Diabetes complications - Neuropathy, Diabetic Foot & Macrovascular

Question 1

What category of of major diabtetic complications does neuropathy fall under?

Answer 1

• Micro-vascular complications

Question 2

Describe the symptoms of diabetic neuropathy

Answer 2

1. Numbness in legs
2. Pain possible not necessary
3. Unusual sensation in legs without obvious cause
4. Decrease vibrational sense
5. impaired sense of position

Question 3

Describe the consequences of neuropathy

Answer 3

• Erectile dysfunction in men
• Low blood pressure when the patient is standing
• Delayed emptying of the stomach causing
  bloating, occasional nausea and vomiting

– Gastroporesis

• Diabetic diarrhoea

Question 4

Describe the treatment of neuropathy

Answer 4

Aim for blood sugar control

• Pain modifying agents
  – Simple analgesics e.g. paracetamol

– Analgesics for nerve pain e.g. amitriptyline,
carbamazepine or gabapentin

Question 5

What is diabetic foot ?

Answer 5

1. Neuropathy in the foot caused my blood vessel damage and/or nerve damage

Question 6

What are the causes of diabetic foot ?

Answer 6

**1. Micro-vascular neuropathy **
Poor circulation of lower limb causes:

• Problems with healing of infection
• Problems getting antibiotics to the site of action in
  sufficient concentration to be effective

**
2. MAcro-vascular nueropath**y

Reduced sensation of pain means severety of ulcer is not known to patient

Question 7

What increases the risk of diabetic foot ?

Answer 7

foot ulceration or amputation

• Presence of callus or deformity of joint, foot or nail

arthritis

• Increasing duration of diabetes
• Poor control of blood glucose or blood pressure
• Poorly fitting footwear

Question 8

What is the management of diabetic foot?

Answer 8

• Wound management
• Reduce the risk of recurrence

– Regular inspection of feet

• No abrasive foot products designed to remove hard skin e.g. foot files

– Optimisation of BP control and blood sugar control

– Urgent referral to a specialist diabetic foot care team if the
patient has ulceration, swelling, cellulitis or discolouration of the
skin

Question 9

How is diabetic foot prevented?

Answer 9

Patient education:
– Be aware and seek medical help immediately if
identify problem

Question 10

What are macrovascular complications?

Answer 10

Cardiovascular disease

Question 11

HOw is the risk for CVD reduced

Answer 11

STATINSpatients aged >40years
diabetes considered at high risk of CVD
should receive a statin (e.g. atorvastatin
20mg(NICE, 2015))

Question 12

How is the risk of CVD reduced? (other drugs)

Question 13

How is the risk of CVD reduced ? (others)

Answer 13

Lifestyle advice:

– Diet:
* 5 portions fruit/veg per day
* Oily fish x twice a week

– Exercise
(30 mins 5x/week)
– Stop smoking