Diabetes Complications Flashcards
Define Type 1 Diabetes.
Insulin deficiency resulting from B-cell destruction due to an autoimmune process.
Define Type 2 Diabetes.
Progressive insulin secretory deficiency in addition to background of insulin resistance.
Define Gestational Diabetes.
Any degree of glucose intolerance with onset during pregnancy.
What are the symptoms of Type 1 Diabetes?
- hyperglycaemia
- polyuria
- polydipsia
- weight loss
What is the pathophysiology of Type 1 Diabetes?
- destruction of beta cells in the pancreas by T-cells
- leads to defective insulin secretion
Type 1 Diabetes is most prevalent in…
Children
What is the treatment for Type 1 Diabetes?
- insulin (different forms available in injection or pump)
- diet
- physical activity
What are the symptoms of Type 2 Diabetes?
- polyuria
- polydipsia
- polyphagia (inc. hunger)
- lack of energy
- blurred vision
- weight gain
- frequent infections
- slow healing
- headaches/dizziness/irritability
- leg cramps
What are the risk factors for Type 2 Diabetes?
- BMI >25
- physical inactivity
- poor diet
- pre-diabetes/vascular disease
- high BP
- low HDL
- high triglyceride levels
- prior gestational diabetes or PCOS
- old age
- family history
- race/ethnicity (aboriginal/torres straight islander/pacific islander)
What are the three tests used to diagnose Type 2 Diabetes?
- Fasting BGL >7 on two separate occasions
- 2 hour post prandial test >11 on two separate occasions
- HbA1c >6.5 on two separate occasions
What concerns (comorbidities) are associated with Type 2 Diabetes?
- blindness/vision loss
- kidney disease
- impotence
- heart disease/vascular disease (MI/CVA)
- lower limb amputations
What factors increase the risk of developing Gestational Diabetes?
- > 30 y.o.
- family history of type 2
- overweight/obese
- ethnicity
- prev pregnancy with gestational diabetes
When are pregnant women screened for Gestational Diabetes?
24 weeks
What are other types of diabetes are there besides T1, T2 and gestational?
- diabetes insipidus
- secondary diabetes (e.g. to trauma)
- latent autoimmune diabetes in adults (LADA)
- maturity onset diabetes of the young (MODA)
What are the main complications of diabetes concerning the feet?
Neuropathy, vascular deficits and infection leading to ulceration and amputation.
What are the two theories concerning deterioration of blood supply and nerve function in diabetes?
Vascular Theory: decreased blood supply leads to hypoxia of the nerve, and thickening of the basement membrane affects microvessels.
Metabolic Theory: insulin is not required for glucose absorption to the nerves.
Neuropathy leads to…
Sensation loss, proprioception changes and biomechanical changes (soft tissue glycolisation) .
What are the symptoms of painful neuropathy?
- severe acral burning
- dull aching or crushing pain that worsens with rest
- may be in combo with elevated BSLs or clinical depression
What are the treatment options for painful neuropathy?
- pepper cream (first line): stimulates the nerves so they aren’t firing pain signals.
- opsite wrap (dressing most commonly used for cannulas): unknown mechanism
Is dry gangrene or wet gangrene worse?
Wet gangrene.
Which vessels does microvascular disease affect?
Arterioles and capillaries.
What is the pathophysiology of microvascular disease?
Basement membrane of epithelium thickens and inhibits transfer of nutrients across the cell wall. ANS effects can also affect microvascular blood flow.
Loss of innervation to the arterioles and venules creates…
Abnormal shunting of blood with subsequent loss of normal tissue integrity. Macrovascular circulation usually still palpable.
What are the most common causes of ulceration?
- neuropathic 67%
- neuro-ischaemic 26%
- ischaemic 1%
- unknown 6%
What is a common pre-ulcerative lesion?
Callus
What does conservative treatment of ulcers involve?
- dressings/offloading
- weight loss
- footwear
- bed rest/crutches/wheelchairs
- felt/foam padding
- accommodative orthoses
- rigid sole/half shoes/rocker soles
What surgical treatment options are there for ulceration?
- ultrasonic debridement
- surgical debridement
How does diabetes impair response to infection?
Diabetics will not respond in the same way to infection as a non-diabetic due to the impairment of cell-mediated immunity. Their ability to heal is proportionate to the BGL control.
What patients are classed as ‘At Risk’?
- Neuropathy OR PVD OR deformity
What patients are classed as ‘High Risk’?
- foot deformity WITH neuropathy OR PVD
- previous ulcer
- previous amputation
How many times a year should a patient with no sensory neuropathy see a podiatrist?
Once every 12 months
How many times a year should a patient WITH sensory neuropathy see a podiatrist?
Once every 6 months
How many times a year should a patient with neuropathy AND signs of PVD or foot deformity see a podiatrist?
Once every 3 months
How many times a year should a patient with previous history of an ulcer see a podiatrist?
Once every 1-3 months
As a podiatrist what is one thing that is essential for every diabetes patient?
DIABETES EDUCATION
