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Endocrinology > Diabetes- Complications 2 - Neuropathy, Diabetic Foot & Macrovascular > Flashcards

Diabetes- Complications 2 - Neuropathy, Diabetic Foot & Macrovascular Flashcards

1
Q

What is Diabetic Neuropathy?

A

Is when diabetes causes damage to your nerves. It can affect different types of nerves in your body, including in your feet, organs and muscles.

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2
Q

What symptoms are experienced with Diabetic Neuropathy?

A
  • Numbness occurs in both legs
  • Pain may or may not be present
  • Paraesthesia (e.g. tingling, itching)
  • Impaired sense of position leading to the patient being unsteady on their feet
  • Decreased vibration sense
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3
Q

What is motor neuropathy?

A

Neuropathy of the autonomic nerves

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4
Q

What are the symptoms of motor neuropathy?

A
  • Erectile dysfunction in men
  • Low blood pressure when standing (Orthostatic hypotension)
  • Delayed emptying of the stomach causing bloating, occasional nausea and vomiting (Gastroporesis)
  • Diabetic diarrhoea
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5
Q

What are the treatment options for diabetic neuropathy?

A
  1. Optimise control of blood sugar - Possible worsening of symptoms at first then improves
  2. Pain modifying agents
    • Simple analgesics e.g. paracetamol
    • Analgesics for nerve pain e.g. Amitriptyline, Carbamazepine or Gabapentin
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6
Q

What percentage range of diabetic patients have neuropathy?

A

23-42%

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7
Q

What percentage range of diabetic patients have vascular disease?

A

9-23%

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8
Q

What percentage of diabetic will get a foot ulcer at some point in their life?

A

15%

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9
Q

What percentage range of diabetic patients with neuropathy/vascular disease/foot ulcer will eventually require amputation?

A

5-15%

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10
Q

Diabetic foot has a significant impact on quality of ____.

A

Quality of life

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11
Q

What is Cellulitis?

A
  • An infection of the deep layers of skin and underlying tissues.
  • It can be serious if not treated promptly
  • The infection develops suddenly and can spread through the body quickly
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12
Q

What is Gangrene?

A
  • A serious condition where a loss of blood supply causes body tissues to die.
  • It can affect any part of the body but typically starts in the toes, feet, fingers and hands.
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13
Q

Diabetic foot contributes to which 5 complications/disabilities?

A
  • Deep ulceration
  • Uncontrollable infection
  • Cellulitis
  • Gangrene
  • Amputation
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14
Q

What percentage range of all amputations are on diabetic patients?

A

40-60%

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15
Q

Diabetic foot does not contribute to premature mortality. True or False

A

False - It does contribute to premature mortality

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16
Q

What are the 2 causes of diabetic foot?

A
  • Peripheral vascular disease (Macrovascular)
  • Peripheral neuropathy (Microvascular)
17
Q

What is peripheral vascular disease?

A

The reduced circulation of blood to a body part, other than the brain or heart, and ischaemia of lower limb due to a narrowed or blocked blood vessel.

18
Q

What does peripheral vascular disease (Macrovascular) cause?

A
  • Problems with healing of infection
  • Problems getting antibiotics to the sit of action in sufficient concentration to be effective
  • Leading to DIABETIC FOOT
19
Q

How does peripheral neuropathy cause diabetic foot?

A

Due to reduced sensation of pain meaning that the ulcer can be very severe and the patient may be totally unaware.

20
Q

Risk of diabetic foot is increased by what factors?

A
  • Previous foot ulceration or amputation
  • Presence of callus or deformity of joint, foot or nail
  • Orthopaedic problems such as arthritis
  • Visual impairment of poor mobility preventing self-care
  • Increased duration of diabetes
  • Poor control of blood glucose or blood pressure
  • Poorly fitting footwear
  • Social deprivation or social isolation
21
Q

What are the management options for diabetic foot?

