Diabetes Complications Flashcards
What are the 3 main microvascular complications of diabetes?
Neuropathy
Nephropathy
Retinopathy
How does microvascular compromise generally occur in diabetes?
Reduced blood flow to small vessels, causing hypoperfusion of nerves in that area
Which parts of the body is most susceptible to diabetic neuropathy?
Feet and hands
What will peripheral neuropathy predominately cause?
Symmetrical pain/loss of sensation in feet/hands
Tingling, burning, sharp pain, cramps
Neuropathy is more common in type 2 diabetes than type 1 diabetes. True/False?
False
Type 1 diabetes more common
What are the major complications of peripheral neuropathy?
Infections/ulcers
Deformities (inc. Charcot foot - bone deformity due to brittle bones)
Amputations
Autonomic neuropathy can cause gustatory sweating. What is this?
Abnormal function of sweat glands, causing profuse sweating at night/during meals
Diabetes is the commonest cause of kidney failure. True/False?
True
What is a reliable sign of diabetic kidney failure that should be screened for?
Raised albumin
There is established microalbuminuria in diabetics if the test is repeated twice and how many are positive?
2/3 positive
List causes of false positive tests for microalbuminuria
Menstruation Pregnancy UTI Vaginal discharge Non-diabetic renal disease
Which class of drugs is useful for diabetics with kidney failure? What other management is available?
ACEi/ ARBs
Dialysis in kidney failure
What eye pathologies do people with diabetes get?
Retinopathy
Cataract (clouding of lens)
Glaucoma (increased fluid pressure –> optic nerve damage)
Visual blurring (acute hyperglycaemia)
What is the main sign of background retinopathy (R1)?
Leaky blood vessels (dots)
What are the main signs of proliferative retinopathy (R4)?
Angiogenesis (due to ischaemia) - new BV formation
Haemorrhage
Leaky blood
What are the main signs of diabetic maculopathy (M1-M2)?
Build up of fluid in macula, causing exudates
Blurred/complete loss of vission
Erectile failure occurs in about 50% of diabetic men. True/False?
True :(
How does Charcot foot appear on XR?
‘Bag of bones’
Outline the treatment options for peripheral neuropathy
Amitryptiline
Duloxetine
Anticonvulsant
Capsaicin cream
What is focal neuropathy? Give some examples
Sudden weakness in specific nerves leading to muscle weakness and pain
Carpal tunnel syndrome, ulnar mononeuropathy, foot drop, bell’s palsy, CN palsy (particularly eye symptoms- double vision, eye ache)
What are the signs of proximal neuropathy or diabetic amyotrophy?
Pain in thighs, hips, buttocks leading to weakness in legs, typically on one side of the body
What are the clinical features of autonomic neuropathy?
Change in bowel/ bladder habit Sexual dysfunction Gustatory sweating Persistant tachycardia Postural hypotension Changes in vision Changes in respiratory function Dysphagia Weight loss Gastroparesis
Outline the management options for autonomic neuropathy
Diet changes (increase fibre, reduce fat, portions)
Promotility (metaclopramide, prochlorperazine)
NSAIDs
Atypical analgesia
Botulinum toxin
Gastric pacemaker
Outline the investigations that should be carried out to detect neuropathy
NCS/ EMG
HR variability
US (bladder, urinary tract)
Gastric emptying studies
What screening tools should be used to diagnose diabetic nephropathy?
ACR (urinary)
DIpstick test (proteinuria)
U+Es/ monitor serum creatinine
What is the target BP for diabetic patients?
130/80mmHg
Outline the pathogenesis of diabetic nephropathy
Angiopathy of capillaries in kidney glomeruli
Outline the treatment options for retinopathy
Laser
Vitrectomy
Anti-VGEF injection
List the drugs that can cause erectile dysfunction
Anti-hypertensives (thiazides, beta blockers)
CNS drugs: anti-depressants, tricyclics, SSRIs, sedatives
Outline the management options for erectile dysfunction
Exercise, weight loss, smoking cessation
PDE inhibitors (sildenafil (viagra), tadalafil, vardenafil)
Refer to andrology clinic (injections, vacuum, surgery)
What lifestyle habits in diabetics can increase their risk of complications?
Poor glycaemic control
Smoking
Alcohol
Poor diet
