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Systems: Endocrine AB > Long Term Complications > Flashcards

Long Term Complications Flashcards

1
Q

What are the 2 classifications of complications?

A
  • Macrovascular affecting large vessels

- Microvascular affecting small vessels

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2
Q

What are the complication risk factors?

A
  • Duration of diabetes
  • Metabolic control
  • Smoking
  • Hypertension
  • Hyperlipidaemia
  • Genetics
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3
Q

What is the main cause of death in diabetes?

A

Cardiovascular macrovascular disease

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4
Q

How does diabetes affect your risk of MI?

A

Increases by 2-5x with higher mortality and morbidity post MI

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5
Q

How does diabetes affect your risk of stroke?

A

Increases by 3x

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6
Q

How does diabetes affect your risk of peripheral arterial disease?

A

Increase by 5x

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7
Q

Describe peripheral arterial disease..

A
  • A diffuse distal disease

- x40 fold increased risk of amputation

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8
Q

What are the cardiovascular risk factors?

A
  • Glucose control
  • Blood pressure
  • Smoking
  • Lipids
  • Proteinuria
  • Family history
  • Gender
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9
Q

What primary prevention is there to reduce CV risk?

A
  • Target HbA1c 53mmols/mol
  • Control BP to <130/80
  • Smoking cessation
  • Statin therapy
  • Lifestyle choices
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10
Q

Give examples of microvascular diseases.

A
  • Retinopathy
  • Neuropathy
  • Nephropathy
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11
Q

What is microvascular disease?

A

Disease of the arterioles and capillaries

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12
Q

What is diabetic the commonest cause of?

A

Blindness in working age population

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13
Q

How can diabetic retinopathy be prevented?

A
  • Good glucose control
  • Tight BP control
  • Early detection and intervention
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14
Q

Give examples of types of diabetic retinopathy.

A
  • Background retinopathy
  • Proliferative retinopathy
  • Maculopathy
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15
Q

Give examples of retinal abnormalities in diabetes.

A
  • Microaneurysms (dots)
  • Blot haemorrhages
  • Hard exudates
  • Cotton wool spots
  • New vessel formation
  • Vitreous haemorrhage
  • Advanced eye disease
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16
Q

How is proliferative retinopathy treated?

A
  • Laser photocoagulation (destruction of peripheral ischaemic retina leads to reduction of endothelial growth factors and regression of new vessels)
  • Vitrectomy
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17
Q

What are the features of diabetic maculopathy?

A
  • Exudates and blot haemorrhages at macula
  • Macular ischaemia
  • Macular oedema deforms the macula
  • Decrease in visual acuity is common in type 2 diabetes
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18
Q

What is the treatment for diabetic maculopathy?

A
  • Grid laser therapy
  • Tight control of blood glucose
  • Tight control of BP
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19
Q

Who re cataracts common in?

A
  • Elderly
  • 2 fold increase in diabetes
  • Those with poor glycaemic control
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20
Q

What dictates when surgery is carried out for cataracts?

A

Visual acuity

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21
Q

What types of diabetic neuropathy are there?

A
  • Peripheral neuropathy (diffuse nerve disease)
  • Mononeuritis (single nerve palsy)
  • Autonomic neuropathy
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22
Q

What percentage of diabetics suffer from peripheral neuropathy?

A

Up to 40%

23
Q

Where does peripheral neuropathy affect?

A

Mainly the feet but also classic ‘glove and stocking’ distribution

24
Q

What are the clinical features of peripheral neuropathy?

A
  • Feet insensitive to trauma
  • Unpleasant chronic symptoms (paraesthesia, burning pain, numbness)
  • May be asymptomatic
  • Small muscle wasting
25
Q

What is the management of peripheral neuropathy?

A
  • Early detection
  • Self-care education
  • Protection of feet
  • Pain relief (capsaisin cream, amitriptyline, gabapentin, duloxetine)
26
Q

How are ulcers prevented?

