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PR - ENDOCRINE > DIABETIC COMPLICATIONS > Flashcards

DIABETIC COMPLICATIONS Flashcards

1
Q

Macrovascular complications

A
  • Peripheral arterial disease
  • MI
  • Stroke
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2
Q

Macrovascular complications - treatment

A
  • ACEi
  • Low dose aspirin
  • Lipid regulating drugs (statins)
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3
Q

When is a low-dose atorvastatin considered?

A

Considered in all type 1 pts
* Offered to age: 40+
* diabetic for 10+ yrs
* nephropathy or other CVD factors
* Qrisk > 10%

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4
Q

Microvascular complications

A
  • Neuropathy
  • Retinopathy
  • Nephropathy
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5
Q

Diabetic nephropathy

A
  • Kidney damage due to diabetes
  • Test ACR
  • Higher ACR = more severe
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6
Q

What ACR level is considered nephropathy?

A

3mg/mmol +

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7
Q

Diabetic nephropathy - Treatment

A
  • ACEi/ARB (even if BP normal)
  • ACEi can potentiate hypo effect of antidiabetic drugs/insulin
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8
Q

Risk of ACEi in nephropathy

A
  • Hyperkalaemia
  • ACEi can potentiate effect of insulin and other ADDs = HYPO
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9
Q

Diabetic neuropathy: types

A

Painful peripheral neuropathy
Autonomic neuropathy
Neuropathic postural hypotension
Gustatory sweating
Erectile sysunction

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10
Q

What is diabetic neuropathy?

A
  • High blood sugars = reduced blood flow and death of nerves
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11
Q

Painful peripheral neuropathy

A
  • Treat with antidepressants (duloxetine licensed, amitriptylline/ nort not licensed)
  • Gabapentin, pregabalin

This can lead to diabetic foot - treat pain and manage infection

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12
Q

Autonomic neuropathy

A

Causes diarrhoea
Treat with codeine or tetracycline

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13
Q

Neuropathic postural hypotension

A

Increase salt intake
Fludrocortisone

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14
Q

Gustatory sweating

A

Antimuscarinic
Propantheline bromide

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15
Q

Diabetic retinopathy

A
  • High blood sugar = damage to retina
  • REPORT changes
  • Loss of vision if left untreated
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16
Q

Erectile dysfunction + diabetes

A
  • Refer to GP
  • High blood sugar over a long period of time can damage the nerves and blood vessles
  • Can cause problems with getting or keeping an erection
17
Q

Sildenafil pt counselling

A
  • Take before food
  • Onset of effect may be delayed if taken with food
18
Q

Visual impairment

A

Yearly eye tests

19
Q

Periodontitis

A
  • Chronic inflammatory gum disease
  • Gingivitis (mild form) > periodontitis
  • Good oral hygiene
  • Regular check ups
20
Q

Gastroparesis

A
  • Long term condition = stomach cannot empty itself on the normal way
  • Bloating, feeling full, N+V
  • Treat vomiting: erythromycin, metoclompramide
21
Q

DKA

A

Severe hyperglycaemia
More common in Type 1
- Body breaks down fat at an accelarated rate.
- Ketones are produced as a byproduct.
- Ketones = acidic = blood becomes acidic.

22
Q

Symptoms of DKA

A

Polyurea
Thirsty
Pear drop breath smells (ketones)
Deep or fast breathing
Lethargy / Unconsciousness
Confusion

23
Q

Diagnosing DKA

A
  1. Check blood sugar level if displaying symptoms of DKA
  2. If blood sugar is above 11mmol/L, check ketone levels (urine/blood)
    * 0.6 - 1.5mmol = slight risk (retest in 2 hours)
    * 1.6 - 2.9mmol = increased risk (contact GP)
    * 3mmol+ = medical emergency
24
Q

How are ketone levels checked?

A

urine or blood

25
Q

0.6 - 1.5mmol

A

slight risk (retest in 2 hours)

26
Q

1.6 - 2.9mmol

A

increased risk (contact GP)

27
Q

3mmol+

A

medical emergency

28
Q

DKA - initial treatment

A
  • replacement of fluid and electrolytes
  • administration of soluble insulin
29
Q

DKA treatment

A
  1. If BP <90, restore volume with 500ml IV NaCl 0.9%
  2. Once BP > 90, give maintenance IV NaCl 0.9%
  3. Start IV Insulin mixed with NaCl and administer at a rate so that
    - Ketone concentration falls at 0.5mmol/L/hr
    - Blood glucose concentration falls at 3mmol/L/hr
  4. When blood glucose ‹ 14 mmol/L → IV Glucose 10%
  5. Continue insulin till ketone <0.3mmol/L and PH > 7.3
  6. When patient able to eat → give fast-acting insulin with a meal
  7. Stop treatment 1 hour after food
30
Q
  1. If BP <90
A

restore volume with 500ml IV NaCl 0.9%

31
Q
  1. Once BP > 90
A

give maintenance IV NaCl 0.9%

32
Q
  1. Start IV Insulin mixed with NaCl and administer at a rate so that
A
  • Ketone concentration falls at 0.5mmol/L/hr
  • Blood glucose concentration falls at 3mmol/L/hr
33
Q
  1. When blood glucose ‹ 14 mmol/L →
A

IV Glucose 10%

34
Q
  1. Continue insulin till ketone
A

<0.3mmol/L and PH > 7.3

35
Q
  1. When patient able to eat →
A

give fast-acting insulin with a meal

36
Q
  1. When do you stop treatment?
A

1 hour after food

PR - ENDOCRINE (25 decks)

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