Diabetic Complications Flashcards
How does diabetic neuropathy present?
Symmetric sensory polyneuropathy (glove and stocking numbness, tingling and pain)
Decreased sensation Absent ankle jerks Charcot joint Rocker bottom sole Swelling, instability, deformity
If foot pulses cannot be felt, do Doppler pressure measurements
How does foot ulceration present and what is the management?
Painless, punched out ulcer in an area of thick callus. Causes cellulitis, abscess and osteomyelitis
Assess degree of neuropathy, ischaemia (clinically, doppler, angiogram), bony deformity (Charcot joint), infection
What is the management of a Charcot joint?
Bed rest/crutches/total contact cast until oedema reduces and bony repair is complete (>8 weeks)
Bisphosphonates may help
Metatarsal head surgery may be needed
If there is cellulitis, give benpen, flucloxacillin, and metronidazole
What is the management of diabetic neuropathy?
1) Paracetamol
2) TCA (amitriptyline)
3) Duloxetine, gabapentin or pregabalin
4) Opiates
If diabetic neuropathy presents suddenly or severely, what may help?
Immunosuppression may help (corticosteroids, IV immunoglobulin, ciclosporin)
What types of autonomic neuropathy can diabetics get?
Postural BP drop Urine retention Gastroparesis Diarrhoea Erectile dysfunction
What is the treatment and symptoms of gastroparesis in diabetics?
Early satiety, post prandial bloating, nausea/vomiting
Diagnose gastroparesis using gastric scintigraphy with a technetium labelled meal
Anti emetics, erythromycin or gastric pacing
How would you treat postural hypotension as a complication of diabetes?
Fludracortisone may help or midodrine
What is the chief cause of death in diabetes?
Vascular disease (MI)
How do you prevent vascular disease in diabetics?
Atorvastatin 20mg for all, and aspirin 75mg reduces vascular events
How would you manage/prevent diabetic nephropathy?
If microalbuminuria is found (urine dipstick is negative for protein but UA:CR >3), start an ACEi even if BP is normal
Spironolactone may also be used instead
What occurs in background retinopathy?
Microaneurysms, haemorrhages and hard exudates
What can be seen in pre-proliferative retinopathy?
Cotton wool spots
Haemorrhages
Venous bleeding
These are signs of retinal ischaemia
Refer to a specialist
What can be seen in proliferative retinopathy?
Formation of new vessels
Refer urgently
What is the pathogenesis of maculopathy in diabetics?
Hyperglycaemia causes high retinal blood flow
Capillary pericyte damage occurs
Capillary occlusion occurs (cotton wool spots) leading to local hypoxia and ischaemia
New vessels form
What is the management of hypoglycaemia?
If mild, give 15-20g glucose tablets, sugary drinks
Severe: IM glucagon
A blood test should be taken 15-20mins after to look for recovery
What are the non diabetic causes of hypoglycaemia?
“EXPLAIN”
Exogenous drugs Pituitary insuffiency Liver failure Addisons disease Islet cell tumours Non pancreatic neoplasms
When would you investigate hypoglycaemia?
Whipple’s triad; if there are symptoms or signs of hypoglycaemia, decreased plasma glucose, and resolution of symptoms post glucose rise
Take a drug history, exclude liver failure
72h fasting may be needed, take bloods, glucose, insulin, C peptide, and plasma ketones if symptomatic
What are the causes of hypoglycaemic hyperinsulinaemia?
Insulinoma, sulfonylureas, insulin injection
What are the causes of hypoglycaemia if insulin is low and there are no excess ketones?
Non pancreatic neoplasm
Anti insulin receptor antibodies
What are the causes of hypoglycaemia if there is low insulin and high ketones?
Alcohol
Pituitary insufficiency
Addisons disease
