Diabetes Complications Flashcards
What are some chronic complications of diabetes?
Macrovascular = IHD, stroke
Microvascular = retinopathy, nephropathy, neuropathy
Cognitive dysfunction/dementia, erectile dysfunction, psychiatric
What do hyperglycaemia and hyperlipidaemia cause?
Age-rage, hypoxia, oxidative stress, inflammation, mitochondrial dysfunction
What are the different types of neuropathies?
Peripheral, autonomic, proximal, focal
What is focal neuropathy?
Sudden weakness in one nerve or a group of nerves causing muscle weakness or pain (e.g foot drop)
What is peripheral neuropathy?
Distal symmetric or sensorimotor neuropathy = pain/loss of feeling in feet or hands, has glove-stocking distribution
What is autonomic neuropathy?
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
What is proximal neuropathy?
Pain in thighs, hips or buttocks leading to weakness in legs (amyotrophy) = lumbosacral plexus neuropathy, femoral neuropathy, diabetic amyotrophy
What are the risk factors for developing a neuropathy?
Increased length of diabetes, poor glycaemic control, greater risk in type 1 than type 2, high cholesterol/lipids, smoking, alcohol, genes, mechanical injury
What are the symptoms of peripheral neuropathy?
Numbness/insensitivity, tingling/burning, sharp pains or cramps, sensitivity to touch, loss of balance and co-ordination
What are some potential complications of peripheral neuropathy?
Charcot foot, painless trauma, foot ulcers
What medications are used to treat painful neuropathies?
Amitriptyline, duloxetine, gabapentin or pregabalin = combinations not recommended, up titrate as needed
When should topical capsaicin cream be used to treat a painful neuropathy?
If localised neuropathic pain and patient wants to avoid/can’t tolerate oral treatments
How does proximal neuropathy start?
Pain in thighs, hips buttocks or legs, usually on one side of the body
In what patient groups in proximal neuropathy more common?
Elderly type 2 diabetics, often associated with marked weight loss, proximal muscle weakness
How does autonomic neuropathy affect the GI system?
Gastric slowing/frequency, constipation or diarrhoea
Gastroparesis
Oesophageal nerve damage = may cause dysphagia
How does gastroparesis present?
Persistent nausea and vomiting, bloating and loss of appetite, can make blood glucose levels fluctuate widely
How is gastroparesis treated?
Improved glycaemic control
Smaller more frequent portions, low fibre and fat
Promotility drugs, anti-nausea drugs, gastric pacemaker
How does autonomic neuropathy affect the sweat glands?
Body can’t regulate temperature properly
Extremes of anhidrosis and hyperhidrosis in 10-75%
Treatment = topical glycopyrrolate, clonidine, botox
How can autonomic neuropathy affect the heart and blood vessels?
Interferes with ability to adjust BP and heart rate
BP may drop sharply after sitting or standing = dizziness
Heart rate may stay high constantly
How is neuropathy screened for in patients?
Diabetic foot screening
What are some diagnostic tools used to investigate neuropathies?
Nerve conduction studies and electromyograms
Heart rate variability
Ultrasound
Gastric emptying studies
What is diabetic nephropathy?
Progressive kidney disease caused by damage to the capillaries in the kidney’s glomeruli
What characterises diabetic nephropathy?
Nephrotic syndrome and diffuse scarring of the glomeruli
What are other names for diabetic nephropathy?
Kummelstein-Wilson syndrome and Nodular Glomerulosclerosis
What are the consequences of diabetic nephropathy?
Development of hypertension, decline in renal function (reduction in GFR of 1ml/min/month if untreated), accelerated vascular disease
How is diabetic nephropathy screened for?
Urinary albumin:creatine ratio (ACR) = screen all patients >= 12 at diagnosis and yearly, confirm abnormal test results with EMU, check Us and Es (eGFR)
What is microalbuminuria?
Excretion of albumin in abnormal quantities but still below limit of protein detection by dipstick
What is the earliest expression of diabetic nephropathy?
Microalbuminuria = allows treatment to reduce risk of progression, standard part of routine diabetic assessment
What are risk factors for the progression of diabetic nephropathy?
Hypertension, high cholesterol, smoking, glycaemic control poor, albuminuria
How should diabetic nephropathy be treated?
BP should be maintained < 130/80mmHg in all diabetics
Patients with microalbuminuria/proteinuria should start ACE inhibitor or ARB
Maintain good glycaemic control
What retinopathies do diabetics get?
Diabetic retinopathy, cataract clouding of lens, glaucoma, acute hyperglycaemic vision blurring (reversible)
What are the stages of retinopathy?
Mild non-proliferative, moderate non-proliferative, severe non-proliferative, proliferative
What is some of the terminology applied to retinopathies?
Haemorrhages = dot, blot, flame
Cotton wool spots = ischaemic areas
Hard exudates = lipid breakdown products
Intra-retinal microvascular abnormalities (IRMA)
How are retinopathy and maculopathy graded?
Graded separately = R0-4 for retinopathy, M1-2 for maculopathy
How do mild and moderate non-proliferative retinopathies present?
Mild = haemorrhages, microaneurysms Moderate = microaneurysms, hard exudates, haemorrhages
How do severe non-proliferative and proliferative retinopathies present?
Severe = IRMA, venous bleeding, haemorrhages Proliferative = new vessel formation
What are some complications of retinopathies?
Bleeding = sudden changes in vision, floaters
Secondary glaucoma, retinal detachment
What is used to image maculopathies in the eyes?
Optical coherence tomography
How are retinopathies screened for?
Annually for all low risk diabetics = identifies those who need referred to eye clinic
How common are erectile dysfunctions in diabetic men?
Occurs in at least 50% of all diabetic men, affects 55% of those over 60 years old
What causes erectile dysfunction in diabetics?
Vasculopathy and neuropathy, some medication (e.g antidepressants, anti-hypertensives)
What drugs can be used to treat erectile dysfunction?
Phosphodiesterase 5 (PDE 5) inhibitors = increase blood flow, effective for about 65% of men (sildenafil, tadalafil, vardenafil)
What are some other treatments for erectile dysfunction?
Vacuum pump = effective in 90%
Lifestyle advice = quit smoking, reduce alcohol, review other medications
What should be screened at least annually in all diabetics?
Eyes, feet and kidneys (ACR, Us and Es)
How can risk of complications in diabetes be reduced?
Good glycaemic control, good blood pressure control, good lipid control
What is diabetes traditionally one of the leading causes of?
Blindness, amputation and dialysis (kidney failure)
What is Charcot arthropathy?
Destructive inflammatory process = fractures and bony destruction cause deformity of the foot
What are the different stages of Charcot arthropathy?
Active destruction = 3 months
Healing phase = 4-8 months
Chronic phase = >= 8 months
How does Charcot arthropathy present?
Hot swollen foot in someone with neuropathy = hard to differentiate from infection (MRI may be helpful)
How is Charcot arthropathy treated?
Non-weight bearing, total contact cast or aircast boot
