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FA17 Endocrine > Diabetes Complications > Flashcards

Diabetes Complications Flashcards

1
Q

Main complications of DM

A 
Microvascular 
Macrovascular 
Opthamology 
Neuropathy 
Nephropathy 
OB
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2
Q

Microvascular complications

A

Damage to small vessels of organs

Esp. Diabetic opthalmopathy and diabetic nephropathy

Related to glycemic control

T1DM

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3
Q

Macrovascular

A

Arteriosclerosis of large vessels

CAD, MI, stroke, peripheral vascular disease

Related to both glycemic control and lipid/HTN

T2DM

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4
Q

Chronic complications of DM

A

Cigarette smoking

T1DM - high rates of ESRD and proliferative retinopathy

T2DM - high rates of MI and CVA

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5
Q

Lipid protein abnormalities in T1DM

A

Moderate hyperglycemia can cause SLIGHT elevation of LDL and TAG, little change in HDL

Not a big deal

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6
Q

Lipid protein abnormalities in T2DM

A

Distinct dyslipidemia develops

High serum TAGs
Low HDL cholesterol
High artherogenic LDL

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7
Q

Lipid goals DM

Who gets lifestyle coaching?

A

Prevention of macrovascular complications is dependent on control of dyslipidemia and HTN

All should have lifestyle coaching

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8
Q

First line treatment of dyslipidemia

A

Statins given at a moderate or high intensity dose

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9
Q

high risk DM

LDL and TG goals

A

LDL: <100 mg

TG: <150 mg

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10
Q

very high risk DM

LDL and TG goals

A

LDL: <70mg

TG: <150

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11
Q

CV complications of DM

A

diabetes is a coronary heart disease risk equivalent

T1 DM pts develop microvascular dz with congestive HF

T2 DM pts develop microvascular disease (CAD, CVA, PAD)

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12
Q

primary CVD recommendations

A

Lower BP <130/80

consider EC ASA

continued diet adherence

exercise 150 min/week

smoking cessation

lower LDL <100

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13
Q

two main categories of retinopathy

A

nonproliferation

proliferative

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14
Q

nonproliferation retinopathy

A

microaneurysms, exudates, intra-retinal hemorrhages, edema, arteriolar ischemia

manifested as cotton wool spots

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15
Q

proliferative retinopathy

A

neovascularization on retina, optic disc, or iris

leads to hemorrhage, fibrosis and retinal detachment

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16
Q

DM ocular complications

A

leaving cause of blindness in adults < 74

increased in AA and Hispanics

accelerated by poor glycemic control

presence of nephropathy is protective of retinopathy

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17
Q

20% of T2DM patients have retinopathy at time of diagnosis bc

A

insidious development

doesn’t come in to get tested until it is bad

rare in T1DM, but happens to all eventually

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18
Q

when is a dilated eye exam

A

annual

5 years after diagnosis (T1DM)

at time of diagnosis (T2DM)

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19
Q

ocular complication screenings early for which patients (3)

A
  1. pregnant women (+ 1yr postpartum)
  2. existing retinopathy
  3. treatment for macular edema
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20
Q

symptoms of retinopathy

A

floaters, blurred vision and loss of visual acuity

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21
Q

prevention of DM retinopathy

A

A1c levels at less than 7%

glycemic control, smoking cessation, HTN control

22
Q

cataracts DM

A

longstanding diabetes as well as poorly controlled DM

req. surgical management and lens replacement

23
Q

macular edema DM

A

20% of T2

fluid and protein collects in central retina (macula) causing blurring and loss of central vision

24
Q

glaucoma DM

A

6% of DM

responsive to usual open angle therapy

25
Q

diabetic nephropathy epidemiology

A

DM is leading cause of ESRD in US

more often in T1DM

detectable at first as microalbuminuria, then goes to proteinuria

26
Q

DM nephropathy is caused by

A

glomerular basement membrane thickening mesangial sclerosis

diabetic glomeruloscreotic changes cause vascular stress, protein leak and GFR decline

27
Q

first sign of nephropathy

A

microalbuminuria

30-300 mg/protein/day

potentially reversible

28
Q

proteinuria

A

continued poor glucose control causes GFR decline

> 300 mg/24 hrs

29
Q

diabetic nephropathy screening

A

done annually with albumin to creatine ratio (random urine sample)

