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Podiatry Practice > Diabetes Complications > Flashcards

Diabetes Complications Flashcards

1
Q

Define Type 1 Diabetes.

A

Insulin deficiency resulting from B-cell destruction due to an autoimmune process.

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2
Q

Define Type 2 Diabetes.

A

Progressive insulin secretory deficiency in addition to background of insulin resistance.

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3
Q

Define Gestational Diabetes.

A

Any degree of glucose intolerance with onset during pregnancy.

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4
Q

What are the symptoms of Type 1 Diabetes?

A
  • hyperglycaemia
  • polyuria
  • polydipsia
  • weight loss
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5
Q

What is the pathophysiology of Type 1 Diabetes?

A
  • destruction of beta cells in the pancreas by T-cells

- leads to defective insulin secretion

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6
Q

Type 1 Diabetes is most prevalent in…

A

Children

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7
Q

What is the treatment for Type 1 Diabetes?

A
  • insulin (different forms available in injection or pump)
  • diet
  • physical activity
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8
Q

What are the symptoms of Type 2 Diabetes?

A
  • polyuria
  • polydipsia
  • polyphagia (inc. hunger)
  • lack of energy
  • blurred vision
  • weight gain
  • frequent infections
  • slow healing
  • headaches/dizziness/irritability
  • leg cramps
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9
Q

What are the risk factors for Type 2 Diabetes?

A
  • 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)
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10
Q

What are the three tests used to diagnose Type 2 Diabetes?

A
  • Fasting BGL >7 on two separate occasions
  • 2 hour post prandial test >11 on two separate occasions
  • HbA1c >6.5 on two separate occasions
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11
Q

What concerns (comorbidities) are associated with Type 2 Diabetes?

A
  • blindness/vision loss
  • kidney disease
  • impotence
  • heart disease/vascular disease (MI/CVA)
  • lower limb amputations
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12
Q

What factors increase the risk of developing Gestational Diabetes?

A
  • > 30 y.o.
  • family history of type 2
  • overweight/obese
  • ethnicity
  • prev pregnancy with gestational diabetes
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13
Q

When are pregnant women screened for Gestational Diabetes?

A

24 weeks

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14
Q

What are other types of diabetes are there besides T1, T2 and gestational?

A
  • diabetes insipidus
  • secondary diabetes (e.g. to trauma)
  • latent autoimmune diabetes in adults (LADA)
  • maturity onset diabetes of the young (MODA)
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15
Q

What are the main complications of diabetes concerning the feet?

A

Neuropathy, vascular deficits and infection leading to ulceration and amputation.

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16
Q

What are the two theories concerning deterioration of blood supply and nerve function in diabetes?

A

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.

17
Q

Neuropathy leads to…

A

Sensation loss, proprioception changes and biomechanical changes (soft tissue glycolisation) .

18
Q

What are the symptoms of painful neuropathy?

A
  • severe acral burning
  • dull aching or crushing pain that worsens with rest
  • may be in combo with elevated BSLs or clinical depression
19
Q

What are the treatment options for painful neuropathy?

A
  • pepper cream (first line): stimulates the nerves so they aren’t firing pain signals.
  • opsite wrap (dressing most commonly used for cannulas): unknown mechanism
20
Q

Is dry gangrene or wet gangrene worse?

A

Wet gangrene.

21
Q

Which vessels does microvascular disease affect?

A

Arterioles and capillaries.

22
Q

What is the pathophysiology of microvascular disease?

A

Basement membrane of epithelium thickens and inhibits transfer of nutrients across the cell wall. ANS effects can also affect microvascular blood flow.

23
Q

Loss of innervation to the arterioles and venules creates…

A

Abnormal shunting of blood with subsequent loss of normal tissue integrity. Macrovascular circulation usually still palpable.

24
Q

What are the most common causes of ulceration?

A
  • neuropathic 67%
  • neuro-ischaemic 26%
  • ischaemic 1%
  • unknown 6%
25
Q

What is a common pre-ulcerative lesion?

A

Callus

26
Q

What does conservative treatment of ulcers involve?

A
  • dressings/offloading
  • weight loss
  • footwear
  • bed rest/crutches/wheelchairs
  • felt/foam padding
  • accommodative orthoses
  • rigid sole/half shoes/rocker soles
27
Q

What surgical treatment options are there for ulceration?

A
  • ultrasonic debridement

- surgical debridement

28
Q

How does diabetes impair response to infection?

A

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.

29
Q

What patients are classed as ‘At Risk’?

A
  • Neuropathy OR PVD OR deformity
30
Q

What patients are classed as ‘High Risk’?

A
  • foot deformity WITH neuropathy OR PVD
  • previous ulcer
  • previous amputation
31
Q

How many times a year should a patient with no sensory neuropathy see a podiatrist?

A

Once every 12 months

32
Q

How many times a year should a patient WITH sensory neuropathy see a podiatrist?

A

Once every 6 months

33
Q

How many times a year should a patient with neuropathy AND signs of PVD or foot deformity see a podiatrist?

A

Once every 3 months

34
Q

How many times a year should a patient with previous history of an ulcer see a podiatrist?

A

Once every 1-3 months

35
Q

As a podiatrist what is one thing that is essential for every diabetes patient?

A

DIABETES EDUCATION

Podiatry Practice (6 decks)

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