Diabetes 2 Flashcards
What are the diabetic neuropathies?
Progressive: Symmetrical sensory polyneuropathy Autonomic neuropathy Reversible: Acute painful neuropathy Mononeuropathy and mononeuritis complex Diabetic amyotrophy
What is symmetrical sensory polyneuropathy?
Most common form affects feet first (loss of vibration, pain and temperature)
Imapired proprioception
Ulceration
Neuropathic arthropathy (Charcot’s joints) in the ankle and knee (grossly deformed and swollen)
Wasting of the small muscles of the hand and distorted foot with a high arch and clawing of the toes
What is acute painful neuropathy?
Burning or crawling pain in the lower limbs
Symptoms are worse at night
What is mono neuritis and mononeuritis multiplex?
One or more individual nerves may be affected Onset may be abrupt and painful Carpal tunnel syndrome III and VI extrocular muscles Unilateral pain, ptosis, dipoplia
What is diabetic amyotrophy?
Presents with painful wasting, usually asymmetrical of the quadriceps muscles
Knee reflexes are diminished or absent
What is autonomic neuropathy?
Affects the cardiovascular system- resting tachycardia, loss of sinus arrhythmia, postural hypotension , peripheral vasodilation
GI- diarrhoea, gastroparesis
Bladder- incomplete emptying followed by painless distended blader
Ereticle dysfunction
What is the management for foot lesions?
Swabbing of ulcers for bacterial culture and early antibiotic treatment
Good local wound care and, if necessary, surgical debridement of
ulcers
Evaluation for peripheral vascular disease by clinical examination, measurement of blood flow (by Doppler probe) and femoral angiography if clinically indicated
Reconstructive vascular surgery for localized areas of arterial occlusion.
What infections are diabetics prone to?
UTI
Cellulitis, boils and abscesses
TB
Mucocutaneous candidiasis
What are the skin complications that occur in diabetes?
Liperhypertrophy
Necrobiosis lipoidica diabeticorum (erythematous plaques, often over the shins, which gradually develop a brown waxy discoloration)
Vitiligo
Granuloma annulare–flesh-coloured rings and nodules, principally over the extensor surfaces of the fingers.
What is the presentation of type 2 diabetes?
Onset over months/years, classic triad (may be less obvious than T1DM)
Lack of energy
Visual blurring: glucose-induced refractive changes
Pruritis vulvae/balatitis: candida infection
Older patients: retinopathy, polyneuropathy, erectile dysfunction, arterial disease
What are causes of secondary diabetes?
Pancreatic disease: CF, chronic pancreatitis, pancreatic carcinoma
Endocrine: Cushing’s, acromegaly, thyroroxicosis, pheochromocytoma, glucagonoma
Drug induced: thiazide diuretics, corticosteroids, antipsychotics, antiretrovirals
Congenital disease: insulin receptor abnormalities, myotonic dystrophy, Friedreich’s ataxia
In which populations is the use of HbA1c inappropriate to diagnose diabetes?
<18yo Acutely unwell Those taking medication that could raise blood sugars Those with end-stage CKD Those with HIV
What is the pathogenesis of diabetic ketoacidosis?
Insulin absense –> increased hepatic glucose production (gluconeogenesis) & reduced uptake of glucose peripherally
Rising plasma glucose –> osmotic diuresis + dehydration
Lipolysis occurs in glucose-starved tissues –> elevated free fatty acids
In liver: free fatty acids –> fatty acetyl-CoA
In mitochondria to generate energy: fatty acetyl CoA –> ketone bodies
Accumulation of ketone bodies = metabolic acidosis
Respiratory compensation = hyperventilation
Acidosis: vomiting (fluid/electrolyte loss)
Renal perfusion falls: impaired excretion of raised H+ and ketones
Increased secretion of Na+ & K+
What is diabetes insidious characterised by?
High plasma osmolality
Low urine osmolality
Hypernatraemia
What criteria is used to diagnose HHS?
Hypovolaemia (due to osmotic diuresis)
Marked Hyperglycaemia (serum glucose>30mmol/L)
No significant ketonaemia/ketonuria (serum ketone <3mmol/L)
No significant acidosis (pH>7.3, bicarb >15mmol/L)
Osmolality >320mmol/kg