30
Q

preferred treatment for DM nephropathy

A

ACE inhibitors + control of HTN

can use ARBs

31
Q

ACE inhibitors and ARBS

A

protect agains renal deterioration in T1DM with nephropathy

seem to improve glomerular hemodynamics

recommended for all DM patients with HTN or normotensive pts with microalbuminuria

only use one

must be stopped if Cr >2

persistent K+ >6 mEq/L

32
Q

consequences of DM nephropathy

A

acceleration of coronary cerebral arteriosclerosis and hypertension

we can really only slow course to ESRD

microalbuminuria independently predicts CV morbidity

33
Q

mc diabetic complication

A

neuropathy

  1. distal symmetric polyneuropathy
  2. isolated peripheral neuropathy
  3. painful diabetic neuropathy
  4. autonomic neuropathy
34
Q

distal symmetric polyneuropathy

A

MC form

presents in stocking glove patterns due to axonal neuropathic process

sensory involvement - dulled perception of vibration, temperature, and pain

denervation of small muscles of foot

alter biomechanics of foot and increase plantar pressures

causes ulcerations

35
Q

common sign of distal symmetric polyneuropathy

A

charcot’s foot

joint subluxation and periarticular fractures

if untreated progresses into rocker bottom

must do daily foot inspection, appropriate footwear distributing weight, meticulous hygiene

36
Q

DM foot ulcers

in well vascularized limb

A

unloading

debridement of wound

potential need for ABX

37
Q

DM foot ulcers

in poorly vascularized limb

A

revascularization

if infected -pt will need amputation

38
Q

isolated peripheral neuropathy

A

sudden loss of function of nerve/nerves

subsequent slow recovery of all or most function

involves either one nerve (mononeuropathy) or multiple nerves in one area (mononeuropathy multiplex)

39
Q

causes of isolated peripheral neuropathy

A

vascular ischemia and traumatic damage

cranial/femoral nerves freq. involved

predominance of motor abnormalities

40
Q

painful DM neuropathy

A

hypersensitivity to light touch, occasionally severe burning pain, most often in lower extremities

occurs particularly at hight

41
Q

diabetic neuropathic chacexia

A

profound and rapid weight loss and unrelenting pain

treat with insulin to improve DM control and analgesics (difficult to successfully treat)

42
Q

general DM neuropathy treatments

A

no effective treatments to reverse DM neuropathy once present

better glycemic control, lipid, HTN control to prevent progression

protection of feet, thearpy/strengthening exercises and surgical deformities

43
Q

drug treatment of painful DM neuropathy

A

anti epileptic drugs (pregabalin/lyrica)

antidepressants

topical agents

44
Q

autonomic neuropathy

manifestations

A

postural hypotension

GI autonomic neuropathy

inability to fully empty bladder

erectile dysfunction

45
Q

symptoms and treatment of autonomic neuropathy

postural hypotension

A

dizziness, orthostasis, syncope

TED hose, Florinef

46
Q

symptoms and treatment of autonomic neuropathy

GI autonomic neuropathy

A

gastroparesis (slow emptying) E-mycin, gastric stimulator)

alternating diarrhea and constipation (antidiarrheals. clonidine, or fiber therapies)

47
Q

symptoms and treatment of autonomic neuropathy

inability to fully empty bladder

A

urinary retention

bethanechol, self cauterization

48
Q

peripheral vascular disease

A

both PAD and venous status

very important bc no blood flow = inability to carry antibiotics (limbs will die)

accelerated in large vessels

49
Q

how does venous stasis manifest itself by

A

dryness and flakey skin

redness

50
Q

prevention and treatment of PVD

A

smoking cessation

glycemic control

management of BP and lipids

screen PAD by checking pulses and ABI tests

51
Q

gangrene of foot

why foot?

A

uncontrolled sugar (bacteria food)

decreased blood supply

neuropathy

more common in DM bc of endothelial issues

52
Q

gangrene of food control

A

glycemic control

daily care of feet

proper footwear

avoidance of agents (i.e. tobacco)

HTN control

treatment of dyslipidemia

revascularization

FA17 Endocrine (10 decks)

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