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Endocrinology > Complications of DM > Flashcards

Complications of DM Flashcards

1
Q

What are the main complications of DM?

A 
DKA
Vascular disease 
Nephropathy 
Diabetic retinopathy 
Cataracts
Diabetic foot
Neuropathy
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2
Q

What are the macrovascular complications of DM?

A

Atherosclerosis -> stroke, IHD (MI), PVD

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3
Q

What are the most common causes of premature death in treated patients?

A

CV problems
CKD
Infections

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4
Q

How would u assess a diabetic patient for PVD?

A
  1. History - sx - intermittent claudication + rest pain
    2 Signs - diminished/absent pedal pulses, cold feet, poor skin and nails, absence of hair on feet and legs
  2. Doppler US
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5
Q

How do you reduce the risk of PVD in DM?

A
  1. Aggressive control of BP
  2. Smoking cessation (major RF)
  3. Statin
  4. ACEi/ARB - if one other major CV RF
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6
Q

What are the microvascular complications?

A
  1. Diabetic retinopathy
  2. Nephropathy
  3. Neuropathy
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7
Q

how long does it take for microvascular complications to manifest after diagnosis in young pts?

A

10-20yrs

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8
Q

why do microvascular complications take less time to present in older patients?

A

probs had unrecognised DM for months or years before diagnosis

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9
Q

Why is it so important to prevent diabetic retinopathy?

A

causes blindness!! (leading cause worldwide)

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10
Q

how is the risk of blindness reduced in dM?

A

Keep HbA1c below 7%

Annual retinal screening (mandatory)

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11
Q

What are the features of background retinopathy?

A

microaneurysms - dots
haemorrhages - blots
hard exudates - lipid deposits

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12
Q

What are the features of pre-proliferative retinopathy?

A

cotton wools spots - infarcts
haemorrhages
venous beading

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13
Q

What occurs in proliferative retinopathy?

A

new vessels form

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14
Q

When should you suspect maculopathy?

A

reduced visual acuity

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15
Q

What is the treatment of maculopathy?

A

laser therapy

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16
Q

Explain the pathophysiology of diabetic nephropathy?

A

thickening of BM -> glomerular damage due to poor glycemic control -> microalbuminuria

17
Q

How is a diagnosis made for diabetic nephropathy?

A

Urine:creatinine ratio >3
Albuminuria -> persistent proteinuria
Normochromic normocytic anaemia
Raised ESR

18
Q

What is the treatment of diabetic nephropathy

A

BP treatment - ACEi or ARBs
Avoid oral hypoglycaemics excreted by the kidney e.g. metformin
Reduce insulin dosage as sensitivity increased

19
Q

What is the commonest form of diabetic neuropathy ?

A

Distal symmetrical neuropathy

20
Q

What are some of the manifestations of diabetic neuropathy?

A

pain - allodyna, paraesthesia, burning at night
autonomic - postural hypotension, gastroparesis, diarrhoea, constipation, incontinence, ED
Insensitivity - glove and stocking sensory loss
Mononeuritis multiplex
Diabetic amyotrophy

21
Q

What is mononeuritis multiplex?

A

simultaneous malfunction of two or more peripheral nerves in separate areas of the body

22
Q

What is diabetic amyotrophy?

What would u see on examination?

A

Painful asymmetrical wasting of quads and other pelvifemorad muscles
Diminished or absent knee reflexes

23
Q

What is the treatment of glove and stocking ?

A 
paracetamol 
Amitriptyline 
Anticonvulsants 
Opiates- tramadol 
Avoiding weight bearing
24
Q

What is a consequence of sensory loss?

A

Diabetic foot ulceration

25
Q

What is the management of diabetic foot ulceration?

A
  1. Foot screening
  2. Check feet daily + shoes for sharp bodies
  3. Keep feet away from heat
26
Q

What are the four main threats to skin and subcut tissue?

A
  1. infection
  2. Ischaemia
  3. Abnormal pressure - keep non weight bearing
  4. Wound environment - give dressings to absorb or remove exudes, maintain moisture
27
Q

What types of infections does diabetes particularly confer a risk to?

A

Urinary tract infections

Skin infections - cellulitis, boils, abscesses

Endocrinology (21 decks)

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