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ZA - Endocrine System > Long Term Complications of Diabetes > Flashcards

Long Term Complications of Diabetes Flashcards

1
Q

What vessels are affected in macrovascular complications?

A

Large vessels making up the CV system

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2
Q

What vessels are affected in microvascular complications?

A

Smaller vessels in the eyes (retinopathy), kidneys (nephropathy) and nerves (neuropathy)

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3
Q

Risk factors for these complications?

A 
Duration of diabetes
Metabolic control
Smoking
Hypertension
Hyperlipidaemia

Genetics

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4
Q

What sort of complication is the main cause of death in diabetes?

A

Macrovascular/Cardiovascular

MI (2-5x), Stroke (3x) and peripheral arterial disease (5x) risks all rise

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5
Q

Explain peripheral arterial disease and the risk that is carries.

A

It is a diffuse and more distal disease

x40 fold increased risk of amputation

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6
Q

CV risk factors?

A

Glucose control
BP
Smoking
Lipids

Proteinuria
FHx
Gender

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7
Q

Primary prevention of CV risk ?

A

Target HbA1x to 53mmols/mol (7%)

Control BP to less than 130/80

Smoking cessation

Statin therapy

Lifestyle choices

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8
Q

How to support smoking cessation?

A

Nicotine replacement

Drug therapy - Zyban or Champix

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9
Q

What statin is used mainly and in what type of patients?

A

Simvastatin

Aged 40 or older or in younger patients with significant complications

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10
Q

What sort of vessels specifically does microvascular disease affect?

A

Arterioles and capillaries

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11
Q

What is the commonest cause of blindness in the working age pop.?

A

Diabetic retinopathy

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12
Q

How to prevent diabetic retinopathy?

A

Good glucose control
Tight BP control
Early detection and intervention

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13
Q

Types of retinoptahy?

A

Background retinopathy (mild, moderate, severe)

Proliferative retinopathy

Maculopathy

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14
Q

Is visual acuity a good guide for detecting retinopathy?

A

No - regular screening is essential

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15
Q

What retinal abnormalities can be spotted in diabetic complications?

A

Microaneurysms (dots)
Blot haemorrhages
Hard exudates
Cotton wool spots

New vessel formation
Vitreous haemorrhage
Advanced eye disease

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16
Q

What exactly is proliferative retinopathy?

A

in proliferative retinopathy ‘new blood vessels’ grow on the surface of the retina and can bleed

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17
Q

Treatment for proliferative retinopathy?

A

Laser photocoagulation -
Destruction of peripheral ischaemic retina = reduction of endothelial growth factors and regression of new vessels

Vitrectomy

18
Q

What exactly is diabetic maculopathy?

A

Exudates and blot hemorrhages at the macula

A macular oedema deforms the macula

Macular ischaemia

Reduced visual acuity - common in type 2

19
Q

Treatment of maculopathys?

A

Grid laser therapy

Tight control of glucose and BP

20
Q

Who is cataracts common in?

A

Elderly
2x fold increase in diabetes
Poor diabetic control increases risk

21
Q

Is treatment for cataract successful?

A

Yes surgery is highly successful - visual acuity after dictates the timing

22
Q

List some diabetic neuropathies.`

A

Peripheral neuropathy - diffuse nerve disease

Mononeuritis - single nerve palsy

Autonomic neuropathy

23
Q

Where does peripheral neuropathy mainly affect? What are the effects? What problems does this raise?

A

Feet mainly but also hands

Unpleasent chronic symptoms like paraesthiae (pins and needles), burning pain and numbness, but may also be asymptomatic

Small muscle wasting

Feet become insensitive to trauma and can become infected

24
Q

Management of PERIPHERAL NEUROPATHY

A

Early detection
Self care education
Protection of feet

Pain relief - capsaisin cream, amitriptyline, gabapentin, duloxetine

25
Q

How are ulcers prevented?

A

Foot screening and risk scores
Patient education on foot care
Regular podiatry for high risk patients
Trauma avoidance/fitted footwear

26
Q

What is charcot foot?

A

Where the arch caves in due to weakening of the bones in the foot due to significant neuropathy.

The bones are weakened enough to fracture, and with continued walking, the foot eventually changes shape

27
Q

What is acute sensory peripheral neuropathy?

A

A rapid onset of neuropathic symptoms - may be very severe with gradual recovery

28
Q

Precipitating factors of acute sensory peripheral neuropathy?

A

Rapid tightening of control

Acute metabolic upset

29
Q

What is proximal motor neuropathy - diabetic amyotrophy ?

A

Wasting of legs/thigh muscles
Weight loss
Can be painful
Affects elderly men with Type 2 DM

Has a good prognosis

30
Q

Where does mononeuritits mainly occur?

A

Cr. N’s 3, 4 and 6

31
Q

What nerve causes acute foot drop when affected?

A

Peroneal nerve

32
Q

What problem is common in autonomic neuropathy? What treatments are effective?

A

Erectile dysfunction

Phosphodiasterase inhibitors - Viagra
Prostaglandins, mechanical devices, implants

33
Q

Other problems you get with autonomic neuropathy? Treatment?

A 
Postural hypotension
Gastric stasis and recurrent Vomiting
Diarrhoea
Abnormal sweating
Peipheral odema
Urinary retention
34
Q

Treatment for postural hypotension?

A

NSAIDs

Fludrocortisone

35
Q

Treatment for gastric stasis and recurrent vomiting

A

Domperidone

36
Q

Treatment for Diarrhoea

A

Loperamide

Codeine phosphate

37
Q

How is autonomic neuropathy diagnosed?

A

Based on symptom pattern and exclusion of differentials

Abnormal ECG rhythm responses - no variation to rate on deep breathing

38
Q

What is diabetic nephropathy?

A

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

39
Q

What does this damage in nephropathy cause?

A

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

40
Q

How do we detect early kidney disease? Screening tests and definitive test?

A

Microalbuminuria

Screening - 1st morning urine sample showing a normal albumin/creatinine ratio (male <2.5 mg/mmol and female less than 3.5)

Definitive - timed over night urine collection for albumin excretion rate - normal = <20μg/min and microalbuminuria = 20-200 μg/min

41
Q

Management of early kidney disease?

A

Optimise glycaemic control

Tight BP control - aim for <125/75 in type 1

ACE inhibitors slows progession

CV risk factor management

ZA - Endocrine System (21 decks)

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