Diabetes Mellitus -2 Flashcards

Question

How is MI managed in a diabetic patient?

Answer 1

Management is similar to non- diabetic population with more caution with usage of thromolytic therapy because of the risk of intraocular haemorrhage in the patient with retinopathy.

Answer 2

* Diabetes can cause a cardiomyopathy even without coronary artery atheroma. * Left ventricular contractility abnormalities detected by echocardiology is the main subclinical feature.

Answer 3

Hypertension is twice more in diabetes than non-diabetic. * Closely associated with metabolic syndrome X, insulin resistance or hyperinsulinaemia

Answer 4

Through * Stimulation of kidney reabsorption of sodium and water. * Stimulation of calcium and sodium in the vascular smooth muscle which enhance contractility causing hypertrophy of vascular smooth muscle, and stimulation of sympathetic nervous systems.

Answer 5

* Hypertension is a major CVS risk factor. *Hypertension can accelerate microvascular complication as nephropathy and retinopathy.

Answer 6

Investigate pt's for * Secondary hypertension (Cushing’s, Conn's disease and Pheochromocytoma) * Renal damage (proteinuria or microalbuminuria, urine microscopy, serum creatinine and electrolytes) * CV damage (ECG, chest x-ray for left ventricular hypertrophy) * Other CV risk factors eg. hyperlipidemia, poor glycemic control

Answer 7

ACE inhibitors are the first choice because: 1. It delays the progression of diabetic retinopathy and reduces microalbuminuria. 2. A thiazide should be used at low dose to avoid worsening of glycemic control and aggravation of dyslipidemia. 3. Beta-adrenoceptors can aggravate hyperglycemia, dyslipidemia and impotence.

Answer 8

- Asymptomatic - Intermittent claudication (calf pain on walking) - Buttock pain may occur if iliac vessels are affected - Decreasing claudication distance and rest pain denote critical ischemia - Unhealed skin wound

Answer 9

- Absence of pedal pulse ( 8% dorsalis pedis, 2% posterior tibialis) - Cold extremities - Pale or bluish color of the skin - thin, shiny skin with scanty hair - dystrophic toenail

Answer 10

- Doppler US - Ankle Brachial Index (ABI) : normal value 0.98 - 1.31 - Angiography

Answer 11

- Early control of blood glucose - Strict control of hypertension. - Stop smoking - Treatment of lipid abnormalities: to the lowest achievable level - ACE inhibitors /angiotensin II receptor antagonists: 25–35% lowering of the risk of heart attack, stroke, overt nephropathy or cardiovascular death - Low dose aspirin: can reduce macrovascular risk, but is associated with a morbidity and mortality from bleeding.

Answer 12

- Stroke is twice higher in diabetic population than non-diabetics - Mortality and disability from stroke are also worse in the diabetic person compared to non- diabetic people (May because of elevation of blood glucose level following stroke)

Answer 13

Retina Renal Glomerulus Nerves

Answer 14

* Focal and multifocal neuropathies e.g. mononeuropathy, amyotrophy, radiculopathy, entrapment neuropathy, mononeuritis multiplex. * Symmetrical neuropathies e.g. diabetic peripheral neuropathy and autonomic Neuropathy * Cranial nerve palsies (III, IV, VI & VII)

Answer 15

Affect (single nerve) peroneal, median or ulnar nerves. It tends to occur at sites of entrapment (wrist) or external compression. * Peroneal nerve palsy is characterized by weakness or paralysis of foot and toe dorsiflexors, foot drop and foot eversion. * Impaired sensation over the dorsum of the foot and the lower anterior aspect of the leg. *The ankle reflex is preserved as is foot inversion.

Answer 16

1-Carpal tunnel syndrome: found in 5.8 % of diabetic patients. It has a less favorable outcome after surgical decompression, as diabetes slows nerve regeneration. 2- Ulnar neuropathy at the elbow affects 2.1% of diabetic patients 3- Peroneal neuropathy at the fibular head affects 1.4–13% of diabetic patients. 4- Lateral cutaneous nerve of the thigh (meralgia paresthetica) affect 0– 1.0% of diabetic patients.

Answer 17

* Impotence * Postural hypotension (giving dizziness and syncope) * Resting tachycardia or fixed heart rate * Gustatory sweating—sweating after tasting food * Dysphagia with delayed gastric emptying, nausea/vomiting * Constipation or diarrhea * Urinary retention or overflow incontinence * absent sweating on the feet (anhidrosis). This increases the risk of ulceration. * Abnormal pupillary reflexes

Answer 18

Annually check the following: * Lying and standing BP (measure systolic BP 2 minutes after standing; normal is difference <10 mmHg drop, >30 mmHg is abnormal) * Pupillary responses to light

Answer 19

* Loss of sinus arrhythmia: Measure inspiratory and expiratory heart rates after 5 seconds of each (<10 beats/min difference is abnormal,>15 are normal). * Loss of heart rate response to Valsalva maneuver: Look at the ratio of the shortest R–R interval during forced expiration against a closed glottis compared to the longest R–R interval after it (<1.2 is abnormal). * BP response to sustained hand-grip: Diastolic BP prior to the test is compared to diastolic BP after 5 minutes of sustaining a grip equivalent to 30% of maximal grip. A diastolic BP rise >16 mmHg is normal, <10 mmHg is abnormal. A rolled-up BP cuff to achieve the required handgrip may be used.