DIABETIC COMPLICATIONS Flashcards
Macrovascular complications
- Peripheral arterial disease
- MI
- Stroke
Macrovascular complications - treatment
- ACEi
- Low dose aspirin
- Lipid regulating drugs (statins)
When is a low-dose atorvastatin considered?
Considered in all type 1 pts
* Offered to age: 40+
* diabetic for 10+ yrs
* nephropathy or other CVD factors
* Qrisk > 10%
Microvascular complications
- Neuropathy
- Retinopathy
- Nephropathy
Diabetic nephropathy
- Kidney damage due to diabetes
- Test ACR
- Higher ACR = more severe
What ACR level is considered nephropathy?
3mg/mmol +
Diabetic nephropathy - Treatment
- ACEi/ARB (even if BP normal)
- ACEi can potentiate hypo effect of antidiabetic drugs/insulin
Risk of ACEi in nephropathy
- Hyperkalaemia
- ACEi can potentiate effect of insulin and other ADDs = HYPO
Diabetic neuropathy: types
Painful peripheral neuropathy
Autonomic neuropathy
Neuropathic postural hypotension
Gustatory sweating
Erectile sysunction
What is diabetic neuropathy?
- High blood sugars = reduced blood flow and death of nerves
Painful peripheral neuropathy
- Treat with antidepressants (duloxetine licensed, amitriptylline/ nort not licensed)
- Gabapentin, pregabalin
This can lead to diabetic foot - treat pain and manage infection
Autonomic neuropathy
Causes diarrhoea
Treat with codeine or tetracycline
Neuropathic postural hypotension
Increase salt intake
Fludrocortisone
Gustatory sweating
Antimuscarinic
Propantheline bromide
Diabetic retinopathy
- High blood sugar = damage to retina
- REPORT changes
- Loss of vision if left untreated
Erectile dysfunction + diabetes
- 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
Sildenafil pt counselling
- Take before food
- Onset of effect may be delayed if taken with food
Visual impairment
Yearly eye tests
Periodontitis
- Chronic inflammatory gum disease
- Gingivitis (mild form) > periodontitis
- Good oral hygiene
- Regular check ups
Gastroparesis
- Long term condition = stomach cannot empty itself on the normal way
- Bloating, feeling full, N+V
- Treat vomiting: erythromycin, metoclompramide
DKA
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.
Symptoms of DKA
Polyurea
Thirsty
Pear drop breath smells (ketones)
Deep or fast breathing
Lethargy / Unconsciousness
Confusion
Diagnosing DKA
- Check blood sugar level if displaying symptoms of DKA
- 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
How are ketone levels checked?
urine or blood
0.6 - 1.5mmol
slight risk (retest in 2 hours)
1.6 - 2.9mmol
increased risk (contact GP)
3mmol+
medical emergency
DKA - initial treatment
- replacement of fluid and electrolytes
- administration of soluble insulin
DKA treatment
- If BP <90, restore volume with 500ml IV NaCl 0.9%
- Once BP > 90, give maintenance IV NaCl 0.9%
- 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 - When blood glucose ‹ 14 mmol/L → IV Glucose 10%
- Continue insulin till ketone <0.3mmol/L and PH > 7.3
- When patient able to eat → give fast-acting insulin with a meal
- Stop treatment 1 hour after food
- If BP <90
restore volume with 500ml IV NaCl 0.9%
- Once BP > 90
give maintenance IV NaCl 0.9%
- 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
- When blood glucose ‹ 14 mmol/L →
IV Glucose 10%
- Continue insulin till ketone
<0.3mmol/L and PH > 7.3
- When patient able to eat →
give fast-acting insulin with a meal
- When do you stop treatment?
1 hour after food
