Diabetic Complications Flashcards
What are complications of Diabetes Mellitus?
Macrovascular
- Ischaemic heart disease
- Stroke
Microvascular
- Diabetic Retinopathy
- Diabetic Neuropathy
- Diabetic Nephropathy
- Diabetic Foot Disease
What are the 2 main factors that can lead to Diabetic Foot Disease?
- Neuropathy: resulting in loss of protective sensation (e.g. not noticing a stone in the shoe), Charcot’s arthropathy, dry skin
- Peripheral Arterial Disease: Diabetes is a risk factor for both macro and microvascular ischaemia
What are the presentations of Diabetic Foot Disease?
Neuropathy
- Loss of sensation
Ischaemia
- Absent foot pulses
- Reduced ankle-brachial pressure index (ABPI)
- Intermittent claudication
What are complications of Diabetic Foot Disease?
- Calluses
- Ulceration
- Charcot’s arthropathy
- Cellulitis
- Osteomyelitis
- Gangrene
How is Diabetic Foot disease screened?
- Screening for Ischaemia: done by palpating for both the dorsalis pedis pulse and posterial tibial artery pulse
- Screening for Neuropathy: a 10 g monofilament is used on various parts of the sole of the foot
How is Screening for Diabetic Foot disease classified?
Low Risk
- No risk factors except callus alone
Moderate Risk
- Deformity
- Neuropathy
- Non-critical limb ischaemia
High Risk
- Previous ulceration
- Previous amputation
- On renal replacement therapy
- Neuropathy and non-critical limb ischaemia together
- Neuropathy in combination with callus and/or deformity
- Non-critical limb ischaemia in combination with callus and/or deformity.
How should patient who are moderate or high risk be managed?
All patients who are moderate or high risk (I.e. any problems other than simple calluses) should be followed up regularly by the local diabetic foot centre.
How is diabetic neuropathy managed?
Managed in the same way as other forms of neuropathic pain
- 1st Line is one of: Amitriptyline, Duloxetine, Gabapentin or Pregabalin
- if the first-line drug treatment does not work try one of the other 3 drugs
- Tramadol may be used as ‘rescue therapy’ for exacerbations of neuropathic pain
- Topical capsaicin may be used for localised neuropathic pain (e.g. post-herpetic neuralgia)
- Pain management clinics may be useful in patients with resistant problems
What are symptoms of Gastroparesis?
- Erratic blood glucose control
- Bloating
- Vomiting
What is Gastroparesis
Gastroparesis is a condition in which your stomach cannot empty itself of food in a normal fashion.
It can be caused by damage to the vagus nerve, which regulates the digestive system.
What is the management of Gastroparesis?
Metoclopramide, Domperidone or Erythromycin (prokinetic agents)
What are the standards that must be met for DVLA about patients with Diabetes Mellitus?
- No severe hypoglycaemic event in the previous 12 months
- The driver has full hypoglycaemic awareness
- The driver must show adequate control of the condition by regular blood glucose monitoring*, at least twice daily and at times relevant to driving •
- The driver must demonstrate an understanding of the risks of hypoglycaemia
- There are no other debarring complications of diabetes
What does the DVLA specifically require from Group 1 drivers in addition?
- If on insulin or tablets that can induce hypoglycaemia then patient can drive a car as long as they have hypoglycaemic awareness, not more than one episode of hypoglycaemia requiring the assistance of another person within the preceding 12 months and no relevant visual impairment. Drivers are normally contacted by DVLA
- If on tablets or exenatide no need to notify DVLA.
- If diet controlled alone then no requirement to inform DVLA
