Diabetes- complications

Question 1

what are the aims for diabetes?

Answer 1

• initially to control and treat symptoms and minimise the occurrence of hypoglycaemia
• long term to prevent development or slow the progression of complications associated with the disease

Question 2

what are the 2 types of complications of diabetes?

Answer 2

micro-vascular disease and macro-vascular disease

Question 3

what can be done to prevent complications?

Answer 3

good diabetes care, reduces risk of complications and delay rate of progression of complications

Question 4

what are some major controllable risk factors of diabetes?

Answer 4

uncontrolled (raised) blood glucose and uncontrolled (raised) blood pressure

Question 5

what are the 3 microvascular complications?

Answer 5

diabetes eye, kidney and nerve disease

Question 6

why are the eyes, kidney and nerves vulnerable to damage?

Answer 6

because the endothelial cells of the retina, kidney and peripheral nervous system allow glucose to enter the cell even in the absence of insulin

Question 7

what are the different formats/syptoms of diabetes eye disease?

Answer 7

• blurred vision
• cataracts at an earlier age than usual
• glaucoma=raised pressure of fluid inside the eye which is resistant to treatment
• most common type is retinopathy

Question 8

what are some common microvascular complications?

Answer 8

• retinopathy
• nephropathy
• neuropathy

Question 9

what are some macrovascular complications?

Answer 9

• cerebrovascual disease
• abnormal ECG
• hypertension
• intermittent claudication (pain in the calf)

Question 10

what actually happens during diabetic retinopathy?

Answer 10

starts off as small haemorrhages and abnormal spots of hardened exudates then leads to infarction of the retina then new blood vessels form but they are fragile

Question 11

what are some risk of retinopathy?

Answer 11

• hypoglycaemia
• hypertension
• increase diabetes duration
• rapid improvement of blood sugars

Question 12

what are some treatment for diabetic retinopathy?

Answer 12

• good glycaemic control (blood glucose)
• effective management of hypertension
• avoidance of smoking
• regular screening= at diagnosis then annually
• laser treatment to seal off the leaking blood vessels

Question 13

what is looked for during a screening to see if a patient might develop nephropathy? test type?

Answer 13

if they have protein presence in the form of albumin in the urine using a urine dipstick

Question 14

what is microalbumin?

Answer 14

monitoring for the presence of microalbuminauria which is very small amount of albumin, it is an early sign of nephropathy.

Question 15

in women when albumin:creatinine ratio is …. shows potential development of diabetic nephropathy and should be treated?

Answer 15

> (larger) 3.5mg/mmol

Question 16

in men when albumin:creatinine ratio is …. shows potential development of diabetic nephropathy and should be treated?

Answer 16

> (larger) 2.5mg/mmol

Question 17

what are some treatment for diabetic nephropathy? and targets

Answer 17

• improve control of diabetes to slow progression HbA1c less than 7% target of 6%
• aggressive control of blood pressure targets of <130/80 for type 1 and <140/90 for type 2
• treat other risk factions e.g. smoking cessation advice

Question 18

what is the first line therapy for lowering high blood pressure in a diabetic?

Answer 18

• start on ACE-I as they are renoprotective e.g ramipril
• if target BP not achieved other drugs e.g. calcium channel blockers (like amlodipine/felodipine) or diuretic
• also restrict dietary sodium intake to less than 100mmol Na+ per day

Question 19

what symptoms may a patient have with diabetic neuropathy?

Answer 19

• numbness occurs in both legs
• pain may or may not be present
• accompanied by unusual feelings without any obvious cause
• impaired sense patient can be unsteady
• decreased vibration sense

Question 20

what are other types of diabetic neuropathy?

Answer 20

motor neuropathy

Question 21

what are some symptoms of motor neuropathy?

Answer 21

• low blood pressure
• erectile dysfunction
• delayed emptying of the stomach causing bloating
• diabetic diarrhoea

Question 22

what are some treatment for diabetic neuropathy?

Answer 22

• optimisation of blood sugar

- pain release for nerve pain

Question 23

what are causes of diabetic foot disease?

Answer 23

• peripheral vascular disease poor circulation= problems with healing of infection and getting antibiotics to site of action
• peripheral neuropathy, reduced sensation of pain

Question 24

what are some management for diabetic foot?

Answer 24

• wound cleaning
• reduce the risk of occurrence= check feet
• no abrasion foot products
• optimisation of BP control and blood sugar control
• referral for ulceration, swelling…

Question 25

what are some ways to prevent diabetic foot?

Answer 25

-patient education such as seeking help if they identify a problem and not to use OTC chiropody products and to get regular reviews

Question 26

how to reduced the CV risk in diabetics? over 40 yrs

Answer 26

all patients aged >40yrs with type 1/2 are high risk and should receive a statin e.g. atrovastatin 20mg

Question 27

how to reduced the CV risk in diabetics? under 40yrs

Answer 27

patients 18-39yrs should be considered for statins if they have other complications

Question 28

what are some other drug therapy to reduce CV risk?

Answer 28

-add antihypertensive (first line ACEI) if BP is persistently >130/80mmHG in T1 or >140/90 <80yrs in T2

Question 29

what are some lifestyle advice to reduce CV risk in diabetic?

Answer 29

• Weight reducing diet if BMI >25
• diet changes
• exercise regularly 30mins 5x/week
• stop smoking