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Endocrine > Long Term Complications of Diabetes > Flashcards

Long Term Complications of Diabetes Flashcards

1
Q

What tissues are concerned with the problems associated with large vessel and small vessel diabetic disease?

A

Large vessel - CVS

Small vessel - Eyes (retinopathy), nerves (neuropathy) and kidneys (nephropathy)

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2
Q

What are the risk factors for complications of diabetes?

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

Macrovascular

(cardiovscular disease)

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4
Q

What comes under the heading of cardiovascular disease?

A

MI

Stroke

Peripheral arterial disease

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5
Q

Look

A

Notice the increase in incidence as age increases

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6
Q

What are you at risk to when there is peripheral arterial disease?

A

•x 40 fold increased risk of amputation

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7
Q

What are the risk factors for cardiovascular disease?

(these are very similar to the risk factors for complications of diabetes)

A
  • Glucose control
  • Blood pressure
  • Smoking
  • Lipids
  • Proteinuria
  • Family history
  • Gender
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8
Q

What is primary prevention for CV risk reduction?

A

Target HbA1c 53 mmols/mol (7%)

Control Bp to less than or equal to 130/80

Smoking cessation

Statin therapy

Lifestlye choices

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9
Q

What are the ways we can prevent diabetic retinopathy?

A

Good glucose control

Tight Bp control

Early detection and intervention

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10
Q

Define what is meant by non-prolifereative diabetic retinopathy

A

No symptoms or signs

Fundus photography shows microaneurysms

Fluorescein angiography shows retinal ischaemia (narrowed or blocked retinal blood vessels)

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11
Q

Define macular oedema

A

Blood vessels leak their contents into the macular region

Can occur at any stage of non-proliferative diabetic retinopathy

Optical coherence tomography will show areas of macular thickening (due to fluid accumulation) of macular oedema

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12
Q

What are the symptoms of macular oedema?

A

Blurred vision and darkened or distorted images that are not the same in both eyes.

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13
Q

What is proliferative diabetic retinopathy?

A

Abnormal new blood vessels form at the back of the eye - they grow into the vitreous

Can result in scarring and contraction of the vitreous - potential for retinal detatchment

These new blood vessels are fragile and susceptible to bursting and bleeding and therefore blurring the vision

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14
Q

What are the 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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15
Q

What is the cause of cotton wool spots?

A

They are caused by damage to nerve fibers and are a result of accumulations of axoplasmic material within the nerve fiber layer.

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16
Q

What is the treatment of proliferative retinopathy?

A

Laser photocoagulation

–Destruction of peripheral ischaemic retina leads to reduction of endothelial growth factors and regression of new vessels

Vitrectomy - bubble is inflated within the eye, this pushes the retina back towards the wall of the eye, tears in the retina are sealed using a freezing probe or a laser treatment

17
Q

What is treatment for macular oedema?

A

Grid laser therapy

Tight control of blood glucose and blood pressure

18
Q

What eye condition is common in the elderly and has a two fold increase when diabetes is present?

A

Cataracts

19
Q

What are the types of diabetic neuropathy?

A

Peripheral neuropathy (diffuse nerve disease)

Mononeuritis (single nerve palsy)

Autonomic neuropathy

20
Q

What are the features of peripheral neuropathy?

A

Feet insensitive to trauma

Chronic symptoms (paraesthesia, burning pain, numbness)

Small muscle wasting

Charcots foot (small bone fractures cause foot deformations)

Ulcers

21
Q

What is the management of peripheral neuropathy?

A

Early detection (foot screening, regular podiatry for high risk patients)

Self care education

Protection of feet (trauma avoidance /fitted footwear)

Pain releif (capsaisin cream, amitriptyline, gabapentin, duloxetine)

22
Q

What are the factors that result in increase risk to the foot?

A

Impaired circulation

Impaired sensation

Impaired vision

Foot shape changes

Abnormal pressures

23
Q

What is acute sensory peripheral neuropathy?

A

Rapid onset of neuropathic symtoms

May be very severe - gradual recovery

24
Q

What are the precipitating factors associated with acute sensory peripheral neuropathy?

A

–Rapid tightening of control

–Acute metabolic upset

25
Q

What is diabetic amyotrophy also known as?

A

Proximal motor neuropathy

26
Q

What are the features of diabetic amyotrophy?

A

Usually affects elderly men (type 2 diabetes)

Usually affects legs

Wasting of thigh muscles

Weight loss

Painful

Good prognosis

Now rarely seen

27
Q

What nerves are often affected in mononeuritis?

A
  • Mainly ocular cranial nerves
  • III
  • IV
  • VI

Mononeuritis is the inflammation of a singular nerve and is a result of a vascular event

Acute onset and gradual recovery

28
Q

What is the sign if the peroneal nerve is affected by mononeuritis?

A

Acute foot drop

29
Q

What are the symptoms of diabetic autonomic neuropathy?

A

Erectile dysfunction

Postural hypotension

Gastric stasis and recurrent vomiting

Diarrhoea

Abnormal sweating, peripheral oedema, urinary retention

30
Q

How do you diagnose autonomic neuropathy?

A

Based on symptom pattern and exclusion of other causes

Abnormal ECG rhythm responses (e.g no variation of rate on dep breathing)

31
Q

What is the disease process of diabetic retinopathy?

A

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

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

32
Q

What is the reversible stage of kidney disease?

A

MICROALBUMINURIA

•SCREENING TEST - first morning urine sample

Normal albumin/creatinine ratio

Male <2.5 mg/mmol; Female <3.5 (female has more albumin)

•DEFINITIVE TEST- timed over night urine collection for albumin excretion rate (AER)

Normal < 20μg/min

Microalbuminuria 20-200μg/min

33
Q

What is the management of early kidney disease?

A
  • Optimise glycaemic control
  • Tight BP control - aim for <125/75 in type 1 diabetes
  • Ace inhibitor therapy slows progression
  • Cardiovascular risk factor management
34
Q

What follows from impaired renal function?

A

Possible nephrotic syndrome

End stage renal disease

Cardiovascular disease (since end stage renal disease is a risk factor for cardiovascular disease)

Nephrotic syndrome: kidney disease, especially when characterized by oedema and the loss of protein from the plasma into the urine due to increased glomerular permeability (also called nephrotic syndrome ).

Endocrine (25 decks)

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