Diabetic Complications Flashcards
Name 3 microvascular complications of DM + how does this occur?
Neuropathy
Nephropathy
Retinopathy
Reduced blood flow leads to hypoperfusion of nerves and other structures
Name 4 eye diseases that diabetic get.
Retinopathy
Cataract
Glacuoma
Visual blurring
2 features of background retinopathy?
Haemorrhgaes
Microaneurysms
Features of pre-proliferative retinopathy?
Haemorrhages Microaneurysms Hard exudate Cotton wool spots Venous beading IRMA
What is severe proliferative retinopathy?
Formation of new blood vessels
Name 2 treatments for retinopathy.
Photocoagulation
Vitrectomy
What is the next step up from proliferative retinopathy?
Diabetic maculopathy
What is another name for nephropathy + 2 classic features?
Nodular glomerulosclerosis
Glomerular fibrosis
Proteinuria
Name 2 tests to screen for diabetic nephropathy?
Urine A:C ratio
GFR
Give the values of A:C for microalbuminemia, proteinuria and nephrotic syndrome.
> 2.5
30
300
Name 4 drugs for diabetic nephropathy treatment starting with most useful.
ACEi
ARB
SGLT2i
Spironolactone
What are the symptoms of peripheral neuropathy + where does is commonly occur?
Numbness and pain
Hands and feet
Neuropathy and … are commonly seen together? Neuropathy is more common in T1DM/T2DM?
Ischaemia
T1DM
Initial test for neuropathy vs. ischaemia?
10g microfilament
Doppler scan
Name the main complication of neuropathy + an example and what it is.
Foot ulcers leading to infection
Charcot’s foot
Inflammation leading to bone destruction and deformity
What is the most common type of diabetic neuropathy and how does it present?
Proximal
T2DM patients with numb thighs, hips and bum
List 5 diabetic emergencies?
HHS DKA Lactic acidosis Alcohol acidosis Hyperglycemia
What do saline, dextrose and fluids all treat + what do saline and dextrose respectively treat?
All treat dehydration
Saline/NaCl = low sodium
Dextrose/sugar = low BG
Explain how DKA works.
Lack of insulin
Less uptake of glucose into cells
Increased glucagon, cortisol etc. which cause lipolysis
Ketones produced
What is the main cause of DKA?
Poor diabetes medication management
What is the blood vs urine measurement of ketones?
Blood = beta-hydroxybutarate Urine = acetoacetate
How can DKA present?
Polyuria/dipsia N and V Tachycardia Dizziness Kussmaul's breathing Acidotic breath Coma/death
Diagnosis values of ketonemia, ketonuria, pH, BG, and bicarb for DKA?
pH < 7.3 Ketonemia > 3 Ketonuria > 2 BG > 11 Bicarb < 15
What is the exception for elevated BG in DKA?
Euglycaemic DM
Explain DKA profile in terms of K, Na, lactate, WBC, amylase and creatinine?
Na low
K, amylase, lactate, creatinine and WBC high
Name 5 serious complications of DKA.
Hypokalemia Cerebral oedema PE ARDS Aspiration pneumonia
Name the 3 main parts of DKA treatment.
IV 0.9% saline then 5% dextrose when BG 15
IV insulin
IV K+
Explain DKA profile in terms of glucose, ketones, de-hydration, pH and osmolality.
High High High Low Variable
If BG normal or low in suspected DKA, suspect what condition?
Alcoholic/starvation ketoacidosis
What is the 3 main parts of treatment for alcoholic ketoacidosis?
IV vitamins
IV 5% dextrose
IV insulin
Explain alcoholic ketoacidosis profile in terms of glucose, ketones, de-hydration, pH and osmolality.
Normal High High Low Variable
What is type A + type B lactic acidosis associated with?
A = tissue hypoxaemia B = DKA
What is blood lactate value in lactic acidosis?
> 5
Explain lactic acidosis profile in terms of glucose, ketones, de-hydration, pH and osmolality.
Normal Normal Normal Low Normal
Name 2 causes of lactic acidosis in DM.
Metformin use
Septicaemia
What are the 3 main parts of lactic acidosis treatment?
Stop offending drug
IV fluids
IV antibiotics
Name the triad of HSS.
Hypovolaemia
Hyperglycaemia
Hyperosmolality
What is a typical history of HSS?
Older person with high carb intake pre-event
Name 2 other causes of HSS?
Drugs
Infection
What are the 3 main parts to HSS treatment?
IV 0.9% saline
IV K+
IV insulin
Explain HSS profile in terms of glucose, ketones, de-hydration, pH and osmolality.
Very high Normal High Normal Very high
Which diabetic complication is more common in T1DM and T1DM?
T1DM = DKA T2DM = HHS
Does DKA or HHS have more serious complications/fatality rate + which one takes longer to develop?
HHS
HHS
How do you calculate the osmolality + anionic gap and provide normal ranges?
Osmo = 2x (Na + K) + urea + glucose = 285-295
Anionic gap = Na + K - Cl + HCO3 = 10-18
What is the BG value for hypoglycaemia?
< 3
Normal blood glucose range encompassing post-prandial ?
3.9-7.1
Treatment for conscious and unconscious hypo?
Conscious = 15-20g glucose Unconscious = 10% IV insulin
