Diabetic Neuropathy & Foot Care Flashcards
1
Q
What is diabetic neuropathy?
A
- Decreased sensation in stocking distribution
- Sensory loss is patchy so must be tested in all areas with a 10g monofilament fibre
- Swelling, instabilty and deformity
- Absent ankle jerks
- Neuopathic deformity such as Charcot joint, pes cavus. claw toes, loss of transverse arch, rocker bottom sole
- Caused by loss of pain sensation, leading to increased mechanical stress and repeated joint injury
2
Q
How is ischaemia tested in diabetics?
A
- If foot pulses cannot be felt, use Doppler pressure measurement
- Any evidence pf vascular disease or neuropathy, rasies risk of foot ulceration
3
Q
How is diabetic ischaemia tested?
A
- Education - daily foot inspection and wear comfortable shoes
- Regular chiropody to remove callus as haemorrhage and tissue necrosis may occur, leading to ulceration
- Treat fungal infections
- Surgery - angioplasty, stents, balloons and recanalisation
4
Q
How do foot ulceration present?
A
- Typically painless
- Punched out ulcer
5
Q
What can foot ulceration lead to?
A
- Cellulitis
- Abscess
- Osteomyelitis
6
Q
How is foot ulceration managed?
A
- Regular chiropody
- Bed rest and therapeutic shoes
- Bisphosphonates may help
- For cellulitis - admit for IV antibiotics (benzylpenicllin and flucloxacillin and metronidazole
- IV insulin may improve healing
- Get surgical help early
7
Q
What are the indications for surgery in foot ulceration?
A
- Abscess
- Deep infection
- Spreading anaerobic infection
- Gangrene
- Rest pain
- Suppurative arthritis
8
Q
How are diabetic neuropathies treated?
A
- Paracetamol
- Tricyclics –> Amitriptyline
- Duloxetine, Gabapentin, Pregabalin
- Opiates
- Immunosupression may help if sudden or severe
- Corticosteroids
- IV immunoglobulin
- Ciclosporin
9
Q
What is Amyotrophy?
A
Painful wasting of quadraceps and other pelvifemoral muscles
10
Q
How does autonomic neuropathy present?
A
- Postural hypotension
- Decreased cerebrovascular autoregulation
- Loss of respiratory sinus arrythmia (vagal neuropathy)
- Gastroparesis
- Urine retention
- Erectile dysfunction
- Diarrhoea
11
Q
How is postural hypotension treated?
A
Flurocortisone
Midodrine
12
Q
What are the side effects of flurocortisone?
A
Oedema
Hypertension
13
Q
How does midodrine work and what are the side effects?
A
Alpha agonist
SE = Hypertension
14
Q
How does gastroparesis present and how is it treated?
A
- Presentation:
- Nausea/vomiting
- Early satiety
- Post-prandial bloating
- Treatment:
- Anti-emetics
- Erythromycin
- Gastric pacing
15
Q
How is the diarrhoea in autonomic neuropathy treated?
A
Codeine phosphate