A
  • Wound management (cleaning, dressings)
  • Reduce the risk of recurrence
  • Referral
    -Systemic antibiotics
  • Check the blood flow to the affected area
22
Q

How can you reduce the risk of recurrence of diabetic foot?

A
  • Check footwear
  • Regular inspection of feet
  • No foot products containing acids
  • No abrasive foot products designed to remove hard skins e.g. foot files
  • Optimisation of BP control and blood sugar control
23
Q

When should referral be considered with diabetic foot?

A

Urgent referral to a specialist diabetic foot care team if the patient has ulceration, swelling, cellulitis or discolouration of the skin

24
Q

Why may systemic antibiotics be given for diabetic foot?

A

For cellulitis or bone infection
- covers gram positive, gram negative and anaerobic bacteria
- High dose, possible IV, therapy to ensure penetration

25
Q

Why may systemic antibiotics be given for diabetic foot?

A

For cellulitis or bone infection
- covers gram positive, gram negative and anaerobic bacteria
- High dose, possible IV, therapy to ensure penetration

26
Q

With diabetic foot, what can be done if blood flow is restricted?

A
  • Surgery such as blood vessel graft to bypass the affected area of the artery
  • Drug treatment to dissolve blood clots (fibrinolytic such as alteplase)
27
Q

How can diabetic foot be prevented?

A
  • Patient education: Be aware and seek medical help immediately if problem is identified
  • Don’t use OTC chiropody products eg Verrucae treatment
  • Regular review - at diagnosis and at least annually
28
Q

What is microvascular disease?

A

Macrovascular disease is a disease of any large (macro) blood vessels in the body.

29
Q

What percentage of deaths from diabetes is due to Cardiovascular Disease?

30
Q

There’s excess mortality rate for cardiovascular disease for type 1 or type 2 diabetes?

A

Type 1 diabetes

31
Q

Risk of cardiovascular disease in type 1 diabetes is 2-4x higher than in non-diabetics. True of False

A

False - Type 2 diabetes

32
Q

How can the risk of Cardiovascular Disease be reduced?

A
  • Use of statins
  • Other drug therapy e.g. Antihypertesive or Aspirin
  • Lifestyle changes/advice
33
Q

Why are patients aged >40 years with type 1 or type 2 diabetes prescribed with statins?

A

All patients aged >40 years with type 1 or type 2 diabetes are considered at high risk of cardiovascular disease and should receive a statin (e.g. Atorvastatin 20mg)

34
Q

What are the risk factors for Cardiovascular disease?

A
  • Retinopathy
  • Nephropathy including persistent microalbuminuria
  • Persistent poor glycaemic control
  • Elevated BP needing antihypertensive therapy
  • Total serum cholesterol >6mmol/L
  • Premature CVD in a first degree relative
  • Features of metabolic syndrome
    • Central obesity
    • Fasting triglycerides >1.7mmol/L
    • Non-fasting triglycerides >2mmol/L
    • HDL cholesterol <1.0mmol/L in men
    • HDL cholesterol <1.2mmol/L in women

-PATIENTS AGED 18-39 WITH TYPE 1 OR 2 DIABETES SHOULD BE CONSIDERED FOR A STATIN IF THEY HAVE ANY OF THE RISK FACTORS

35
Q

What other drug therapy other than statins can be used for reducing the risk of Cardiovascular Disease?

A
  • Add antihypertensive (first line ACEI)
    • If BP is persistently > 130/80mmHg in Type 1
    • If BP is >140/90 (<80yrs) or >150/90 (>80yrs) in Type 2
  • Aspirin- DO NOT OFFER to either Type 1 or Type 2 unless they have established cardiovascular disease
36
Q

What lifestyle advice can be given to reduce the risk of cardiovascular disease?

A
  • Weight reducing diet if BMI > 25
  • Diet: 5 a day/ Oily fish x2 a week/ Reduced saturated fat intake/ Good control of blood sugar
  • Exercise - 30 mins 5 times a week
  • Stop smoking

Endocrinology (14 decks)

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