual eye exam
Foot exam
Microalbuminuria

29
Q

True or false: having DM is equivalent to having an MI

A

True

30
Q

What are the preventative measures for CVD in DMs?

A

Exercise
Smoking cessation
ACE inhibitors

31
Q

When is daily ASA treatment indicated for DM pts? (5 risk factors)

A

If have risk factor

  • family h/o CVD
  • HTN
  • Smoking
  • Dyslipidemia
  • Albuminuria
32
Q

What was the result of the ADVANCE trial?

A

6.5% vs 7.3% showed lower incidence in nephropathy, but no difference in mortality

33
Q

What was the result of the ACCORD trial?

A

Aggressive treatment has a higher incidence of CV death

34
Q

True or false: aggressive glycemic control has been shown to reduce coronary heart disease in high risk patients

A

False–not been shown

Endocrine (32 decks)

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