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Endocrine > Diabetes Complications > Flashcards

Diabetes Complications Flashcards

1
Q

What are some chronic complications of diabetes?

A

Macrovascular = IHD, stroke
Microvascular = retinopathy, nephropathy, neuropathy
Cognitive dysfunction/dementia, erectile dysfunction, psychiatric

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2
Q

What do hyperglycaemia and hyperlipidaemia cause?

A

Age-rage, hypoxia, oxidative stress, inflammation, mitochondrial dysfunction

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3
Q

What are the different types of neuropathies?

A

Peripheral, autonomic, proximal, focal

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4
Q

What is focal neuropathy?

A

Sudden weakness in one nerve or a group of nerves causing muscle weakness or pain (e.g foot drop)

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5
Q

What is peripheral neuropathy?

A

Distal symmetric or sensorimotor neuropathy = pain/loss of feeling in feet or hands, has glove-stocking distribution

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6
Q

What is autonomic neuropathy?

A

Affects nerves controlling heart rate and blood pressure as well as internal organs = changes in bowel/bladder function, sexual response, sweating, heart rate and BP

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7
Q

What is proximal neuropathy?

A

Pain in thighs, hips or buttocks leading to weakness in legs (amyotrophy) = lumbosacral plexus neuropathy, femoral neuropathy, diabetic amyotrophy

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8
Q

What are the risk factors for developing a neuropathy?

A

Increased length of diabetes, poor glycaemic control, greater risk in type 1 than type 2, high cholesterol/lipids, smoking, alcohol, genes, mechanical injury

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9
Q

What are the symptoms of peripheral neuropathy?

A

Numbness/insensitivity, tingling/burning, sharp pains or cramps, sensitivity to touch, loss of balance and co-ordination

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10
Q

What are some potential complications of peripheral neuropathy?

A

Charcot foot, painless trauma, foot ulcers

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11
Q

What medications are used to treat painful neuropathies?

A

Amitriptyline, duloxetine, gabapentin or pregabalin = combinations not recommended, up titrate as needed

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12
Q

When should topical capsaicin cream be used to treat a painful neuropathy?

A

If localised neuropathic pain and patient wants to avoid/can’t tolerate oral treatments

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13
Q

How does proximal neuropathy start?

A

Pain in thighs, hips buttocks or legs, usually on one side of the body

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14
Q

In what patient groups in proximal neuropathy more common?

A

Elderly type 2 diabetics, often associated with marked weight loss, proximal muscle weakness

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15
Q

How does autonomic neuropathy affect the GI system?

A

Gastric slowing/frequency, constipation or diarrhoea
Gastroparesis
Oesophageal nerve damage = may cause dysphagia

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16
Q

How does gastroparesis present?

A

Persistent nausea and vomiting, bloating and loss of appetite, can make blood glucose levels fluctuate widely

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17
Q

How is gastroparesis treated?

A

Improved glycaemic control
Smaller more frequent portions, low fibre and fat
Promotility drugs, anti-nausea drugs, gastric pacemaker

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18
Q

How does autonomic neuropathy affect the sweat glands?

A

Body can’t regulate temperature properly
Extremes of anhidrosis and hyperhidrosis in 10-75%
Treatment = topical glycopyrrolate, clonidine, botox

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19
Q

How can autonomic neuropathy affect the heart and blood vessels?

A

Interferes with ability to adjust BP and heart rate
BP may drop sharply after sitting or standing = dizziness
Heart rate may stay high constantly

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20
Q

How is neuropathy screened for in patients?

A

Diabetic foot screening

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21
Q

What are some diagnostic tools used to investigate neuropathies?

A

Nerve conduction studies and electromyograms
Heart rate variability
Ultrasound
Gastric emptying studies

22
Q

What is diabetic nephropathy?

A

Progressive kidney disease caused by damage to the capillaries in the kidney’s glomeruli

23
Q

What characterises diabetic nephropathy?

A

Nephrotic syndrome and diffuse scarring of the glomeruli

24
Q

What are other names for diabetic nephropathy?

A

Kummelstein-Wilson syndrome and Nodular Glomerulosclerosis

25
Q

What are the consequences of diabetic nephropathy?

