diabetic complications

Question 1

diabetes and CVD
- risk factors and how to reduce risk of CVD in diabetes

Answer 1

• diabetes is a strong RF for CVD
• other RF for CVD include smoking, hypertension, obesity, dyslipidaemia
• CV risk in pt with diabetes can be reduced by using ACEi and lipid regulating drugs

Question 2

CV risk in pt with diabetes can be reduced by using the following drugs

Answer 2

ACEI
lipid regulating drugs

Question 3

in pt with diabetic nephropathy, you need to reduce BP to the lowest achievable level because..

Answer 3

This slows the rate of decline or glomerular filtration rate and reduces proteinuria

Question 4

as long as there is no contraindications all diabetics with confirmed nephropathy with ACR of 3mg/mmol or more need to receive

Answer 4

treatment with ACEI or ARB even if BP is normal

Question 5

in pt with CKD and proteinuria, give the following monotherapy treatment because…

Answer 5

give ACEi or ARB as monotherapy to reduce rate of progression of CKD

Question 6

T2D + CKD who are already on ACEi or ARB, offer add on therapy with …… if ACR is over 30mg/mmol

Answer 6

SGLT2i (-flozin)

Question 7

consider add on therapy with SGLT2i to pt with T2D and CKD who are already on ACEi/ARB if their ACR is

Answer 7

3-30

(and give it is their ACR is over 30mg/mmol)

Question 8

when adding ACEi, be aware that it can cause the following effect when it is given with insulin and oral antidiabetic drugs

Answer 8

ACEi can potentiate the hypoglycaemic effect of insulin and oral antidiabetic drugs
Effect more likely during the first weeks of combined treatment and in pt with renal impairment

Question 9

treatment hypertension in pt with T2D, regardless of age or if they are black

Answer 9

1. ACEi / ARB
2. • CCB or TLD
3. • all 3
4. resistant hypertension

Question 10

Consider monotherapy with ……… in pt with painful diabetic peripheral neuropathy

Answer 10

with antidepressant drugs including TCA’s (e.g. amitriptyline and imipramine (unlicensed use)), duloxetine and venlafaxine (unlicensed use)
may also consider pregabalin and gabapentin
consider opioid analgesics in combo with gaba if pain not controlled with monotherapy

Question 11

Autonomic neuropathy - diabetic diarrhoea

Answer 11

can often be managed by tetracycline (unlicensed use) or codeine phosphate as the best alternative
May also try other anti diarrheal preparations
Erythromycin (esp IV) may be beneficial for gastroparesis (unlicensed use)
Patients with suspected gastroparesis should be considered for referral to specialist services if the differential diagnosis is in doubt or if the patient has persistent or severe vomiting

Question 12

Neuropathic postural hypotension

Answer 12

Increased salt intake (to counteract low BP) and the use of mineralocorticoid fludrocortisone acetate (unlicensed use) may help to increase plasma volume but uncomfortable edoema is a common side effect
Fludrocortisone can be combined with flurbiprofen and ephedrine hydrochloride both unlicensed
Midodrine unlicensed is an alpha agonist that may also be useful in postural hypotension

Question 13

Gustatory sweating treatment

Answer 13

Can be treated with an antimuscarinic such as propantheline bromide
Side effects are common

Question 14

treatment of neuropathic oedema

Answer 14

In some patients ephedrine hydrochloride (unlicensed use)offers effective relief

Question 15

optimal diabetic and BP control should be maintained to prevent visual impairment

Answer 15

to prevent onset and progression of diabetic eye disease