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Endocrine > Diabetes Complications > Flashcards

Diabetes Complications Flashcards

1
Q

Name two macrovascular complications

A

IHD and Stroke

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2
Q

Name three microvascular complications

A

Neuropathy, Nephropathy, Retinopathy

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3
Q

State three non vascular complications

A

Dementia, erectile dysfunction, psychiatric

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4
Q

What helps to prevent complications?

A

HbA1c target

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5
Q

What are the key issues that lead to complications?

A 
AGE-RAGE (glucose binds to proteins to produce toxic products) 
Oxidative stress
Hypoxia 
Inflammation 
Mitochondrial dysfunction
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6
Q

Name four types of neuropathy

A

peripheral
proximal
autonomic
focal

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7
Q

Describe peripheral neuropathy

A

glove-stocking distribution, starts on long nerves distally (usually toes)

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8
Q

What are the symptoms of peripheral neuropathy?

A

numbness, tingling, sharp pain, sensitivity, loss of balance

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9
Q

State three consequences of peripheral neuropathy

A

charcot foot
painless trauma
foot ulcers

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10
Q

Describe charcot arthropathy

A

destructive inflammatory process involving fractures/bony destruction and foot deformity. Presents as hot swollen foot and requires MRI to diagnose

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11
Q

What is the treatment for charcot arthropathy?

A

Airiest boot/non-weight bearing

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12
Q

In general what are the drugs available for a painful neuropathy

A

amitriptyline, duloxetine, gabapentin, prcegablin, capsaicin cream

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13
Q

How does proximal neuropathy present?

A

Pain in the thighs, hips, buttocks leading to weakness in the legs (amyotrophy) - associated with marked weight loss

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14
Q

How is proximal neuropathy treated?

A

symptomatic treatment as will resolve over time

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15
Q

What nerves does autonomic neuropathy affect?

A

Nerves regulating; heart rate/BP, gastric motility, respiration, urination, sexual function & vision

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16
Q

Describe the effect of autonomic neuropathy in the digestive system

A

gastric slowing, gastroparesis (slowed stomach emptying) can mess with glucose levels due to disturbed carbohydrate absorption rate, oesophageal nerve damage can impact swallowing

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17
Q

What is the treatment for autonomic neuropathy affecting the digestive system?

A

Improve glycemic control, dietary advice, promotility drugs, anti-nausea drugs, Bo-tox, gastric pacemaker

18
Q

How does autonomic neuropathy impact the sweat glands?

A

Body cannot regulate temperature - nerve damage can also cause perfuse sweating at night/while eating

19
Q

What is the treatment for sweat gland related problems?

A

topical glycopyrrolate, clonidine, bo-tox

20
Q

Describe focal neuropathy

A

sudden weakness in one nerve/group of nerves causing weakness/ pain

21
Q

Give some examples of focal neuropathy

A

carpal tunnel syndrome/foot drop/bells palsy

22
Q

What are the risk factors for diabetic complications?

A
  • poor glycemic control
  • type 1>type 2
  • high cholesterol
  • smoking/alcohol
  • genetics
  • mechanical injury
23
Q

What are the effects of diabetes on the kidneys?

A

Damage to capillaries in the glomeruli (scaring & proteinuria) means protein leaks through into the urine

24
Q

What are the consequences of nephropathy?

A
  • development of hypertension
  • decline in renal function
  • accelerated vascular disease
25
Q

How is kidney function tested?

A

Albumin:creatinine
Protein:creatinine

26
Q

What is the normal creatinine level?

A

female <3.5 male <2.5

27
Q

State the values which suggest microalbuminuria

A

ACR <30 PCR<50 but above normal values

28
Q

Can microalbuminuria be detected on dipstick?

A

No

29
Q

How many times must the test be repeated to be deemed positive?

A

3 - 2/3 samples must be positive

30
Q

State the values which suggest macroalbuminuria/protienuria

A

ACR>30 PCR>50

31
Q

Can macroalbuminuria be detected on dipstick?

A

Yes

32
Q

When measuring kidney function using urine what must you be careful of?

A

False positives e.g. pregnancy, UTI, discharge

33
Q

How often should diabetics have their kidney function tested?

A

Annually

34
Q

When is the best time to take a sample?

A

1st pass morning sample

35
Q

What is the treatment for diabetic nephropathy?

A

ACE inhibitor/ARB

36
Q

What is the mechanism of action of ACE inhibitors?

A

relax efferent arterioles & decrease filtration pressure

37
Q

State the target BP for diabetics

A

<140/80

38
Q

Are SGLT2 inhibitors good or bad for kidneys?

A

Shown to be beneficial in kidney disease

39
Q

What disease can present in the eye in diabetics?

A
  • diabetic retinopathy
  • diabetic macular oedema
  • cataract
  • glaucoma
  • acute hyperglycaemia (reversible visual blurring)
40
Q

What are the four stages of retinopathy?

A

Background/mild
Moderate
Severe
Proliferative

41
Q

What is treatment for retinopathy?

A

Laser eye surgery & vitrectomy

Endocrine (17 decks)

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