A

Development of hypertension, decline in renal function (reduction in GFR of 1ml/min/month if untreated), accelerated vascular disease

26
Q

How is diabetic nephropathy screened for?

A

Urinary albumin:creatine ratio (ACR) = screen all patients >= 12 at diagnosis and yearly, confirm abnormal test results with EMU, check Us and Es (eGFR)

27
Q

What is microalbuminuria?

A

Excretion of albumin in abnormal quantities but still below limit of protein detection by dipstick

28
Q

What is the earliest expression of diabetic nephropathy?

A

Microalbuminuria = allows treatment to reduce risk of progression, standard part of routine diabetic assessment

29
Q

What are risk factors for the progression of diabetic nephropathy?

A

Hypertension, high cholesterol, smoking, glycaemic control poor, albuminuria

30
Q

How should diabetic nephropathy be treated?

A

BP should be maintained < 130/80mmHg in all diabetics
Patients with microalbuminuria/proteinuria should start ACE inhibitor or ARB
Maintain good glycaemic control

31
Q

What retinopathies do diabetics get?

A

Diabetic retinopathy, cataract clouding of lens, glaucoma, acute hyperglycaemic vision blurring (reversible)

32
Q

What are the stages of retinopathy?

A

Mild non-proliferative, moderate non-proliferative, severe non-proliferative, proliferative

33
Q

What is some of the terminology applied to retinopathies?

A

Haemorrhages = dot, blot, flame
Cotton wool spots = ischaemic areas
Hard exudates = lipid breakdown products
Intra-retinal microvascular abnormalities (IRMA)

34
Q

How are retinopathy and maculopathy graded?

A

Graded separately = R0-4 for retinopathy, M1-2 for maculopathy

35
Q

How do mild and moderate non-proliferative retinopathies present?

A 
Mild = haemorrhages, microaneurysms
Moderate = microaneurysms, hard exudates, haemorrhages
36
Q

How do severe non-proliferative and proliferative retinopathies present?

A 
Severe = IRMA, venous bleeding, haemorrhages
Proliferative = new vessel formation
37
Q

What are some complications of retinopathies?

A

Bleeding = sudden changes in vision, floaters

Secondary glaucoma, retinal detachment

38
Q

What is used to image maculopathies in the eyes?

A

Optical coherence tomography

39
Q

How are retinopathies screened for?

A

Annually for all low risk diabetics = identifies those who need referred to eye clinic

40
Q

How common are erectile dysfunctions in diabetic men?

A

Occurs in at least 50% of all diabetic men, affects 55% of those over 60 years old

41
Q

What causes erectile dysfunction in diabetics?

A

Vasculopathy and neuropathy, some medication (e.g antidepressants, anti-hypertensives)

42
Q

What drugs can be used to treat erectile dysfunction?

A

Phosphodiesterase 5 (PDE 5) inhibitors = increase blood flow, effective for about 65% of men (sildenafil, tadalafil, vardenafil)

43
Q

What are some other treatments for erectile dysfunction?

A

Vacuum pump = effective in 90%

Lifestyle advice = quit smoking, reduce alcohol, review other medications

44
Q

What should be screened at least annually in all diabetics?

A

Eyes, feet and kidneys (ACR, Us and Es)

45
Q

How can risk of complications in diabetes be reduced?

A

Good glycaemic control, good blood pressure control, good lipid control

46
Q

What is diabetes traditionally one of the leading causes of?

A

Blindness, amputation and dialysis (kidney failure)

47
Q

What is Charcot arthropathy?

A

Destructive inflammatory process = fractures and bony destruction cause deformity of the foot

48
Q

What are the different stages of Charcot arthropathy?

A

Active destruction = 3 months
Healing phase = 4-8 months
Chronic phase = >= 8 months

49
Q

How does Charcot arthropathy present?

A

Hot swollen foot in someone with neuropathy = hard to differentiate from infection (MRI may be helpful)

50
Q

How is Charcot arthropathy treated?

A

Non-weight bearing, total contact cast or aircast boot

Endocrine (42 decks)

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