A
  • Foot screening and risk scoring
  • Patient education on foot care
  • Regular podiatry for those at high risk
  • Trauma avoidance/fitted footwear
  • Huge morbidity from ulcers
27
Q

What skeletal abnormality may occur in diabetes?

A

Charcot foot caused by charcot neuro-arthropathy

28
Q

What risk factors makes someone’s feet more at risk?

A
  • Impaired circulation
  • Impaired sensation
  • Impaired vision
  • Foot shape changes
  • Abnormal pressures
29
Q

What is acute sensory peripheral neuropathy?

A

Rapid onset of neuropathic symptoms

30
Q

What are the precipitating factors for acute sensory peripheral neuropathy?

A
  • Rapid tightening of glycaemic control

- Acute metabolic upset

31
Q

Describe the progression of acute sensory peripheral neuropathy.

A
  • May be very severe

- Gradual recovery

32
Q

What is another name for proximal moto neuropathy?

A

Diabetic amyotrophy

33
Q

Who is mainly affected by proximal motor neuropathy?

A

Elderly men with T2DM

34
Q

Where does proximal motor neuropathy affect mainly?

A

-Legs mostly

35
Q

What are the clinical features of proximal motor neuropathy?

A
  • Wasting of thigh muscles
  • Weight loss
  • Painful
36
Q

What is the prognosis of proximal motor neuropathy?

A

Good

37
Q

What does mononeuritis mainly affect?

A

Ocular cranial nerves

  • III
  • IV
  • VI
38
Q

Other than the ocular cranial nerves, what other nerve does mononeuritis affect?

A

Peroneal nerve causing acute foot drop

39
Q

How does mononeuritis progress?

A

Presents like a vascular event:

  • Acute onset
  • Gradual recovery
40
Q

Give 7examples of presentations of autonomic neuropathy.

A
  • Erectile dysfunction
  • Postural hypotension
  • Gastric stasis and recurrent vomiting
  • Diarrhoea
  • Abnormal sweating
  • Peripheral oedema
  • Urinary retention
41
Q

What interventions are there for erectile dysfunction?

A
  • Phosphodiasterase inhibitors e.g. Viagra and Cialis
  • Prostaglandins
  • Mechanical devices
  • Implants
42
Q

How can postural hypotension be managed?

A
  • NSAIDs

- Fludrocortisone

43
Q

What is the treatment for gastric stasis and recurrent vomiting?

A

Domperidone

44
Q

What is the treatment for diarrhoea?

A
  • Loperamide

- Codeine phosphate

45
Q

How is autonomic neuropathy diagnosed?

A
  • Based on symptom pattern and exclusion of other causes

- Abnormal ECG rhythm e.g. no variation of rate on deep breathing

46
Q

What is diabetic nephropathy?

A

Damage to the structure and function of the meshwork of capillaries which make up the glomerulus

47
Q

What happens to the glomeruli in diabetic nephropathy?

A

Glomeruli become leaky to larger molecules and eventual reduction in ability to filtrate blood

48
Q

What percentage of T1DM patients will develop diabetic nephropathy after 30 years?

A

25%

49
Q

What are the stages in kidney disease?

A
  • Normal
  • Microalbuminaemia
  • Proteinuria
  • Impaired renal function +/- nephrotic syndrome
  • End stage renal disease
50
Q

What stage kidney disease is reversible?

A

Microalbuminaemia

51
Q

What is the screening test for microalbuminuria?

A

First morning urine sample
-Normal albumin/creatinine ratio
Male <2.5 mg/mmol; Female <3.5

52
Q

What is the definitive test for microalbuminuria?

A

Timed over night urine collection for albumin excretion rate (AER)

  • Normal < 20μg/min
  • Microalbuminuria 20-200μg/min
53
Q

How is early kidney disease managed?

A
  • Optimise glycaemic control
  • Tight BP control - aim for <125/75 in type 1 diabetes
  • Ace inhibitor therapy slows progression
  • Cardiovascular risk factor management

Systems: Endocrine AB (25 decks)

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