Diabetes (complications) Flashcards
What are the three main complications?
CVD
Nephropathy
Neuropathy
A regular review of diabetic patients should include an annual test for what, using Albustix?
Urinary protein - should also include serum creatinine measurement.
In the regular review of a diabetic patient, what should occur following a negative urinary protein test?
A test for microalbuminuria (the earliest sign of nephropathy).
Provided there are no CIs, all diabetic patients with nephropathy causing proteinurea or with established microalbuminuria (at least 3 positive tests) should be treated with what?
An ACE inhibitor or an ATRA even if the blood pressure is normal; in any case, to minimise the risk of renal deterioration, blood pressure should be carefully controlled.
Do diabetic patients with nephropathy causing proteinurea or with established microalbuminuria need to have elevated BP before treatment with an ACEI or ATRA can begin?
no
Patients with diabetic nephropathy are particularly susceptible to developing what?
Hyperkalaemia - do not treat with both ACEI and ATRA.
ACEi can have what impact on the hypoglycaemic effect of insulin and oral antidiabetic drugs?
When is this effect more likely?
Can potentiate it.
More likely in first weeks of combined treatment and in patients with renal impairment.
What may relieve mild-to-moderate pain due to neuropathy in patients with T1 diabetes?
Paracetamol or NSAID like ibuprofen.
Duloxetine is an effective treatment of painful diabetic neuropathy, what can be used if duloxetine is ineffective or unsuitable?
Amitriptyline [unlicensed use]
or
Nortriptyline [again unlicensed].
If treatment of painful diabetic neuropathy is not effectively achieved using amitriptyline or duloxetine, what is the next stage of treatment?
Pregabalin should be trialed.
If treatment with one agent is ineffective in managing painful diabetic neuropathy, what can be trialed?
Combination therapy of duloxetine or amitriptyline with pregabalin if monotherapy at the maximum tolerated dose does not control symptoms.
There is evidence that neuropathic pain may respond to treatment with opioid analgesics. What agents can be used for this?
Tramadol, morphine, oxycodone.
Of the three opioid analgesics used for neuropathic pain, which can only be initiated under specialist supervision?
Morphine and oxycodone.
Tramadol can be prescribed while the patient is waiting for assessment by a specialist if other treatments have been unsuccessful.
Gabapentin and carbamazepine are sometimes used for the treatment of neuropathic pain. What other agent, used topically, can be used for neuropathic pain?
What are the problems surrounding its use?
Capsaicin cream 0.075% - however it causes intense burning sensations during the initial treatment period.
In autonomic neuropathy, diabetic diarrhoea can often be managed by what antibiotic in an unlicensed use?
tetracycline - but codeine phosphate is the best drug.
Erthyromycin (esp IV) may be beneficial for gastroparesis [unlicensed use] but this needs confirmation.
